Meniscus Tear Overview

A meniscus tear is a common knee injury involving damage to the menisci, the crescent-shaped cartilage in the knee joint. Each knee has two menisci: the medial meniscus (inner side) and the lateral meniscus (outer side). These structures act as shock absorbers, stabilise the knee, and distribute weight evenly across the joint.

Symptoms

Symptoms of a meniscus tear can vary depending on the severity and location of the tear but commonly include:

1. Pain: Often felt along the knee joint line, worsened by twisting, pivoting, or squatting.

2. Swelling: Develops gradually over hours or days after injury.

3. Stiffness: Difficulty bending or straightening the knee fully.

4. Locking: A sensation that the knee is stuck or catching during movement.

5. Instability: The knee may feel wobbly or give way.

6. Popping Sensation: A pop at the time of injury is common in acute tears. Popping sound may be heard when moving the knee.

Causes

Meniscus tears can result from:

1. Trauma: Sudden twisting or pivoting movements, especially during sports.

2. Degeneration: Wear and tear in older adults, often associated with osteoarthritis.

3. Overuse: Repeated stress on the knee, particularly in athletes or physically demanding jobs.

Types of Tears

1. Vertical: Runs along the length of the meniscus.

2. Horizontal: Splits the meniscus into top and bottom halves.

3. Radial: Extends from the inner edge outward.

4. Complex: A combination of tear patterns.

5. Bucket Handle: A piece of the meniscus folds over, potentially causing knee locking.

6. Flap Tear: A loose flap of cartilage interferes with joint movement.

Diagnosis

1. Medical History: Evaluating the injury's context, symptoms, and onset.

2. Physical Examination:

   • McMurray Test: Rotating the knee while applying pressure to check for pain or clicking.

   • Thessaly Test: Having the patient stand on one leg and rotate to elicit symptoms.

3. Imaging:

   • X-rays: Rule out fractures or arthritis.

   • MRI (Magnetic Resonance Imaging): Provides detailed images of the meniscus and other knee structures.

   • Ultrasound: Occasionally used for dynamic assessments of the joint.

4. Arthroscopy: A minimally invasive surgical procedure that can diagnose and treat tears simultaneously.

Treatment

Non-Surgical Options

1. R.I.C.E. Protocol:

   • Rest: Avoid activities that worsen symptoms.

   • Ice: Apply for 15–20 minutes every few hours.

   • Compression: Use an elastic bandage to reduce swelling.

   • Elevation: Keep the leg elevated to minimize swelling.

2. Medications:

   • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for pain relief.

3. Physical Therapy:

   • Strengthening muscles around the knee (e.g., quadriceps, hamstrings).

   • Restoring range of motion.

4. Bracing: Knee braces can provide support and stability.

5. Corticosteroid Injections: For significant swelling or pain, though not a long-term solution.

Surgical Options

1. Meniscectomy:

   • Partial Meniscectomy: Removal of the damaged portion.

   • Total Meniscectomy: Rarely performed due to long-term joint degeneration risks.

2. Meniscus Repair:

   • Sutures are used to stitch the torn pieces together.

   • Most effective for peripheral (outer edge) tears due to better blood supply.

3. Meniscus Transplant:

   • For severe cases, a donor meniscus is transplanted.

Recovery Process

1. Post-Surgery Rehabilitation:

   • Weight-bearing restrictions initially (may require crutches).

   • Gradual physical therapy for strength, stability, and flexibility.

   • Full recovery typically takes 3–6 months, depending on the treatment.

2. Non-Surgical Recovery:

   • Symptoms may improve in 4–8 weeks with rest and therapy.

   • Persistent or worsening symptoms may require surgical intervention.

Complications

1. Chronic knee pain or stiffness may arise if not treated properly.

2. Increased risk of osteoarthritis in the affected knee.

3. Incomplete healing, especially in non-surgical cases.

4. Recurrent injuries due to joint instability.

Prevention

1. Strengthening Exercises:

   • Target the quadriceps, hamstrings, and core for joint stability.

2. Proper Technique:

   • Ensure proper form during physical activities and sports.

3. Stretching:

   • Enhance flexibility to reduce strain on the meniscus.

4. Protective Gear:

   • Use braces or appropriate footwear during high-risk activities.

Prognosis

The prognosis depends on the tear's type, location, and treatment. Peripheral tears heal better due to better blood supply, while degenerative tears in older adults may require ongoing management.