Cartilage injury – Tearing your Meniscus
Commonly referred to as your ‘cartilage’, your knee meniscus is a piece of fibrocartilage that separates the thigh bone (femur) from your shin bone (tibia). Each knee joint has a medial (inside) meniscus and a lateral (outside) meniscus. The role of the meniscus is to assist with the rotational stability as well as acting as a shock absorber to dampen the tremendous forces on the knee that are created when you walk, run and jump.
As a hinge joint. the knee is very susceptible to injury in sports such as football. This is because of the large forces produced by kicking the ball. It is also the centre of the lever arm of the leg, so it is susceptible to greater forces being transmitted from the trunk through the hip, and from the ground through the foot and ankle.
HOW IT HAPPENS?
In the younger population, the knee meniscus is usually torn traumatically (ie. in an obvious incident/accident), by twisting on a slightly flexed knee while playing football or other sports. In older adults, underlying wear and tear causes degeneration of the meniscus, with arthritic changes that can result in pain. These changes may also predispose it more easily to injury or a tear.
A painful twist occurring on a slightly flexed, weight-bearing knee will indicate the likelihood of a meniscus tear. You may also experience clicking, popping, or locking of the knee as well as pain when attempting to squat down. These symptoms are usually accompanied by pain along the knee joint line and joint swelling.
WHAT’S GOING ON INSIDE?
Your meniscus receives its nutrition from blood and synovial fluid within the joint capsule. The outside of the meniscus has a blood supply from the synovial capsule and will tend to heal without the need for surgery. However, tears of the inner meniscus do not usually heal owing to a lack of blood supply and these injuries often require surgery.
Clinical examination by a specialist therapist or sports doctor will determine damage to the medial or lateral meniscus. An MRI scan is the most accurate non-invasive test to confirm a meniscus tear. Whilst people may hope that meniscus tears will heal over time on its own. Unfortunately this is rarely the case as meniscal blood supply is limited.
Meniscus tears, are usually classified in three grades. Grade 3 is a true meniscus tear confirmed by arthroscope examination close to 100% accurate. Grades 1 and 2 are not considered serious and may not even be apparent with an arthroscopic examination.
TYPES OF MENISCAL TEAR
There are a variety of factors that are used to determine the ideal treatment of a meniscus tear including age, pre-rehab results and if there is other damage than just a torn meniscus. With different mechanisms of injury, there are a number of different types of meniscal tears including:
Often common finding as a result of an MRI scan by the age of , Incomplete and intrasubstance tears of the meniscus are usually signs of degenerative changes of the cartilage and a rarely sign of a problem. As a result they are stable injuries and generally do not require surgical treatment.
Often causing catching symptoms in the knee, a flap tear of the meniscus is an unusual pattern of tear. Usually, the flap of the meniscus causing the symptoms can simply be removed conservatively without removing much cartilage tissue.
A bucket-handle tear is a large type of horizontal tear of the meniscus. Due to the degree of tear blocking normal knee function, the knee often becomes ‘stuck/locked’ limiting normal knee function and motion. As a result, Bucket-handle tears often require more urgent surgical treatment in order to allow the knee to start bending again.
Radial tears of the meniscus, are reportedly the most common type of meniscus tear. Located within an area of the meniscus where there is no blood supply. Due to this, surgical treatment is typically required which involves trimming out the damaged portion of the cartilage.
Unlike the other meniscal tears, a horizontal tear can sometimes be surgically repaired by sewing the torn portions back together. The key to the success of this approach is determined by the position of the tear and crucially, its blood flow. If located near the other edge within the vascular portion of the meniscus, then the meniscus has the potential to heal and recover. Unfortunately, if the tear is located more centrally, the tear will not heal even if repaired.
A complex tear is aptly named as there are a number of tears often involving both radial and horizontal patterns. Typically complex tears are not repaired because of the complex nature of the tear. However in some unusual circumstances, some of the torn meniscus can be removed, while other portions may be repaired.
With development in technology, in many cases such as non-complex tears, meniscal surgery involves a 20-30 minute key hole surgery and you can walk out of the hospital in the same day.
WHAT CAN I DO?
Immediately after injury apply the ‘PRICE’ protocol, which stands for Protect, Rest, Ice, Compression and Elevation, for the first 24–72 hours. Protection may include the use of crutches if walking is painful or not possible. Rest is relative – just don’t try anything that is painful and ensure to elevate your leg utilising gravity to help to reduce swelling and aid circulation. Ice the injury regularly for 10–20 minutes several times a day. Compression, using strapping or bandage, will help to reduce the swelling and bleeding as well as the pain by giving the injury some support.
Initially it is important to avoid activities and exercises that place excessive stress through your meniscus and further delay your healing. In some cases, your therapist may advise you to keep weight off your knee. In this instance, crutches may be recommended. Everyone is different and each case is different so it is important to seek appropriate medial advice and guidance from a qualified professional.
HOW REHABILITATION CAN HELP
A small meniscus tear, or a tear on the outside/perimeter of the meniscus can take approximately 6–8 weeks to fully heal and will usually respond quickly to rehabilitation. For more severe injuries surgery may be required; however, most surgeons will recommend a few weeks of rehabilitation before contemplating surgery. Rehabilitation may may successfully rehabilitate your knee injury without the need for surgery. If not, it will put you in the very best place for optimal post-surgical recovery as rehab will also be required.
Your physio/rehab will aim to:
- Reduce pain and inflammation
- Normalise joint range of motion
- Strengthen your knee: especially quadriceps (vastus medialis) and hamstrings
- Strengthen your lower limb: calves, hip, pelvis and core muscles
- Improve patellofemoral (knee cap) alignment
- Normalise your muscle length/balance
- Improve your proprioception and balance
- Improve your technique and function, eg. walking, running, squatting, hopping and landing to minimise your chance of re-injury.
One of the major roles of your meniscus is shock absorption. Luckily, the other vital shock absorbers around your knee are your muscles. Meniscal injuries are commonly associated with other knee injuries, which need to be treated in conjunction with your meniscal tear. Research has proven that by strengthening your leg muscles, your bone stresses reduce and your knee becomes more dynamically stable.
If you would like advice or support for your meniscal injury or want to get your rehabilitation started. Don’t hesitate to get in touch.
The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical advice. If you are suffering with back pain golfing contact us today for free advice and support.