Meniscus Injuries
MBBS (SINGAPORE) MMED (ORTHO) FRCS ED (ORTH)
Meniscus tears are one of the most common knee injuries.
The menisci (plural for meniscus) are “shock-absorbers” in your knee and are found within the knee joint, between the thigh bone (femur) and shin bone (tibia).
Twisting injuries to the knee can cause the menisci to rip.
What is Meniscus Injuries?
Meniscus injuries, also known as meniscal tears, occur when the cartilage in the knee is torn. If the damage is severe, the torn portion can move out of place, locking the knee.
Meniscal tears can result from stress, injury, or degeneration. It is important to recognise the signs and seek medical attention as soon as possible, as early diagnosis and management can help prevent further complications.
What Are The Types of Meniscus Injuries And Patterns?
A meniscus tear can be categorised through location, specific tear pattern, or proximity to a blood supply. The outside third of the meniscus is where tears are highly-likely to occur because of their proximity to the blood supply.
Types of Meniscus Tears
Meniscus tears come in various forms, each affecting the knee differently. Here are some common types:
- Bucket Handle Tear
This type involves a vertical tear that creates a “bucket handle” shape, where a segment of the meniscus is moved out of place. It often causes the knee to lock and is seen in about 10% of meniscus tears.
- Radial Tear
A radial tear cuts across the meniscus from the inner edge outward, usually running perpendicular to the tibia and meniscus fibres. It’s a common tear, making up about 28% of medial meniscus tears, and can disrupt weight distribution in the knee.
- Complex Degenerative Tear
This tear is caused by gradual wear and tear, often associated with knee osteoarthritis. It can be a mix of different tear patterns and usually develops over time rather than from a specific injury.
- Parrot Beak Tear
Named for its beak-like shape, this tear occurs at the edge of the meniscus and involves a triangular piece of cartilage. While less common, it can cause significant knee pain.
- Displaced Flap Tear
In this tear, a piece of the meniscus lifts away from its normal position, restricting knee movement and causing discomfort.
- Longitudinal Peripheral Tear
This tear runs along the length of the meniscus, parallel to the knee’s joint line. It typically affects the outer edges of the meniscus and can impact knee stability and movement.
What Causes Meniscus Injuries?
Meniscus injuries or tears often result from a combination of trauma and gradual wear. Below are some common causes:
Twisting or Rotating the Knee
One of the most frequent causes of meniscus tears is twisting the knee while bearing weight, especially during activities like sports. This twisting motion can put a lot of strain on the meniscus and lead to a tear.
Cumulative Stress
Sometimes, meniscus injuries develop gradually. You might start by ignoring minor knee pain during daily activities. Over time, this minor discomfort can worsen, and even a simple movement, like stepping onto a high step, can trigger a tear if the meniscus is already weakened.
Direct Impact
A sudden impact to the knee, such as a forceful collision or direct blow, can cause the knee joint to flex or move abnormally, leading to a meniscus tear.
Uneven Surfaces
Walking or running on uneven ground can put excessive strain on the knee. The uneven force applied to the cartilage can result in a meniscus tear.
Symptoms Of Meniscus Tear
Risk Factors for Meniscus Injuries
Meniscus injuries can occur due to various risk factors that increase the likelihood of damage to the knee cartilage. Understanding these factors can help you take steps to protect your knees and reduce the risk of injury.
- Age: As we get older, the meniscus becomes less flexible and more prone to damage. This makes it easier to tear, especially during physical activities.
- High-Impact Sports: Participating in sports that involve sudden twists, turns, or heavy impacts, such as football, basketball, and soccer, increases the risk of meniscus injuries.
- Previous Knee Injuries: A history of knee injuries, including previous meniscus tears or other damage, can weaken the knee and make it more vulnerable to further injuries.
- Poor Technique: Using improper techniques while exercising or playing sports, such as incorrect lifting or sports form, can put extra stress on the knee and lead to meniscus tears.
- Overuse: Activities that involve frequent bending and twisting of the knee, such as running or cycling, can gradually wear down the meniscus and make it more vulnerable to tears.
- Obesity: Carrying excess weight adds more pressure to your knees, increasing the risk of meniscus tears.
- Weak Muscles: Weak muscles around the knee, such as the quadriceps and hamstrings, can reduce support for the knee joint and make you more susceptible to injury.
How Is Meniscus Tear Diagnosed?
Physical Examination
Your doctor may perform an in-depth examination of your symptoms and review your medical history to determine the cause of your injury.
In order to confirm the tear, your doctor may use and perform:
- The McMurray test to check the range of motion of your knee.
- A circular motion of your knee to identify the tear as it puts more strain on the meniscus and produces an audible clicking sound.
Imaging Tests
- Imaging tests such as an X-ray, MRI, or CT Scan may also be required.
- If none of the aforementioned examinations confirms the diagnosis of a meniscal tear, your doctor may recommend surgery or meniscus transplantation.
How To Treat Meniscus Injuries?
Treatment options can generally be classified into 2 categories: non-invasive and invasive options. I generally start patients off with non-invasive treatment modalities first, unless the pathology is such that surgery is clearly required.
If non-invasive options prove to be ineffective, it may then be necessary to resort to more invasive options.
RICE. The majority of sports-related injuries can be treated with the RICE protocol. RICE is the acronym for Rest, Ice, Compression, and Elevation.
- Rest. Immediately stop engaging in the activity that injured you. Crutches may be suggested by your doctor to avoid putting too much pressure on your injured leg.
- Ice. Apply cold packs for 20 minutes, as frequently as needed. Do not apply ice to the skin directly.
- Compression. Wear a stretchable compression bandage to prevent swelling.
- Elevation. When resting, lean back and elevate your leg above your heart to help minimise pain and swelling.
To lessen the aftermath effect of the trauma, your doctor may advise you to take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, or naproxen to reduce pain, swelling, and discomfort.
Meniscal Debridement (resection)
During the arthroscopic meniscal debridement treatment, microscopic surgical instruments are inserted through small incisions. The torn meniscus segment is removed, leaving behind a small but healthy piece of cartilage.
Meniscal Repair
Keyhole surgery, also known as ALL-Inside repair, can be used as a mode of treatment for some meniscal tears, without the need for external incisions. The restoration of the meniscal tear is frequently done simultaneously with an ACL reconstruction to treat both the ligament injury and the meniscal tear as much as possible. Despite its complexity, meniscal repair has a success rate of 60%-70%.
How to Prevent Meniscus Injuries
While avoiding every possible cause of meniscus tears is difficult, taking some precautionary steps can help reduce your risk. Here are some practical steps to keep your knees healthy:
- Strengthen Your Leg Muscles: Building up the muscles around your knee, especially your quadriceps and hamstrings can offer better support and stability to your knee joint, reducing the chance of injury.
- Warm Up Properly: Always start with a thorough warm-up before diving into physical activities. Stretching and light exercises prepare your muscles and joints for more strenuous movements, helping to prevent injuries.
- Avoid Overfatigue: Don’t push your leg muscles to the point of exhaustion. Overworking your muscles can increase stress on your knees and make them more susceptible to injury.
- Gradually Increase Activity Intensity: If you’re starting a new exercise routine or ramping up your activity level, do so gradually. This allows your body to adapt to increased demands and helps prevent sudden knee strain.
- Wear Proper Footwear: Choose the right shoes for your activities to provide the necessary support and grip. For instance, wear cleats or supportive athletic shoes to avoid slipping or twisting your knee during exercise.
Anatomy/ Pathology
The knee is a hinged joint formed between the thigh-bone (femur) and the shin-bone (tibia). The meniscus is a c-shaped cartilage located between the 2 bones at the periphery of the knee joint. They act as “shock absorbers” within the joint. There are 2 menisci (plural for meniscus) in each knee.
Frequently Asked Questions
Will my meniscus tear heal on its own?
What is the role of the meniscus?
Can I still walk or move with a torn meniscus?
What will happen if I delay treatment or leave a torn meniscus untreated?
How long will it take for me to recover after surgery?
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