Meniscus Injury
How it happens
An onset of a meniscus problem can vary depending on activities as well as the age of the injured people. A bad tackle in a football game, or walking downhill, or preparing for a marathon, as well as spending a lot of time kneeling, can all be a cause for the damage on your meniscus.
After examination, I had to tell each patient that there was a possibility that the cartilage was damaged.
So, what can a physiotherapist do, to help? Is an operation needed? Is an MRI scan needed ? Is rest or activity the best solution?
What is the Meniscus?
The meniscus is a bean-shaped piece of tough, rubbery cartilage between the shinbone (tibia) and the thighbone (femur). It helps to increase the congruity between a very flat top of the shin with the round end of the femur. Like two wedges on the inside and the outside of the knee, they act as a shock absorber. These two pieces of cartilage glide in the joint when we straighten and bending the knee. They can get damaged by sudden twisted movements, through an accumulation of impacts, extensive compression, or trauma.
In brief, the meniscus is a cartilage structure which helps reabsorb the shocks of impact and is important for the health of the knee joint. It is particularly important to protect the knee from osteoarthritic damages.
Can a Meniscus Tear Heal?
The meniscus doesn’t have a direct blood supply. Its nourishment depends on the neighbouring structures, and it is kept healthy through the alternating of rhythmic compression and release of pressure. A little bit like squeezing a sponge and releasing it while underwater.
So, if you keep the sponge squeezed, no fresh water will replenish it. This is the equivalent of keeping a prolonged pressure on the knee, like in a squat position or prolonged standing.
If you stop squeezing the sponge the similar situation arises; no exchange of fresh water/nutrients. This would happen if you stopped completely loading the affected leg.
So, what is the best course of action? Will the injury heal over time on its own?
It depends on the knee injury type, on the condition of the person, and on their goals. There are different types of meniscus tears, and some tears, or the discomfort generated by it, won’t heal without treatment.
If your tear is on the outer third of the meniscus, it may heal on its own or be repaired surgically. This area has rich blood supply and blood cells can regenerate meniscus tissue or help it to heal after surgical repair.
But if the tear is in the inner two-thirds, which lack blood flow, the tear cannot be repaired and may need to be trimmed or removed surgically.
Do you need an MRI Scan?
If you have a minor meniscus tear and your symptoms aren’t too severe, an MRI won’t be needed. This is usually the case if your knee isn’t locking, you can straighten the joint and are able to walk without too much discomfort and you can cope with the pain with help of the usual pain killers or anti-inflammatory medications.
In this scenario I would suggest a treatment to help against possible pain or swelling, build up an exercise plan to support a good muscle balance and a symmetric gait. This is to avoid adaptation in movement patterns, which can become damaging over time. I will also discuss your goals in terms of activities and suggest changes and adaptations to training where needed. In most of the cases this resolves the problem, and you won’t need an MRI or arthroscopy.
If your symptoms are moderate to severe, and Ia meniscus tear and other knee injuries seem possible, either an MRI or arthroscopy may be recommend. Usually, you will be complaining of locking and popping of the knee, swelling and pain. The movement is restricted and you are limping. I will in this case write to your GP and ask for a referral. Alternatively, I will be able to refer you for a private MRI scan.
Independently of the degree of the meniscus damage, a carefully planned exercise regime is vital to prepare you for a possible arthroscopy. The aim is to reduce swelling and pain, maintain a good range of movement and the activity of your core, gluts, and other muscles. This will help to maintain a good knee stability and prepare you for a quicker return to normal activities.
A meniscus repair is possible only in certain types of injury.
In the case of a suspected injury with mild symptoms, a tailored exercise plan and adaptation of the activities (reduction of high impact activities for example) can help to avoid surgery. An MRI scan is not always needed. This depends on the age and goals of the patients as well.
If your symptoms are moderate to severe, a referral for an X-Ray/MRI may be needed. SWISSPHYSIO can refer you for a private imaging. If surgery is suggested, you will have the best results by following a carefully planned exercise program pre and post-procedure.
Take home message:
A knee injury does not always require an MRI scan. Being injured doesn’t mean you have to stop moving. Find a health professional you trust for advice on how to go back to your best performance. This can entail some rest but should also advice you for an adequate exercise plan.
Keep active and fit in preparation for surgery, follow the professional advice. Do not overdo but also don’t get complacently lazy.
At SWISSPHYSIO we know how to help you.