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Home  /  Blog  /  Knee Injury: Healing the Meniscus
knee injury
24th January 2023

Knee Injury: Healing the Meniscus

I have recently seen a lot of patients who asked for my help after a knee injury. The onset of the problem was very different as well as the age of the injured people. One complained of knee pain after impact in a football game, the other suddenly felt pain walking downhill, another one was preparing for a marathon, another was spending a lot of time kneeling, and so on.

After examination, I had to tell each patient that there was a possibility that the cartilage was damaged.

So, what can I do as a physiotherapist, to help these people? Do they need an operation? Do they need an MRI scan? Can they continue with their sport or activity?

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 bend 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 I think you have a minor meniscus tear and your symptoms aren’t too severe, I won’t recommend an MRI. 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 I suspect you have a meniscus tear and other knee injuries, I may recommend either an MRI or arthroscopy. 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 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.

My Own Experience with Knee Injury

10 years ago I suffered a knee injury in a ski accident. After a short period of active rest (less impact but strengthening exercises) I was back to my usual activities, including tennis and volleyball. One day though, I landed from a jump and my knee gave way. Orthopaedic tests and then MRI confirmed an injury of my cruciate ligament and damage of my medial meniscus. Because the symptoms weren’t bad I opted for conservative treatment and followed my own advice. I also worked with a personal trainer to push me outside my comfort zone.

Few months later, my right knee acutely hurt when I was rushing in an airport, on my way to teach a course. This time the sharp pain didn’t diminish with treatment and few weeks later I underwent a partial menisectomy.

I returned to my rehab exercises and built them up, and I am pleased to be able to enjoy sport and be active. I know though that if I miss my strengthening exercises for more than 2 weeks, my knees will hurt.

My message to you is:

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.

Published on: 24th January 2023