Traumatic Meniscal Tear
What is a meniscal tear?
In answering this question we should probably start by posing another question; what is a meniscus?
A meniscus (singular) is a type of cartilage that exists within your knee joint. As with most joints in the body the knee has cartilage within its structure. Unlike most this takes two different forms. As well as the common smooth type of cartilage that is seen in most joints and is attached to the ends of the bones (articular cartilage), we also have a more fibrous type of cartilage, one on each side of the knee, that we call menisci (pleural). The one on the inside of your knee is the medial one, on the outside is our lateral.
As with all aspects of the body these are affected by age, not just old age, but simply the process of getting older. Up to our twenties your menisci are often healthy, with a good blood supply. At this stage in life if you are to tear your menisci you would expect to do this with a reasonable amount of force; a loaded, twisting movement. It is not uncommon that these are sustained during sporting activity such as football, hockey or skiing.
As we move through our 30’s, 40’s and 50’s we tend to find that our menisci can be somewhat more worn, but still remain well functioning and pain free. However we do sometimes see that increasingly small amounts of force are needed to elicit a tear. There is a separate section on this site dealing with degenerative tears to the menisci here.
The different types of tear that one can sustain are pictorialized above. These can be sustained on either medial or lateral side, however medial meniscal tear is seen more frequently.
What are the symptoms of meniscal tear?
Meniscal tears will often lead to pain within the knee joint. This is commonly localized to the joint line, with the medial meniscus giving pain on the inside and the lateral on the outside. On occasion tears to a particular part of the meniscus can cause pain behind the knee. The pain is often felt as a sharp catching pain, particularly aggravated by twisting the knee. This pain can sometimes lead to the knee momentarily giving way from under you.
Dependent on the type and stability of the tear people will sometimes report that their knee feels as if it will lock. By this it is meant that the knee has a block to movement. An inability to move at all or sometimes people will lose the ability to fully straighten the knee. Sometimes the knee will lock at the time of injury and will not go straight at all. On other occasions a knee may lock, but can be unlocked with manipulation.
It is common that a knee with a traumatic meniscal tear will swell up. This often accumulates over a number of hours, commonly noticed as a swelling and stiffness the next morning. If swelling appears immediately after injury this could be suggestive of a more significant injury such as fracture or ACL rupture.
What can I do for myself?
First of all if you have sustained an injury to the knee and you are unable to straighten it, if you are worried that the pain is significant or swelling has accumulated immediately then it is recommended that you seek specialist attention.
Early Management - Outside of this scenario you should treat your knee using the acute soft tissue advice here. When you have undertaken the acute soft tissue treatment you should try to regain your range of motion, the ability to full straighten and fully bend your knee, while maintaining as much muscle function as possible. These exercises may be of help [link when I find one]. It would be fair to suggest that early good quality injury management means that you should improve as quickly as possible. This is a service we are able to offer.
Recovery phase – Once you have noticed your knee starting to feel somewhat easier with the early management it is a good idea to start to think about recovery:
- Regaining full flexibility
- Regaining full strength
- Returning to previous levels of activity
As well as these flexibility exercises, you should also start to work your muscles. These simple exercises may be of use at the beginning.
Once you start this journey how far you continue depends on what you wish to get back to doing. If you have a specific sport or hobby that you wish to return to then gaining the help of a rehabilitation specialist would be advised. This is something we would be able to help you with.
What other treatments are available?
If your pain, giving and swelling remains despite treatment for longer than a few months there is the option of undergoing an arthroscopy. Arthroscopy is commonly referred to as a ‘keyhole’ operation. Two small incisions are made in your knee by a specialist surgeon using specialist equipment while you are in an operating theatre. When they are inside your knee they may be able to repair the meniscal tear (dependent on type and position of the tear – the likelihood that your tear will be repairable diminishes with age). If not the unstable fragment of menisus will be resected (taken away). Due to our excellent links with local specialist knee surgeons we are able to help with decisions surrounding this process.
If your knee is locked and unable to be straightened from the start it is likely this will need to be done much sooner. Hence the need to get a specialist opinion.