What is a Meniscus Tear - What you need to know

Meniscus tears are one of the most common knee injuries in today’s day and age. Since sports have developed into a faster, higher impact and more physical load as the years go by – athletes are in the highest risk category of suffering a torn meniscus.

However, like all injuries, meniscus tears can happen to anyone and at any age. Here’s what you need to know about meniscus tears.

What is a meniscus?

First, let’s take a minute to understand exactly what the meniscus is and what it does. The meniscus is a c-shaped piece of cartilage in your knee, that sits between your tibia (shin bone) and your femur (thigh bone).

There are 2 menisci in each knee - one is located on the inside of the knee and the other is on the outside of the knee. These are known as your medial and lateral menisci.

The meniscus is made up of a soft and fibrous cartilage, called “fibrocartilage” which not only provides an amazing amount of shock absorption from knee impact, but it also provides cushioning and stability for your knee.

Without a meniscus, you would struggle to complete the simplest daily tasks such as walking and standing due to the immense pressure on your bones.

Your meniscus plays a very important role in your ability to walk, run and jump.

What is a meniscus tear?

A torn meniscus is exactly what it sounds like – a type of tear in the cartilage inside your knee joint.

There are a few types of meniscus tears that can happen.

• Incomplete/intrasubstance tear
  An incomplete tear is a tear within the outer edges of the meniscus. Often, these occur due to degenerative changes in the meniscus.
   
• Radial tear
  Radial meniscus tears are among the most common tears. This is where a tear has occurred from the outside of the meniscus, inwards.
   
• Horizontal tear
  A horizontal tear is when the tear runs alongside the fibers of the meniscus. These can happen anywhere in the cartilage.
   
• Bucket-handle tear
  Bucket handle tears are a more complex type of injury. These are called as such, because the torn part of the meniscus flips inwards (like a bucket handle) and can cause an obstruction in the knee joint – causing the individual to lose full range of motion in the knee.
   
• Complex tear
  A complex tear is a combination of tear patterns within the meniscus. They often include elements of both horizontal and radial patterns.
   
• Flap tear
  A flap tear is not as common compared to the other patterns. It is when a portion of the meniscus is “peeled” back, creating an obstruction in the knee joint.

Unfortunately, the type of tear an individual might experience is random and will depend on how the injury occurred and the movements during the injury.

What causes a meniscus to tear?

A torn meniscus can happen to anybody as a result of any movement or activity that involves forcefully twisting or rotating your knee.

Athletes are at a higher risk of meniscus tears, especially if they’re involved in contact sports such as football or basketball. Among athletes, meniscus tears are a very common injury due to sport becoming much faster and intense.

Among older individuals who aren’t involved in sport, meniscus tears can still happen!

As we age, our bodies don’t perform like they used to when we were younger – this is due to the degeneration of our joints and muscles. Wear and tear on your knees as you age, increases your risk of a torn meniscus.

Here are some of the most common ways a meniscus can tear:

• Direct impact
  Direct impact to the knee (such as a tackle in football) can cause the meniscus to tear.
   
• Pivoting
  The torsion generated while pivoting can cause a meniscus tear. An example of this is turning around too quickly, without picking up your heel from the ground or pivoting in basketball or netball.
   
• Change of direction
  A sudden change in direction such as performing a cut in basketball or soccer, can cause the meniscus to tear.
   
• Lifting heavy weights
  Lifting heavy weights that involve bearing weight with your knees puts a lot of pressure on your joint. Examples of these are: Heavy squats, leg extensions or Olympic weightlifting.
   
• Sudden stop or hard deceleration
  Your meniscus acts as a shock absorber and like any shock absorber, when too much pressure is placed on it, it can compress.
   
• Skiing
  A torn meniscus from skiing is very common as both speed and impact are contributing factors in the sport.
   
• Stepping on uneven ground
  Accidentally stepping on uneven ground with full bodyweight can cause an unnatural movement in the knee joint, leading to an injury.

 

Meniscus tear symptoms

If you think you may have torn your meniscus, you should see your physiotherapist for an evaluation and to complete imaging (such as an MRI or an ultrasound) to confirm. However, there are a few common occurances or meniscus tear symptoms:

• At the time of the injury, you heard and felt a popping sensation in your knee.
• Your knee was swollen after the injury or is still swollen.
• Pain in the knee joint
• Difficulty extending of flexing/bending your leg
• Sometimes your knee gets “stuck”

Depending on the degree of injury, you might feel “fine” after the initial trauma has gone, but over time the injury will get worse without adequate treatment.

It’s important to keep a close eye on the progression of your knee injury after the initial injury while you recover.

Meniscus Tear Treatment

Depending on the location of the tear and the degree of which it was torn, your treatment might begin with a decision between non-surgical (conservative) and surgical treatments.

Don’t worry though, surgery isn’t doom and gloom! It just depends on where the tear is and what you want your outcome to be.

Some areas of the meniscus don’t get direct blood supply, which simply means natural healing is less likely to happen.

Some meniscus tear recovery can heal over time with physio treatment while others require some surgical intervention to fix it.

It’s best to see a physiotherapist to get a diagnosis through a physical exam and imaging to determine the best plan for you.

Conservative Meniscus Tear Treatment

Meniscus tear treatment often starts out with conservative treatment as you will need to manage the initial pain and swelling. Your Physiotherapist will likely recommend the following:

• RICE method
  Rest – Rest the knee joint and avoid any activities that give you knee pain. Especially any that involve twisting, pivoting or rotating the knee joint.
  
  Ice – Ice can reduce pain and swelling after the initial injury and any time swelling occurs. Apply a cold pack for 15 minutes, every 4 to 6 hours during the first few days of the injury. Afterwards, apply as often as needed.
  
  Compression – to prevent additional swelling, apply a compression bandage.
  
  Elevation – as with most swelling, keep the injured knee higher than the heart to reduce swelling. Do this by lying down and keeping the knee supported.
   
• Anti-inflammatory pain relief
  Using anti-inflammatory pain relief such as Nurofen or Advil, can help you manage your pain while your body recovers.
   
• Physiotherapy 
  A physiotherapist can help provide you with a tailored plan of exercises and stretches to vastly improve muscle strength, range of motion, stability, and flexibility. The main goal you will both work towards is strengthening the muscles that support the knee joint, making it stronger and more stable. The stronger your quadriceps, hamstrings and calves are, the less likely you are to reinjure the knee and experience knee pain.

If the injury isn’t too severe or pain is caused by the degeneration of the meniscus, a conservative/non-surgical approach may be the best path for recovery. Conservative treatments can usually see meniscus tear recovery take about 6-8 weeks to see a return to regular activities.

Surgery

Surgery is usually considered if pain persists after trying a conservative approach, or if the tear is not likely to heal on its own.

Knee arthroscopy is one of the more commonly performed surgeries to repair a torn meniscus. It’s done by inserting a small camera through an incision in the knee joint and surgical instruments through another small incision.

If surgery is required, your surgeon will discuss your options. The 2 most common procedures are a meniscus repair or a meniscectomy (removal of a section of the meniscus).

Once the surgery is complete the meniscus needs time to heal. Doctors will commonly refer you to a physiotherapist to start work on a rehabilitation program that includes stretches and exercises to introduce flexibility and range of motion.

How can a physiotherapist help a torn meniscus?

Meniscus tear rehabilitation involves increasing mobility and strength, reducing pain and progressing through certain physical movements that involve knee stability. A physiotherapist can help you on the journey to making a return to sport or to your regular daily activities.  

Whether or not surgery was done, it’s important to start your rehabilitation with a physiotherapist once any initial pain and swelling has stopped.

Each rehabilitation program is individualized, depending on the person and the severity of the injury, but the main progressions of a rehab program can involve the following:

• Protecting the knee from further injury
• Slowly starting to introduce load on the muscle group to ensure the muscles stay strong and active
• Exercise and progressive load to strengthen the lower limb muscles and build stability
• Progression through landing and jumping mechanics
• Progression through specific meniscus tear exercises to help track progress

A physiotherapist will work with you to ensure the right progress is being made to achieve your goals.  

At Back In Motion, our goal is to provide you with long lasting results, which we call Results4Life ™. This is centered around using a defined path to help measure progress in your rehabilitation. Our approach addresses key areas that are fundamental to lasting recovery from not only injury or pain-relief but treatment and prevention of injury re-occurrence.

Back In Motion is always here to help you!

With practices Australia-wide, we’re Australia’s leading provider of physiotherapy and related services. Contact us on 1300 859 981 to organize a booking with one of our physiotherapists and we can help you with your meniscus tear!