Understanding Meniscal Injuries: Causes, Symptoms, and Treatment Options

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Meniscal Injury

The meniscus is a C-shaped piece of cartilage (a type of connective tissue)within the knee. There is an inner (medial) and outer (lateral) meniscus in each knee.

It acts as a shock absorber in the knee, helps to lubricate the knee, and helps to stabilise the knee joint.

Common Patterns of injury

Meniscal injuries are some of the most common injuries in the knee. A common way that this occurs is a sudden twisting injury to the knee during activity. This can sometimes also result in ligament injuries.

Sometimes, a meniscus tear can occur in a meniscus that is already worn out. Tears of this sort can happen without any injury. Even the act of stepping off the curb is sometimes enough. Typically, a patient might complain of sudden pain in the knee, with a sudden popping sound. The knee is usually not immediately swollen but may get swollen later. If in any doubt, one should seek medical advice as soon as possible.

Signs and Symptoms

The signs of a meniscal injury can vary depending on the individual and the severity of the tear, but there are a few symptoms that most patients with this injury will have. Here is a list of common problems that someone with a meniscal injury might face:

  • pain that is confined to medial (part of the knee facing toward the other knee) and lateral (facing away from other knees)
  • An inability to bend or straighten the knee (locking)
  • swelling – can be delayed (a while after the injury) or intermittent (comes and goes)
  • knee stiffness
  • unable to extend knee fully

How is this injury diagnosed?

Based on your history of injury, the doctor will likely carry out a focused examination which may include assessment of your knee range motion, assessing for tenderness (pain when pressing) at the joint, and special tests for assessing the ligaments and cartilage within the joint.

An example of such a test is known as McMurray’s test where knee movements are made in an attempt to reproduce the pain or clicking within the knee.

After examining your knee, the doctor will usually offer an MRI scan, which uses a magnetic field to generate an image of the inside of your knee. It is very sensitive and will allow a doctor to diagnose meniscal tears, cartilage injuries and ligament injuries by looking at the tissues directly.

Common types of meniscus tears

The Radial Tear is the most common type. Imagine a knife piercing the centre of the C-shaped cartilage.

The Horizontal Tear is a longitudinal tear along with the C shape. Usually easier to repair

A Bucket Handle Tear is similar to a horizontal tear, but more severe and involves more of the meniscus. Part of the meniscus can get stuck in the knee and cause a painful locking sensation. Usually requires urgent surgery.

What does this mean to the Patient?

Menisci have a poor blood supply, with only ⅓ of the meniscus supplied directly by nutrients from our circulation. Menisci heal very poorly, and will usually require some form of surgery to repair. As meniscus tears do not heal well, they can have both short and long-term effects on you.

Usually, a patient with a torn meniscus will find it difficult to extend the knee fully and may feel pain or swelling when trying to move the knee. In the short term, this will affect your ability to participate in sporting activities that you enjoy.

In the longer term, untreated meniscal tears can lead to wearing out of the knee cartilage, a condition known as osteoarthritis. Osteoarthritis results in pain and stiffness of the knee, and can severely impact your lifestyle.

Early diagnosis and treatment remain the best option for minimising the risk of osteoarthritis, and patients are encouraged to seek medical opinion early.

What are the Treatment Options?

There are various treatment plans, both surgical and non-surgical.

Non-Surgical Treatment

If your doctor does not recommend surgery for the meniscal tear, he/she might recommend some of the following non-surgical treatments,

  • Activity modification and rest can help to relieve symptoms, and in some selected patients, may allow the meniscus to heal
  • Pain-relieving medications such as Non-Steroidal Anti-inflammatory Drugs (NSAIDs) may help the control pain symptoms and restore some degree of function
  • Knee rehabilitation can likewise relieve knee pain, and improve knee function
  • Knee injections with autologous proteins can sometimes be considered in lieu of surgery if surgery is not a consideration.

Surgical Treatment

Surgical treatment is the mainstay of treatment for meniscal injuries. Depending on the type of tear, the age of the patient, and the severity of the tear, severe treatment options may be offered. All of the subsequent treatments can be performed using arthroscopic surgical techniques (keyhole surgery).

  • Partial meniscectomy, where part of the torn meniscus is deemed irreparable and removed.
  • Meniscal repair, where the torn part of the meniscus is placed back in its original position and repaired using sutures.
  • In severe cases, a total meniscectomy may be the only option available. Total meniscectomy is when the entire meniscus is removed. In younger patients, there is an option of transplanting a meniscus from a donor into your knee.

In general, patients undergoing surgery will have their sutures removed after 2 weeks, during which they may be advised to move around using crutches. Patients who have undergone meniscal repair may sometimes be advised to wear a knee brace for 2 to 6 weeks.

What is the Rehabilitation and Recovery Process like?

Regardless of the type of treatment offered, most patients will be recommended to undergo a course of rehabilitation. This process improves knee range of motion and strength. The period of rehabilitation varies, and most patients should expect to return to activity within 2 months. Patients who underwent partial meniscectomy in particular, can usually return to sport within 6 weeks.

For assessment of your condition, please book an appointment with Dr Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology