Description
The meniscus is a C-shaped structure in the knee that sits on top of the leg bone (tibia). Each knee has two menisci, an inner and outer meniscus. The inner meniscus is called the “medial” meniscus, and the outer meniscus is called the “lateral” meniscus. The meniscus functions like an adapter between the rounded thigh bone (femur) and flat tibia. It also serves as a “shock absorber” to help distribute the forces between the two bones over a greater area (rather than point to point), helps supply nutrition to the cartilage that lines the bones (articular cartilage), and helps stabilize the knee. The meniscus is rubbery tissue that loses its elasticity (rubberyness) with age. Nonetheless, each individual meniscus can be torn. Meniscus tears are very common, occurring in up to one third of all sports injuries. The inner meniscus is injured most often.
Common Signs and Symptoms
- Pain, especially with standing on the affected leg and squatting, and tenderness along the joint of the knee
- Swelling of the affected knee, usually starting 1 to 2 days after the injury (may occur right after the injury)
- Locking or catching of the knee joint, causing an inability to straighten the knee completely
- Giving way or buckling of the knee
- Direct blow to the knee, twisting, pivoting, or cutting (rapidly changing direction while running), as well as kneeling or squatting
- Without injury, due to aging
- Contact sports (football), sports in which cleats are used with pivoting (soccer) or sports in which good shoe grip and sudden change in direction are required (racquetball, basketball, squash)
- Previous knee injury
- Associated knee injury, particularly ligament injuries
- Poor physical conditioning (strength and flexibility)
- Appropriately warm up and stretch before practice or competition.
- Maintain appropriate conditioning:
- Thigh, knee, and leg strength
- Flexibility and endurance
- For jumping sports (basketball, volleyball) or contact sports, consider protecting vulnerable joints with supportive devices, such as wrapped elastic bandages, tape, or braces (although these have not been proven effective).
- Wear proper protective equipment and ensure correct fit, including proper cleats for the surface.
Some meniscal injuries can heal on their own, and some do not heal but may not cause any symptoms. However, the only definitive treatment for meniscal tears requires surgery. Surgery may provide complete pain relief in 6 weeks.
Possible Complications
- Frequent recurrence of symptoms, resulting in a chronic problem; appropriately addressing the problem decreases frequency of recurrence
- Repeated knee injury, particularly if sports are resumed too soon after injury or surgery
- Progression of the tear (the tear gets larger) if untreated
- Arthritis of the knee in later years. This is the most common long-term problem after meniscus tear, and can occur whether you have surgery or not
- Complications of surgery, including infection, bleeding, injury to nerves (numbness, weakness, paralysis) continued pain, giving way, locking, nonhealing of meniscus (if repaired), need for further surgery, and knee stiffness (loss of motion)
Initial treatment consists of medications and ice to relieve pain and reduce the swelling of the affected joint. Sometimes walking with crutches until you walk without a limp is recommended (you may put full weight on the injured leg). Range-of-motion, stretching, and strengthening exercises may be carried out at home, although referral to a physical therapist or athletic trainer may be recommended. Occasionally I may recommend a brace or immobilizer or crutches to protect the joint. Surgery is often recommended as definitive treatment and is performed arthroscopically. Usually the tear is removed partly or completely, although in some instances it is possible to repair the meniscus (less than 20% of the time). After surgery or immobilization, stretching and strengthening of the injured, stiff, and weakened joint and surrounding muscles are necessary. These may be done with or without the assistance of a physical therapist or athletic trainer.
Medication
- Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact our office immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.
- I will sometimes prescribe a pain medication, such as Vicodin. Use only as directed and only as much as you need.
- Cold is used to relieve pain and reduce inflammation. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity which aggravates your symptoms. Use ice packs or an ice massage.
- Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.
- Symptoms get worse or do not improve in 2 weeks despite treatment
- New, unexplained symptoms develop (drugs used in treatment may produce side effects)
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