Knee meniscal injuries

Causes of knee meniscal injuries

A meniscus tear is a common injury among sports players, who can damage the meniscus during a collision, impact or sudden pivoting movement. Often, this type of injury is accompanied by other knee damage, such as a torn anterior cruciate ligament. Older people may also be at risk of tearing their meniscus due to degeneration in the cartilage as the result of ageing. An older person can develop a torn meniscus from simply twisting the knee awkwardly when getting up from a chair.

Symptoms of knee meniscal injuries

Some people feel a popping sensation when this type of injury occurs. Often you can still walk with a torn meniscus and athletes sometimes continue playing. Within a few days, however, your knee will become increasingly painful and swollen. Other symptoms, which may vary in severity, include:

• Stiffness and loss of movement in the knee
• The affected knee catching or locking
• Feeling like your knee might give way

Diagnosis of knee meniscal injuries

Your doctor will check for tenderness around the knee joint, which is often an indicator of a meniscal tear. They may gently bend and rotate your knee to check for pain or ‘catching’ within the joint. If they suspect a meniscal tear, you will be referred for an X-ray to rule out other possible causes of knee pain, including osteoarthritis. An MRI scan may be used to examine the soft tissue in your knee joint, including the cartilage, ligaments and tendons.

Treatment of knee meniscal injuries

If tests reveal that you have torn your meniscus, the treatment will depend on the type, extent and location of the tear, as well as factors such as your age and general state of fitness and health. If you tear the outer third of the meniscus, this has a good blood supply and may heal on its own. However, the inner two-thirds of the meniscus have a poor blood supply and are referred to as the ‘white’ zone. Tears in this section cannot heal on their own as there is not sufficient blood flow so they will require surgery.

If your doctor advises that your meniscal tear can heal without surgery, you will be advised to follow the RICE protocol:

• Rest – take time out from whatever activity caused the injury. You may need to use crutches to avoid putting weight on your damaged knee while it heals.
• Ice – use a cold compress for at least 20 minutes several times a day but be careful to avoid putting ice directly onto the skin.
• Compression – wear an elastic compression bandage to reduce swelling.
• Elevation – keep your leg elevated above the level of your heart to bring down swelling.

You can take anti-inflammatories and pain killers to relieve the pain and swelling. Your doctor may also recommend an injection of corticosteroids into the affected joint to provide short to medium-term pain relief. A treatment called platelet-rich plasma injections – which uses platelets from the patient’s own blood to promote healing – may also be used.

If surgery is needed to repair the tear, it will normally done arthroscopically, which means using keyhole surgery. A thin instrument called an arthroscope is inserted into the joint via a small incision. It has a miniature camera at one end which allows the orthopaedic surgeon to see inside your knee. They can then insert tiny surgical instruments through other small incisions to trim the damaged meniscus or repair the tear using stitches. If only damaged tissue is trimmed, the procedure is called a partial menisectomy. Following surgery, you will be given a programme of exercises to follow by a physiotherapist to help you rebuild muscle strength and restore your knee’s mobility.

Outcomes of treatment for knee meniscal injuries

It normally takes around three to six months to recover fully from meniscal repair surgery. If you have a partial menisectomy, the rehabilitation time is much shorter – only three to six weeks. With the right diagnosis and treatment, there is no reason for you not to make a good recovery from a meniscal tear.