Meniscus tears of the knee and what it means for you.

Updated: Feb 27




The meniscus in the knee is a common site of injuries in the knee in both young and old. It is commonly involved in traumatic sporting knee injuries such as ACL ruptures but can also present as a more degenerative issue as we get older.


What is the meniscus and what is its role ?


The menisci are very important in the normal function and long-term health of the knee joint. They assist the knee by:


  • Increasing stability of the knee joint.

  • Distribute axial load.

  • Absorb shock.

  • Provide lubrication and nutrition to the knee joint.

  • contribute to proprioception / joint position sense in the knee.


Anatomy of the meniscus.


The meniscus are crescent-shaped wedges of fibrocartilage located on the medial and lateral aspects of the knee joint.


The front of the meniscus is significantly wider than the back of the meniscus, and as a complete structure is concave to allow the femur to sit into it.


Both the medial and lateral meniscus have an anterior and posterior horn that attach the meniscus near the ACL and PCL.



The outer edge of the meniscus of is thick, convex, and attached to the joint capsule.

It has some blood supply and is sometimes referred to as the red zone. Due to this it has potential to heal or repair if injured or repaired.


The inner edge of the meniscus tapers to a thinner edge that is not attached to the knee.

It does not have a significant blood supply and is known as the white zone. This region has a lower potential for healing.



Meniscus tears of the knee.


Tears to the knee can be divided into traumatic and non traumatic degenerative tears.

Traumatic tears can then be divided into stable or unstable. Unstable tears are commonly associated with injuries to the Anterior cruciate ligament.


Tears are also categorised by their location and shape:



Symptoms of a meniscus tear.


Torn meniscus generally produces pain in the region of the tear and swelling in the knee joint. Symptoms are often made worse with pivoting on a fixed foot and squatting movements.


Torn meniscus fragments can get caught in the knee joint and cause catching sensations. If a large enough fragment becomes lodged between the bearing surfaces, the knee may ‘lock’ and become unable to be fully bent or extended.



Surgery or no surgery for the meniscus tear.


The goal in traumatic tears is to preserve the meniscus as best possible so as to prevent earlier than expected secondary OA changes in the knee.


Options for treatment include;


Arthroscopies and meniscus tears.


This was a fairly common solution for meniscus tears but is becoming less popular now due to the increased incidence of knee osteoarthritis post surgery. However it does have a role in the unstable tear especially if the tear is affecting the movement at the knee and can certainly make a difference to pain and function.


Meniscus repairs.


The goal of meniscus surgery is to preserve healthy meniscus tissue. A meniscus tear requires a blood supply to heal. Only the outer third portion of the meniscus has blood supply to enable healing of a tear. Repairs are generally limited to this peripheral region of the meniscus.


Meniscus repair is considered when:


  • The patient is healthy and wishes to remain active.

  • Result of acute trauma.

  • The patient understands the rehabilitation.

  • The meniscus tear is located in the periphery of the meniscus.

  • Tear affecting function of the knee.

  • The meniscus tissue is of good quality,


Conservative Rehabilitation.


In acute stable tears it has been shown that up to 85% of individuals will have an extremely good if not excellent result with exercise based management.


Patients with degenerative tears that have a robust and supervised exercise programme can be managed conservatively and do extremely well.

However around a third of these patients may require arthroscopy to achieve satisfactory pain relief and functional outcomes.


Summary


If possible we want to preserve the meniscus and get your knee pain free, strong and stable. This will involve settling down the initial acute phase and getting the knee "quiet" again.

Here are some examples of the type of exercises we use to get the knee started.




After that a progressive exercise program to strengthen and stabilise the knee will give you the best possible outcome in the short and long term.


Feel free to get in touch if you have any questions


Cheers


Dave

If you have any knee related issues and want to get back to full activities ASAP you can book in to see us here


References:

  1. Treatment of meniscal tears: An evidence based approach

  2. A 12-Week Exercise Therapy Program in Middle-Aged Patients With Degenerative Meniscus Tears: A Case Series With 1-Year Follow-up


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