Knee – Meniscal injuries
Meniscus is a crescent shaped fibrocartilaginous structure in the knee joint between the end of two bones, femur and tibia. It is a commonly injured structure in the knee. Menisci provides stability and equal weight bearing and it also acts as a shock absorber. There blood supply only to the outer aspect of the menisci and the menisci on the inner aspect of the joint called as medial meniscus is mostly injured.
The tear can be due to trauma which is seen in younger people or can be a degenerative tear. In younger patients the menisci are tough and rubbery, but can be torn in forceful twisting injuries. Traumatic tears are commonly associated with sports activity like football, soccer, skiing or tennis when the knee is twisted under stress or in full weight bearing. Menisci becomes weak and less elastic with age and can be torn with a fairly minor injury or even with a simple squat or even rising from a chair or getting out of a car.
The common risk factors are over weight, intense training, decreased muscle strength or incorrect position of your legs.
Meniscus Injury Symptoms
Pain along the line of the joint or a vague pain felt all over the knee. Pain can be a combination of ache and sharper pain. Pain is worst with twisting, squatting or any activities when menisci can be pinched. Symptoms may settle with rest. The joint may also become swollen and stiff. If the torn part of the meniscus is large it can cause locking. This is caused by a large fragment getting caught in the joint and acting like a wedge preventing the knee from fully straightening. Difficulty in performing activities that loads the knee like going downstairs.
Knee Meniscal Treatment
Conservative management is preferred in most of the cases with a minor traumatic tear and in degenerative tears of meniscus. Your Physiotherapist can help you in the recovery process to reduce the pain and discomfort in the knee and to gain function.
Initial treatment is focussed on reducing pain and swelling in the knee with cryotherapy and electrical modalities and acupuncture. Manual therapy and exercises is focussed on regaining good knee control, restoring range of movement and muscle function. Your physiotherapist will be able to advice you on graded exercise to strengthen the knee muscles and to promote recovery. Orthotic assessment can be done if needed to correct the deviations in your feet to reduce stress in your knees. Proprioception (joint position sense) exercises and core stability exercises are also helpful to improve function.
Surgical correction is done if there is a large torn meniscus causing locking or in case of severe tear which can be repaired. Knee arthroscopy is most commonly performed. Your surgeon inserts miniature camera and surgical instruments through small incisions to repair the tear or to remove the torn part. Your Physiotherapist can help you before the surgery to restore and improve the range of movement and muscle strength which helps you with a faster post operative recovery. Post operative treatment and mobility progression can be done by your physiotherapist by following the surgical precautions and protocols.