A meniscus tear develops when there is damage to the cartilage the lines the knee joint. Tears may develop suddenly due to an injury, or come on gradually over time due to wear and tear.
The result of a torn meniscus is pain, swelling, stiffness, instability and sometimes locking (where the knee gets stuck in one position).
The meniscus is made up of thick, crescent shaped bits of cartilage that line the knee on either side of the joint. There are two parts, the medial meniscus, on the inner side of the knee and lateral meniscus, on the outer side of the knee. The meniscus acts as a shock absorber and ensures correct weight distribution through the knee.
A meniscus tear tends to occur either suddenly from a specific injury or gradually due to wear and tear:
Meniscus tears usually happen during sporting activities eg football, rugby and skiing. Usually they occur when the foot is fixed (eg studs in the ground) and the knee is slightly bent and then twisted by a sudden turn initiated either by you or by a force to the outside of the knee.
More commonly, it is the medial meniscus (on the inner side of the knee) that is injured, and sometimes the medial collateral ligament (MCL) is injured at the same time – see MCL Tear.
Cartilage tends to become more brittle with age and everyday use of the knee can cause a meniscus tear. Often this affects the edges of the meniscus which get frayed and torn. Symptoms may gradually build or they may be triggered by a particular event eg twisting the knee awkwardly. Meniscus tears are also a common feature of Knee Arthritis.
There are 4 types of meniscus tear:
a) Normal meniscus - what a normal meniscus looks like
b) Longitudinal Tear – tear that happens along the length of the meniscus
c) Bucket Handle Tear - tear where part of the cartilage detaches from the tibia leaving a flap of cartilage
d) Radial Tear – tear that starts at the outer edge of the cartilage and comes inwards
e) Degenerative changes - the cartilage wears away loosing its smooth surface becoming brittle and thin
1) Knee Pain: With a torn meniscus there is often a lot of pain in the knee, especially when trying to straighten it fully or when bearing any weight though the leg. It is more common for the medial meniscus to get damaged which causes medial knee pain (pain on the inner side of the knee).
2) Knee Swelling: usually develops over the first 48 hours.
3) Locking: With more severe injuries there may also be locking of the joint – where the joint gets stuck and can’t move further.
Locking can occur for 2 reasons:
a) True locking – this is where something gets stuck inside the knee joint – usually a small fragment of cartilage (see bucket handle tear above). Often if you move the leg around for a bit the knee then unlocks as the cartilage fragment moves out of the way
b) Pseudolocking – this usually occurs due to pain. If performing a movement is particularly painful, the body will often prevent itself from moving further to try and make sure no more damage is done.
Unfortunately, torn knee cartilage is not very good at regenerating. Tissues require a good blood supply to heal and whilst blood capillaries do feed the outer edges of the meniscus, the central parts of the meniscus are avascular (have no blood supply). This means they can’t properly heal. There are two options with a torn meniscus:
If it is a small meniscus tear, rehab aims to reduce pain and swelling and improve muscle strength. The most appropriate course of action is:
1) PRICE: (Protect, Rest, Ice, Compress and Elevate) for a few days and then a rehab programme to strengthen the knee and regain any loss of movement and function. Click the links to find out how to use them effectively
2) Tubigrip: can help in the short term to reduce swelling and to provide some support to the knee. Long term use is not advised as it can result in weakening of the muscles. Click the link to find out more
3) Knee Brace: Knee braces provide much more stability than tubigrip, so can be really useful, especially if the knee feels unstable. Usually a basic advanced brace basic or advanced knee brace will provide enough support - you shouldn't need an Elite brace.
5) Exercises: Building up the strength of the muscles surrounding the knee joint helps to reduce the amount of weight going through the knee and therefore through the cartilage, and can really help to reduce the effect of a meniscus tear. Go to the torn meniscus exercises section for simple exercises you can do at home to recover.
If exercises haven’t resolved the knee pain from your meniscus tear, your doctor may advise surgery. Most surgery for torn knee cartilage is performed arthroscopically (keyhole surgery). This is where they make 2 or 3 small holes around the knee.
The aim is to preserve as much of the cartilage as possible since it won’t regrow. It may involve removing any debris (torn bits of cartilage) and sewing up tears where possible.
Following surgery, it is important to exercise to regain full strength, movement and balance at the knee.
If this isn’t sounding quite like your knee pain, visit the Knee Pain Diagnosis section for help with diagnosing your knee problem.
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Updated 30th April 2013
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