Meniscal injuries are common in sports. There are two meniscii in the knee joint. Each meniscus is a roughly ‘moon-shaped’ pad and they lie beside each other on the top surface of the tibia (shin bone). The Meniscus in the knee joint is also often referred to as cartilage.
The menisci have several functions:
• Shock absorber within the knee
• Provide nutrition for articular cartilage
• Reduce friction during movement
• Increase stability & joint congruency
• Limit extreme flexion and extension
• Proprioceptive function
MECHANISM OF INJURY
There are 2 ways your meniscus can get damaged. Sometimes it is often down to normal wear and tear of the joint as we get older or due to previous injury of it can happen acutely or suddenly. It commonly occurs acutely when the foot is planted on the ground and the knee is twisted at the same time, intentionally or due maybe due to a tackle in sport. This injury does not have to occur at speed as the mechanism of twisting while the joint is weight bearing can cause the meniscus to get trapped between the bones and pinched. If the force is sufficient, a meniscus tear may result. Tears are more common of the medial (inside) meniscus than the lateral (outside) meniscus and the medial meniscus MAY have better repairing qualities.
As mentioned above degenerative meniscus damage is a normal part of aging and arthritic changes associated with that. Strengthening the muscles with specific exercises can minimise this wear and tear and stabilise the joint. Essentially, when the joint is stronger the two leg bones that make up the joint don’t shift and move around as much so there is less friction on the meniscus, reducing wear and tear.
WHAT ARE THE SYMPTOMS?
Pain and swelling are the most common signs of an injury to your meniscus. If the tear occurs from a sudden injury, you may feel/hear a pop at the time of the injury. Swelling after the injury can often gradually increase over a 1-2 day period. You may also feel like your knee is “locked” where you are unable to move it through the full range of motion. If your tear is more of a chronic degenerative tear, you may just have symptoms of pain, swelling & stiffness off and on based on your activity level.
DO I NEED SURGERY?
NO, not all the time. A meniscal tear may settle conservatively without giving many problems. Conservative treatment does require treatment on the joint, this treatment often means getting certain muscles to relax and or activate around the joint. It is also imperative to get the joint strong as this will minimise more wear and tear in the joint. In fact, since 2002, several randomised clinical trials demonstrated no additional beneﬁt of arthroscopic surgery compared to non-operative treatment, sham surgery or sham arthroscopic surgery on degenerative meniscal damage. Unfortunately though, if a tear does not heal, a ‘flap’ of cartilage MAY interfere with the normal mechanics of the joint and interfere with movement some keyhole surgery may be required.
WHY DOES IT HURT?
At first it just hurts because of the fresh injury and swelling. Later it hurts when you move your knee and the torn or worn pieces get caught between the bones and pull on the meniscus. This is why is it so important to get the joint strong. It will minimise the amount of friction going on in the joint
ESSENTIAL REHAB EXERCISE - this should be performed pain free
Wall Slide Exercise
1.Stand with your back, shoulders, and head against a wall and look straight ahead.
2. Keep your shoulders and feet relaxed, place one foot away from the wall, shoulder’s width apart.
3. Keeping your head against the wall, slide down the wall, lowering your buttocks toward the floor until your thighs are almost parallel to the floor.
4. Shift your weight over to affected leg
5. Hold this position for 30 seconds. Make sure to tighten the thigh muscles as you slowly slide back up to the starting position.
6. Do 3–5.