Meniscus Tear

Introduction

The cartilage structures that surround the knee joint make a buffer that protects the bones from one another. When the leg twists or turns in an awkward way, this leaves the menisci are vulnerable to injury.  While some of the parts of the meniscus can heal on their own, in some cases an individual may need surgery. When surgery must be performed, the method of choice for most doctors is Arthroscopic. This means that the joint doesn’t have to be opened up, and the patient is susceptible to less complications.

Knee Joint Anatomy

Bones in the Knee

The knee is one of the more structurally complex areas of the body. The knee is composed of three bones:

  • The Tibia, or shinbone
  • The Femur, or thighbone, sits on top of the tibia, the larger leg bone.
  • The Patella, or kneecap, glides in a groove on the end of the femur.

Muscles in the Thigh

Large muscle groupings in the thigh give the knee its strength and stability:

  • The quadriceps muscles-group of muscles on the front of the thigh that straighten and rotate the leg.
  • The hamstring muscles- located on the back of the thigh and bend or flex the knee.

Ligaments Surrounding the Knee

Ligaments are strong tissues that provide stability and allow the leg to move. They also enable flexibility while maintaining balance. Four ligaments connect our knee bones together:

  • The medial collateral is located on the inside of the knee, and the lateral collateral is at the outer side of the knee. These two ligaments help the joint to resist side to side stress.
  • The anterior cruciate ligament and the posterior cruciate ligament cross each other inside of the knee joint. These ligaments help to keep the joint aligned. They also counteract forward and backward forces and keep the bones in place. They also control rotation of the tibia.

Cartilage, Synovium, and Nerve Fibers

Two cartilage disks, Menisci, are located on the end of the tibia. This cartilage forms a smooth surface, allowing the bones to glide easily during motion. The menisci act as shock absorbers when we walk or run.

A smooth tissue capsule covers the bones in our knee, and a thin synovial membrane lines this capsule. The synovium secretes a liquid known as synovial fluid. The synovial fluid acts as a cushion and lubricant between the joints, which allows the knee to move painlessly. Proprioceptive nerve fibers are inside in the ligaments and joint capsules, sending signals throughout the body.

Meniscus Tear Causes

As previously mentioned, the menisci are especially prone to tear if they are twisted enough, as they are left vulnerable in this position. Any movement that requires a pivot, cutting sideways, or quickly changing directions, those associated with sports, can cause the meniscus to tear.

Meniscus Tear Symptoms

Some patients say that they’ve heard a popping noise when he or she tells what happened. One can expect to see swelling, and feel some pain, and tightness that may continue to  increase over several days. Most will not be able to straighten the knee. Meniscus tears cause the knee to buckle, get stuck or catch, or actually lock in position.

Meniscus Tear Diagnosis

If you suspect you have torn your meniscus, you should seek immediate medical attention. A doctor can evaluate your knee and will examine your knee and your leg alignment. You may be asked to perform simple movements to help the doctor determine muscle strength, joint motion, and stability.

McMurray’s and Apley’s Test

The McMurray’s test and Apley’s compression test are both used for diagnosing meniscus tears. They both involve bending your knee while your doctor moves the foot and leg in different positions to assess the menisci. The doctor will then evaluate excess fluid and swelling around your knee joint. After this, your doctor will more than likely order an X-ray to see the condition of your bones. In come cases, you may need an MRI.

Meniscus Tear Treatment

Minor tears located on the outer sections of the meniscus should be able to heal on their own. Most doctors tell their patients to use the RICE (rest, ice, compression, elevation) to help these times of tears. The doctor may also recommend physical therapy as it can help strengthen the muscles that move the knee joint.  Your doctor may recommend a knee brace for sports or custom shoe inserts to support the arch of the foot.

Meniscus Tear Surgery

Your doctor may recommend surgery if you have a larger tear on the outer section of your meniscus or larger tears in the inner areas.  For the most part, meniscus tear repairs can be performed as an outpatient surgery. Most meniscus repairs are performed as outpatient surgeries.  The majority of medical professionals prefer Arthroscopic surgery because it is less invasive. It’s also associated with a lot less pain, swelling, infection, and bleeding. This type of surgery also has a faster recovery time than open surgery.

Many meniscus tear surgeries are outpatient procedures. The patient may either be anesthetized for surgery or receive a nerve block. The surgeon will make one or more small incisions, about a quarter to half inch in length, near the joint. The surgeon will fill the joint space with a sterile saline solution, to expand the area. The surgeon will then insert an arthroscope and will reposition it to see the joint from multiple angles.

Meniscus Tear Recovery

Most patients may go home the same day after surgery and are sent home with pain medication to help the post-surgery pain.The doctor may advise ice or to keep the leg elevated and may also prescribe blood thinning medication and special support stockings.  

Walking and movementing are a critical component of your recovery. Exercising, or physical therapy, usually begins right after the surgery. At first, the patient will need to use a walker or crutches while moving. Later, the doctor may prescribe a knee brace. It can take four to six months to restore the coordinated leg movements.

An occupational therapist can show you how to complete everyday tasks with your movement restrictions, such as getting dressed, bathing, etc.

Following the come care instructions is crucial to your success. In fact, it’s dependant on it. As with most surgeries, the recovery times will differ depending on the severity of the injury, the type of procedure, and the patient’s overall health. Generally, most patients should be able to resume some of their regular activities in as little as one to three weeks after his or her procedure. The majority of patients can resume functional activities after a meniscus tear surgery.

Meniscus Tear Prevention

It is crucial and critical that the patient adheres to the exercise program and safety precautions given by the doctor, while staying as active as possible. If your doctor sets restrictions on your activities, the patient must understand that these restrictions allow the meniscus to heal properly. Individuals should only return to intense physical activity once the doctor has cleared them to do so.

Sports Physicians Orthopedics and Rehabilitation of Texas