Conditions and treatments
Meniscal Tear
The menisci are two “C-shaped” structures located between the thigh bone (femur) and the shin bone (tibia), being their major function shock absorption. Moreover, they also providing congruency between both bones and stability. Thus, they are a core structure in the health of the knee, making sure our daily life activities do not generate excessive loads in the joint.
What causes a meniscus tear?
With time and activity as they are submitted to repetitive stress they lose their properties, becoming more fragile and less elastic, thereby losing their tolerance to loads. They may tear when the loads overcome their structural capacity, which may happen after a squat or just a sudden change of direction.
What are the symptoms and how are tears diagnosed?
The symptoms vary from little discomfort to pain and a locking sensation that impairs weight-bearing or the capacity to straighten the knee. When there is a sudden impact, twist, or hyperflexion, a “pop” and intense pain may be reported, with subsequent swelling, giving way or locking sensation. Other times, only slight discomfort after a long walk or a squat maybe felt, without significant impairment on daily life activities.
Diagnosis is made by conducting a thoroughly medical examination, where symptoms are interpreted, and a systematic gait and joint analysis is performed. X-rays are needed to understand the overall status of the joint. To provide further information of the knee, a MRI scan may help characterise the tear, and provide further detail on the joint status.
How is it treated?
Not all menisci lesions require invasive treatment procedures. Decision depends on symptoms, patient activity level, concomitant injuries, and the type of tear.
Where non-operative treatment is advised, first steps are pain management, icing, mobilising the joint, and progressively return to weight-bearing and a normalised gait. Some cases physiotherapy may be indicated to help achieving these goals, as well as to improve balance and control of the lower limb. Fitness exercises to strengthen core and thigh muscles are recommended, and counselling on the type of sports you wish to practise may be necessary.
When pain subsists, guided injections may help controlling pain, allowing strengthening exercises to be better tolerated, which will improve lower limb condition.
Where surgery is recommended, a key hole surgery with a camera and instruments is performed to directly visualise the joint from the inside. Two treatments may be offered, depending on the type of tear and quality of the meniscus. According to most recent evidence, a repair should be performed anytime a surgeon can execute it as it is the only hope to deliver back the function of the meniscus. Although an idea of the pattern and quality of the tissue may be obtained from the MRI, only a direct look can properly tell if the repair is possible. Where the repair is possible, a staged rehabilitation programme is initiated after surgery. First stage, priority is to protect the repair, so weight-bearing is not allowed and controlled range of motion is needed. The joint will be mobilised, pain and swelling will be managed. Next, the gait pattern will be normalised, balance and muscular controlled optimised. Last stages, the programme will focus on strengthening, sports specific drills, and injury prevention mechanisms. Where a repair is not possible, the non-functioning tissue that may be causing symptoms is removed. Pain, swelling is managed, and the person is allowed to start weight-bearing as tolerated, being the goal to normalise the gait pattern as soon as possible. Balance, conditioning and strengthening are worked out through next stages.
