Your knee joint is the largest joint in the body and is made up of three bones—the femur (thighbone), the tibia (shinbone), and the patella (kneecap).
The joint is supported by ligaments - strong bands of connective tissue - that attach the bones to each other and help control and support the knee’s movement.
The knee joint also contains the menisci – two C-shaped pads of cartilage that are attached to the top of the tibia. The menisci act as shock absorbers, helping protect and stabilise the joint and enabling the knee to flex smoothly.
About the Menisci
The Menisci in your knee serve several functions:
When you are upright, whether running, walking or simply standing, your weight is transferred through the thigh bone to the shinbone and through to the feet. The menisci act as a protective cushion that stops the two bones touching and grinding against each other as the knee moves.
They absorb the stresses that are transferred through the knee as we move
Because of their particular shape, they distribute the load evenly through the knee, helping prevent excessive wear in a one area
What’s a Meniscal tear?
Meniscal tears are very common, both as sports injuries and also as a result of long-term wear and tear on our knee joints.
When people talk about ‘torn cartilage’ in their knee they usually mean a meniscus injury. When the meniscus is damaged, and the surface that allows the bones to glide over each other in the knee joint is no longer smooth, irritation occurs, often accompanied by pain, stiffness and sometimes ‘locking’ as the knee bends and straightens.
a. Causes
Meniscus tears often happen during sports. These can occur through either a contact or non-contact injury—for example, by sudden changes of direction, twisting or stopping movements. It can also be caused by performing exercises with a deep knee bend– like a squat or lunge – when lifting heavy weights.
With osteoarthritis, Menisci can also degenerate over time, and as the tissue ages and wears it can become prone to tearing. Sometimes something as simple as twisting awkwardly while climbing stairs, or getting in or out of a chair, or can be enough to cause a tear. You may not even be aware that anything has happened at the time.
b. Meniscal tear symptoms
You might feel a "pop" when your meniscus tears. However, most people can still walk normally on the injured leg, and athletes can often carry on playing with a tear.
However, a few hours – or even a day or two - later, the knee will often become stiff and swollen.
Other common symptoms of a meniscus tear include:
Pain - which can vary in severity – and may come and go
Reduced range of motion in the knee
The knee ‘locking’ or ‘catching’
Instability in the knee
However, where meniscal damage is degenerative, the onset of symptoms can be slower and incremental, so can go relatively unnoticed.
c. Diagnosing a Meniscal tear
When your doctor examines your knee, they will look for any tenderness along the joint line – it’s one of the most common indicators of a meniscal tear.
They may also perform a McMurray test. Your doctor will flex and rotate your knee, and any resulting pain, clicks, or a ‘clunking’ feeling within the joint will indicate a tear.
As these tests are not definitive, your doctor may also order an MRI scan to assess the tissues of the knee, and to check for any associated injuries in the knee – an ACL tear perhaps.
d. Grading tears
Meniscal injuries are graded on the severity of the tear:
minor tear - slight pain and swelling, which usually goes away in 2 or 3 weeks
moderate tear - pain at the side or centre of the knee, swelling increases over 2 or 3 days, but walking is usually possible. Symptoms may ease over a week or two but return following a twist or overuse
severe tears - pieces of the torn meniscus can enter the joint, causing the knee to catch, pop, or lock. You may not be able to straighten it. Your knee may feel "wobbly" or give way without warning.
Treatment
Where tears are relatively minor, they can often repair themselves over time – usually 6-8 weeks. Additionally, many types of degenerative tear do not require surgery.
However, if the tear is bigger, symptoms are more significant or they don’t respond to other forms of treatment over time, surgery may be required to repair the tear.
Your age, medical history and lifestyle will also be a factor in deciding which option is right for you.
a. Conservative management
There are a range of options available to help you recover without surgery. These include:
RICE (rest, ice, compression and elevation) – best implemented as soon as possible after the injury and continued for several days
Anti-inflammatory medication
Physiotherapy to improve muscle strength around the knee, stabilise the joint, reduce pain and swelling and prevent future recurrence of the injury
Orthotics – you may be given a knee brace or support to stabilise the knee, and limit movement while the meniscus repairs
Cortisone injections to reduce pain and swelling
b. Surgery
You may be recommended for a surgical repair for one of several reasons
The tear is not responding to more conservative treatment
The area of the meniscus doesn’t have enough blood flow to repair itself naturally.
The torn part of the meniscus is causing you a lot of pain, or is impairing knee function and needs to be removed
The tear is complex, and the damaged area needs to be trimmed to improve knee function.
Depending on the severity of the tear, and its causes, surgery may involve either repairing the torn meniscus or removing the damaged part of it.
If the tear is degenerative – i.e., the result of long-term wear - it will generally require part of the damaged tissue to be removed, while less serious tears can sometimes be repaired with keyhole surgery.
References
Post-operative healing
A Meniscal Resection will take time to heal - generally around 3 to 4 months, depending on a number of factors, including:
your age and lifestyle
your medical history and any underlying conditions
how fit and active you were before your injury
how well you follow your rehab programme
Post-surgical rehabilitation is one of the most important elements in the recovery process and can significantly impact how fully and quickly you recover.
If you have had Meniscal Resection surgery – whether a meniscectomy or a partial meniscectomy (removal of some or all of the damaged part of the meniscus) - recovery is normally quick.
You are likely to be asked to rest your knee for 1-2 weeks before starting your rehabilitation to get you back to normal.
Your surgeon will explain the programme that they would like you to follow.
As part of your rehabilitation, this App will guide you through a series of exercises to restore range of motion, strength and stability to your knee, and to help prevent future injuries.
Once you start your rehabilitation, it’s important to follow the App’s guidance as closely as possible. Ignoring or overdoing your rehab exercises can harm the speed and quality of your recovery.
Braces
If you have had a meniscal resection, it is unlikely that you will need to wear a knee brace after your operation.