The Meniscus is the cartilage that lives in the knee and acts as a cushion between the tibia and femur. It is a C-shaped structure that is located on both the outside and inside of the knee. The meniscus provides 50% of the weight bearing in the joint. If it is torn the femur and tibia start to carry the load, which can lead to joint degeneration and early arthritis, if not addressed.
Anatomy of Your Knee
Not only is your knee one of the largest joints in your body, but it is also the most multi-faceted joint. Your knee connects the thigh bone (femur) to the shin bone (tibia). The knee joint also contains your kneecap, which is referred to as the patella. All components within your knee joint assist in the process of allowing you to walk, jump, sit and squat.
There are also two forms of cartilage that are also located in your knee joint. Articular cartilage provides a cushion for the ends of your bones, while your menisci provide protection for the area between your bones. This enables the bones to move smoothly against other bones.
The word menisci is also the plural form of the word meniscus. Your menisci are pads of cartilage that are curved. In many cases, they are described as crescent-shaped. One meniscus within this tandem is referred to as the medial, which is located on the inside of your knee. The second meniscus is referred to as the lateral, which is located at the outside of the knee. They are tasked with the responsibility of cushioning the area between your thigh bone and your shin bone.
The outer edge of your menisci is also thick. This supports your knee joints, while also keeping the femur positioned properly. The cushion that your menisci supply will protect the bones from making direct contact with other bones. But if the menisci become damaged, then the smooth process of bones gliding without contact is interrupted. That will cause pain, which is an indication that you have suffered a torn meniscus.
Causes of a Torn Meniscus
There are two ways that people end up with a meniscus tear. First, they can experience an acute tear from a fall or an athletic injury. Sports with a lot of rotation or twisting, and deep knee bends can put individuals at greater risk. With the advent of an acute tear, people usually experience swelling, pain and limited range of motion in the knee.
The second way that people can get a meniscus tear is that over time the tissue or cartilage can degenerate weaken. When it can no longer withstand the load of the joint, it breaks down. These tears often happen without an injury and are generally the product of wear and tear on the joint over time. Sometimes additional weight can cause increased stress across the meniscus and as people age it may put them at a higher risk of a meniscus tear because the tissue quality is poor or weak. This type of tear can develop over weeks or months and doesn’t get better with anti-inflammatory medication or rest. Often people complain of pain or swelling with activities.
A torn meniscus is one of the more frequent injuries that can occur with the knee. This injury is also the most common reason for knee surgery in the U.S.
If you are involved in an activity that causes you to rotate or twist your knee with a sufficient amount of force, then you are vulnerable to encountering this unwanted condition.
This includes the type of movements that are involved with various contact sports such as football, basketball and tennis. Sometimes, deep squats, the act of kneeling or failed attempts to lift heavy items can also result in a torn meniscus.
Your cartilage will lose strength as you experience the aging process. This also increases the likelihood of developing a torn meniscus. Older athletes are particularly vulnerable to the possibility of a meniscal tear, as over 40% of people age 65+ experience this condition.
Symptoms
If you suspect a torn meniscus there are four symptoms that are commonly experienced in people with this injury:
- Individuals with a meniscus tear often complain of pain along the joint line
- They often have pain or weakness with bending the knee and sometimes they have a catching or locking sensation
- With an acute tear, individuals may notice a lot of swelling in the knee and often report that they heard or felt a pop.
- Individuals may experience pain going from a seated position to standing or when they are going up and down stairs
If you experience a popping sensation during the forceful rotation or twist that was discussed previously, this is an indication that you may have suffered a torn meniscus. This is also the case if you encounter pain whenever you attempt to rotate or twist your knee.
This is also true if you have swelling or stiffness, along with any difficulty that you might encounter when attempting to straighten your knee. It also applies if you are contending with the sensation that your knee is locked during your attempts to move it. While many individuals might be capable of briefly functioning while a tear exists, the knee will eventually swell and become stiff.
There are actually three different areas of meniscus that can be torn or injured:
- A Lateral tear – This type of tear happens along the outside edge of the knee
- A Medial tear – This type of tear is on the inside of the knee and it is often associated with deep knee flexion.
- A Meniscal Root tear – A tear at the root of the meniscus where it inserts into the bone – either in the front – the anterior root or the back of the knee – the posterior root. Not a lot was known about these tears in the past, but recently we’ve learned the importance of repairing these tears as they can lead to rapid joint wear
Treating a Meniscus Tear
If you are dealing with any of the symptoms that were just mentioned, then it is recommended that you visit a physician. Once you have discussed your medical history and the symptoms that prompted your visit, the doctor will check your knee for any tenderness that may exist in the area where your meniscus is located. This will usually reveal the existence of a torn meniscus.
He or she might also ask you to bend and straighten your knee. If this movement results in a clicking noise, then that is also a signal that you have experienced a tear. Your physician might also order X-rays or an MRI before providing any diagnosis.
If your physician determines that you have a torn meniscus, the treatment plan will be created based upon the specifics of your tear. In some cases, a meniscus issue can be treated with the combination of ice, rest and maintaining an elevated leg. Anti-inflammatory medication such as ibuprofen or aspirin might also be involved in order to reduce swelling and discomfort. When these are the recommended forms of treatment, then the issue can eventually heal.
But in other cases, the likely treatment plan will involve surgery. There are several forms of surgical procedure, and factors that exist with your situation will dictate how your orthopedic surgeon recommends that you proceed.
The first step in diagnosing a meniscus tear is to get an X-ray of the knee to be sure there is no fracture or bony abnormalities. If there is a lot of swelling in the knee, we often will recommend getting an MRI to assess the meniscus. Once we know what the problem is we can offer treatment. For degenerative tears that are more chronic – we may start with a steroid injection. Patients usually get good relief. We can also treat these types of meniscus injuries with anti-inflammatories and physical therapy.
For acute tears, we may start with 6 – 8 weeks of physical therapy. If the symptoms do not resolve with physical therapy, we often will recommend surgery in younger patients, especially those who have an athletic tear. The reason for that is that in athletes, the tear pattern is usually larger, and it may involve more of the structural integrity. Another reason we treat these tears surgically in younger patients is that the tissue quality is good, it is easier to fix and the surgical outcomes are better than in an older patient.
Today, we try to fix most meniscus tears, if they can be repaired. Years ago, the approach was taking the meniscus out which was sometimes referred to as “cleaning the joint out”. With this approach, we now know that increases the load on the tibia and femur and the expectation is that it will lead to arthritis over time and a knee replacement may be necessary in 15 – 20 years. In fact, recent research has shown that people who had their meniscus removed 15 – 20 years ago today, many of those patients have knee pain.
If you have pain in your knee or joint – get it checked out by an orthopedic doctor. It’s always better to be safe than sorry.
Your path to recovery starts here. Schedule an appointment with OrthoTexas or find a location near you.