Knee Meniscus Injury

What Is It?

The menisci are cartilaginous structures that fill the space between the femur (the large bone of the upper thigh) and the tibia (the shin bone). There is a lateral meniscus on the outside of the knee and a medial meniscus on the inside of the knee and they are both attached to the tibia. Menisci act as shock absorbers in the knee joint. They are often referred to as cartilage, but this is inaccurate. Specific movements or positions of the knee will stress either the lateral or the medial meniscus. If these movements are taken to the extreme of the range the affected meniscus may be damaged or torn.

How It Happens?

Meniscal injuries can happen in a variety of different settings. These injuries are common amongst the athletic population especially if the athlete is involved in a contact sport such as soccer and football. Wrestling is also a sport that commonly produces meniscal injuries since the athletes are often in a low stance or a crouch position. Meniscal injuries also commonly occur with occupations such as mining and carpet laying where the worker will spend a large amount of time in the squat position.

Symptoms

The following symptoms are common findings after a meniscal injury:

Sudden onset of pain: type of pain associated with "giving way" in the joint.

Knee joint will often lock when the leg is almost straight; often the patient will try to wiggle the leg back and forth to unlock the knee.

Intermittent buckling and clicking of the knee for no apparent reason.

Chronic or intermittent swelling.

Walking with a bent knee or a pointed foot.

If there is bruising and swelling with severe generalized pain within minutes of the injury, this often indicates there is also a tear of a ligament within the knee joint.

Testing

MRI and arthrograms are used to visualize tears in the menisci. Menisci are not visible on x-rays.

Causes

The most common position of injury for the medial meniscus is to have the knee bent with the lower leg faced into rotation away from the midline of the body. The medial meniscus may also be injured with the leg straight and the lower leg forced to rotate towards the midline of the body. In some cases the medial meniscus may be torn with forced bending of the knee or forced straightening of the knee without any accompanying rotation. It is also possible to injure the medial meniscus while twisting on a semi-bent knee for example the squatting position.

The lateral meniscus is most often inured during full weight bearing with the knee bent excessively.

What You Should Do?

Following a meniscal injury it is important to try and control the swelling. An ice pack applied to the knee for 10 – 15 minutes will help to decrease the inflammation and as a result the pain and swelling will also decrease. It is also important to avoid the activities that aggravate the symptoms; perform movement only within a pain-free range of motion.

How Physiotherapy Can Help Me?

Meniscal injuries may or may not require surgical repair. In either case the physiotherapist will initially concentrate on reducing the swelling, inflammation and pain in the knee. The physiotherapist has a variety of different modalities that are indicated to help reduce the inflammatory process and pain. Once the inflammation in the knee is under control it will be important to strengthen the muscles surrounding the knee. The physiotherapist is skilled in progressing the exercises appropriately in order to decrease the chance of a re-injury.


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