The knee is the largest joint in the body. The knee allows the leg to bend where the femur attaches to the tibia. The knee flexes and extends, allowing the body to perform many activities, from walking and running to climbing and squatting. There are a variety of structures that surround the knee and allow it to bend and protect the knee joint from injury.
The lateral meniscus is attached to the shin and is located on the outer side of the knee. This C-shaped cartilage is responsible for maintaining the stability of the knee. The lateral meniscus absorbs shocks, protecting the joint. It also keeps the joint lubricated and regulates the joint’s movement to prevent hyperextension. The rubbery nature of the meniscus makes it susceptible to tears when it is twisted during an irregular movement.
Lateral meniscus tears are quite common. The rubbery piece of cartilage is susceptible to tears when the knee twists or turns in unnatural or quick movements. Degenerative tears can also occur with age or due to untreated cumulative traumas. If a tear of the later meniscus occurs, it can be minor or severe. In a severe lateral meniscus tear, the meniscus can be torn in half, ripped around its circumference, or ripped to the extent that it hangs on by a fiber. Patients who suffer a tear of the lateral meniscus may have minor or moderate pain and limited movement of the knee joint. Meniscus tears present with swelling and tightness along with the inability to stretch the leg out.
Generally, the tears of the lateral meniscus are classified as the following:
- Flap tear – In a flap tear, the tear occurs on the side of the lateral meniscus, splitting the inner tissue away from the edge and causing a flap.
- Bucket handle tear – A bucket handle runs between the outer edge of the meniscus and the interior tissue. As the edge of the meniscus is separated from the rest of the cartilage, if the torn piece of cartilage were lifted up, the shape of a bucket handle is then formed.
- Radial tear – In a radial tear, a tear occurs on one edge of the meniscus and moves into the tissue, perpendicular to the edge.
Causes & Symptoms
Throughout the causes of a lateral meniscus tear, a forceful twist or sudden stop can cause the end of the femur to grind into the top of the tibia, pinching and potentially tearing the cartilage of the lateral meniscus. This knee injury can also occur with deep squatting or kneeling, especially when lifting a heavy weight.
Lateral meniscus tear injuries often occur during athletic activities, especially in contact sports, such as football and hockey. Motions that require pivoting and sudden stops, in sports like tennis, basketball, can also cause lateral meniscus damage. Sports injury does not have to occur during a game but can also occur in practice, where the same motions lead to meniscus damage.
Lateral meniscus tears often do not cause symptoms. However, some patients with a torn lateral meniscus know when they’ve hurt their knees – there may be the onset of knee pain and the patient may hear or feel a ‘pop’ in their knee. As with any injury, there is also an inflammatory response, including pain and swelling.
The swelling within the knee joint from a lateral meniscus tear typically takes a few hours to develop and depending upon the amount of pain and fluid accumulation, the knee may become very difficult to move. When fluid accumulates within the enclosed area of the knee joint, it may be difficult and painful to fully extend or straighten the knee, since the knee has the most space available when it is about 15 degrees flexed.
After the injury, the knee joint irritation may gradually settle down and feel relatively normal as the initial inflammatory response resolves. However, other symptoms can develop over time and may include any or all of the following:
- Intermittent swelling of the knee joint.
- Giving way or buckling.
- Locking (this occurs when a piece of torn meniscus folds on itself and blocks the full range of motion of the knee joint).
Pain with running and/or walking longer distances.
Who gets Lateral Meniscus Tear?
One of the many risk factors of developing a torn lateral meniscus is simply getting older; with age cartilage begins to gradually wear out, losing its blood supply and its resilience. Increasing body weight also puts more stress on the lateral meniscus. Routine daily activities such as walking and climbing stairs increase the potential for wear, degeneration, and tearing.
Additionally, it is also estimated that 6 out of 10 patients older than the age of 65 have a degenerative lateral meniscus tear. Many of these tears may never cause problems. As mentioned earlier, the risk for lateral meniscus tears is particularly high for athletes, especially those who participate in contact sports, such as football, or activities that involve pivoting, such as basketball or tennis.
How Does it Affect You? How Serious is it?
If lateral meniscus tear injuries are left untreated, the tear can eventually limit your daily life and ability to participate in exercise and sports. In severe cases, it can develop into long-term knee problems, like arthritis. In addition, moving around with a torn lateral meniscus could pull fragments of the cartilage into the joint causing larger knee issues which could require more significant surgery in the future.
Surgery can be done by performing a knee replacement, however, there are several complications that can occur after surgery has been dealt with, such as the following below:
- Infection – All surgeries require incisions; cuts that allow surgeons to open an area of the body and make repairs. Therefore, this means there is a chance of infection, but it’s an extremely small possibility. However, when infections do arise, they are considered serious.
- Longer-term knee stiffness – It is normal to feel stiff and swollen for a few months after surgery. However, sometimes that stiffness can last longer than usual – longer-term stiffness is typically caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
- Persistent knee pain – Some discomfort immediately after surgery is normal. The pain usually lessens after two or three months, however, some patients can continue to have persistent knee pain after surgery.
- Implant failure – There is a small chance that a meniscus repair will fail. Implant failure is when the replacement joint isn’t able to work properly. Normally, persistent pain and stiffness can be signs of an implant failure.
Recommended Treatment & Rehabilitation
Throughout the diagnosis of a lateral meniscus tear (or meniscus tears in general), your doctor will begin with a medical history and a physical examination. If he or she suspects an acute injury, your doctor may ask about the mechanism of that injury to help understand the stresses that were placed on the knee. Generally, many patients who participate in athletic events or training can pinpoint the specific timing and details of the injury. Non-athletes may remember a twist or deep bend at work or doing chores around the house.
Physical examination commonly includes palpating the joint for warmth and areas of tenderness, assessing the stability of the ligaments, and testing the range of motion of the knee joint and the power of the quadriceps and hamstring muscles. There have been various tests described to assess the internal structures of the knee. Some of these following tests will detect a lateral meniscus tear:
- McMurray’s test – McMurray’s test is performed with the patient lying down and the examiner bends the knee while rotating it. The click is felt over the meniscus tear as the knee is brought from full flexion to 90 degrees of flexion. The patient may also experience pain along with the click.
- Joint line test – Joint line tenderness is a test where the area of the meniscus is felt, and a positive test is confirmed when there is pain in the area where the meniscus is found.
If surgery is considered, a magnetic resonance imaging (MRI) scan for the knee may be ordered. MRI scans allow for deeper viewing of the soft tissues in the knee joint, which can be integral in determining the location and severity of the tear. It will also indicate how much excess fluid is in the knee and whether or not any torn piece of the lateral meniscus has lodged within the joint itself.
One of the most common surgical procedures for a lateral meniscus tear is a knee arthroscopy. It normally takes less than an hour for this treatment to progress. Generally, the surgeon may use the arthroscope to look at the tear and decide what surgical technique to perform, such as:
- Meniscus repair – The surgeon sews torn pieces of cartilage back together so they can heal on their own. However, because of the tear type and blood supply, less than 10% of tears are repairable.
- Partial meniscectomy – The surgeon trims and removes the damaged cartilage and leaves healthy meniscus tissue in place.
Your surgeon may insert other surgical tools depending on the technique used. When the meniscectomy or meniscus repair is complete, the surgeon closes the portals with stitches or a surgical strip. Then, finally, the team will cover your knee with a bandage.
Lateral meniscus tears can often be controlled without the need for surgical treatment. A physiotherapist can design a treatment plan to help determine whether your knee will recover without surgery. Your physiotherapist can help manage pain and swelling in the knee area and work with you to gradually restore full strength and mobility to your knee with the following treatments:
- Manual therapy – Your physiotherapist may apply a hands-on treatment that will include massage, stretching, or joint mobilization in order to help reduce swelling and stiffness and restore muscle function around the knee.
- Neuromuscular electrical stimulation (NMES) – Your physiotherapist may use NMES which uses electrical current to gently stimulate / contract the muscles around your knee to help improve their strength.
- Supporting equipment – It may be necessary to use supporting equipment such as crutches, a cane, or a walker in the short term. Your physiotherapist will make recommendations about which device is suitable for you and will instruct you on how to use these devices properly.
Your physiotherapist will design certain exercises to help build and maintain your strength during recovery and help restore full movement to your knee. Strengthening the muscles around the knee and throughout the leg helps ease pressure on the healing knee tissue. The following exercise examples include:
First, stand with your back against a wall, with your shoulders and head against the wall. Your feet should be shoulder-width apart and one foot from the wall. Next, bend your knees slightly to bring your buttocks toward the ground. Stop at about 15 degrees of bend, feeling the muscles in your thighs working. Hold this position for 10 seconds, then repeat 2-3 times a day at a slow pace.
Hamstring heel digs
Lie on your back with your knees bent and feet flat on the floor. Afterward, flex your feet so only your heels are touching the ground. Dig your heels into the ground and slowly slide them about 4-6 inches away from your body. Bring your heels back toward your body, returning to your starting position. Repeat this method 8-10 times a day.
Sit on a sturdy chair or bench with your feet flat on the floor. Flex your right foot and lift your foot off the floor, straightening your right leg. Next, slowly lower the foot back to your starting position. Repeat this exercise 10 times on the right side, then once again on the left leg 2-3 times a day.
Alternative & Homeopathic Treatment
Fortunately, there are several ways of treating lateral meniscus tears homeopathically – the following are some treatments for you to try at home:
- Rest – Limit activities to include walking if the knee is painful.
- Ice applications – This is used to help reduce pain and swelling. apply it for 15-20 minutes every 3-4 hours for 2-3 days or until the pain and swelling are resolved.
- Compression – Use an elastic bandage on your knee to manage swelling.
- Elevation – with a pillow under your heel when you are sitting or lying down.
- Non-steroidal anti-inflammatory drugs (NSAIDs) – Anti-inflammatory medications such as ibuprofen and naproxen can be used to help with pain and swelling.