A meniscus is a crescent or c-shaped cartilage disk that is found in the knee. There are two menisci in each knee. We have one on the inner side of the knee which we call the medial meniscus and one on the outer side of the knee which we call the lateral meniscus.
The menisci serve a very important function in the knee. Our meniscus functions as a shock absorber or cushion to help minimize the stress on another type of cartilage that we have in the knee which is called the articulate cartilage. The articulate cartilage coats the ends of our bones within a joint. By protecting the articulate cartilage, the meniscus helps prevent the onset of arthritis.
A meniscus tear can occur when the knee is suddenly twisted while the foot is planted. The medial meniscus is a significant shock absorber on the inside medial aspect of the knee joint, and it absorbs about 50% of the medial compartment shock. Thus, when there is a medial knee injury such as a medial meniscus tear, it is essential to repair the tear. If it isn’t repaired there will be an increase in the medial compartment load, which ultimately leads to osteoarthritis.
A medial meniscus tear appears in a variety of patterns such as the following:
- Horizontal
- Degenerative
- Longitudinal
- Displaced flap
Most new-onset (or acute) medial meniscus tears do cause pain. The pain is typically located along the inner portion of the joint, at the joint line, or in the back of the knee, especially when one squats down. Tears in the front part of the meniscus are less rare, but these can cause problems going down hills or down the stairs. Long-standing meniscus tears, or chronic tears, may or may not cause symptoms.
Typically, when they do cause symptoms, however, people will notice them when they have possibly a further tear of an underlying tear, and there will be pain along the joint line with squatting, twisting, turning, or kicking type maneuvers.
Causes & Symptoms
A medial meniscus tear can happen from many factors. First, a sporting injury can cause it. Medial meniscus tears commonly occur with an ACL tear. This is because the medial meniscus acts as a secondary stabilizer to prevent the knee from slipping forward, and when the ACL tear happens, it puts extra stress on the medial meniscus which then leads to it tearing.
In addition, deep squats put extra stress on the back of the knee and can cause a medial meniscus tear to occur. Other causes include twisting, turning, or pivoting types of activities where extra stress is placed on the inside of the knee, whereby a medial meniscus tear can occur.
As people age, they are more likely to have degenerative meniscus tears. Aged, worn tissue is more prone to tears. An away ward twist when getting up from a chair may be enough to cause a tear in an aging meniscus.
When a medial meniscus tear occurs, you may hear a popping sound around your knee joint. Afterward, you may experience the following symptoms:
- The feeling of your knee locking or catching.
- Difficulty moving your knee or inability to move it in a full range of motion.
- A sudden feeling that your knee is giving way or unable to support you.
You may also experience a slipping or popping sensation, which is normally an indication that a piece of cartilage has become loose and is blocking the knee joint.
Who gets a Medial Meniscus Tear?
The medial meniscus can be torn during activities that cause direct contact or pressure from a forced twist or rotation. A sudden pivot or turn, deep squatting, or heavy lifting can lead to injury. Many athletes are at risk for a medial meniscus tear. Sports that require sudden turns and stops may put you at higher risk for medial meniscus tears. Some of these sports include:
- Football
- Basketball
- Soccer
- Tennis
In addition, some studies have shown that medial meniscus tears are growing increasingly common in children. This is because children are participating in organized sports at an earlier age. Additionally, when focusing on just one sport, a child is more likely to experience a meniscus tear. The same goes for adolescents who participate in competitive sports.
The medial meniscus can also weaken with age. Tears are more common in people over the age of 30. Movements such as squatting or stepping can lead to injury in someone with weak menisci. If you have osteoarthritis, you’re at higher risk of injuring your knee or tearing your meniscus.
Osteoarthritis is a common joint disorder involving pain and stiffness in your joints caused by again and wear and tear. When an elderly patient experiences a medial meniscus tear, it is more likely to be related to degeneration. This is when the cartilage in the knee becomes weaker and thinner.
How Does it Affect You? How Serious Is It?
Endurance is an important part of sports. In the case of medial meniscus tears, some people think the injury will heal overtime on its own. But the truth is that there are different types of meniscus tears, and some tears won’t heal without treatment.
If your tear is on the outer one-third of the meniscus, it may heal on its own or be repaired surgically. This is because this area has a rich blood supply and blood cells can regenerate meniscus tissue (or help it heal after surgical repair). However, if the tear is in the inner two-thirds, which lack blood flow, the tear cannot be repaired and may need to be trimmed or removed surgically.
If medial meniscus tear is left untreated, part of the meniscus may come loose and slip into the joint. You may need surgery to restore full knee function. Untreated medial meniscus tears can increase in size and lead to complications, such as arthritis.
Arthritis pain is distinctly different from meniscus tear pain. Arthritis arises slowly, unlike a meniscus tear. Therefore, over the years, you may notice that your knees have become “creakier”, are stiffer in the mornings, or feel an increase in pain after activity.
Recommended Treatment & Rehabilitation
After discussing your symptoms with your doctor, he or she will examine your knee and test your range of motion during a diagnosis. They’ll look closely at the spot where the meniscus is along your joint. Next, your doctor may also perform a test known as the McMurray test to look for a medial meniscus tear.
This test involves bending your knee and then straightening and rotating it. You may also hear a slight pop during this test. After a physical exam, imaging tests may be ordered to confirm a tear of the medial meniscus. The following imaging tests include:
X-ray
This test will not show a medial meniscus tear. However, it can be helpful to determine if there are any other causes of your knee pain, such as osteoarthritis.
Magnetic Resonance Imaging (MRI)
An MRI uses a magnetic field to take multiple images of your knee. An MRI will be able to take pictures of cartilage and ligaments to determine if there is a meniscus tear. Sometimes, meniscus tears may not show up on an MRI because they can closely resemble degenerative or age-related changes. Additionally, a doctor may make an incorrect diagnosis that a patient has a torn medial meniscus. This is because some structures around the knee can closely resemble a meniscus tear.
Arthroscopy
With an arthroscopy session, a small incision or cut is made near the knee. The arthroscope is a thin and flexible fiber-optic device that can be inserted through the incision. Surgical instruments can be moved through the arthroscope or through additional incisions in your knee.
Ultrasound
An ultrasound uses sound waves to take images inside the body. This will determine if you have any loose cartilage that may be getting caught in your knee.
Medial meniscus tears can often be managed without surgery. A short course of treatment provided by a physiotherapist can 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 restore full strength and mobility to your knee. The following physiotherapy treatments include:
Manual therapy
Your physiotherapist may apply a hands-on treatment that can include massage, stretching, or joint mobilization, to help reduce swelling and stiffness and restore muscle function around the knee.
Compression
Your physiotherapist will recommend the use of compression bandages, stockings, or pumps to assist in the reduction of or prevent further accumulation of edema. Your physiotherapist may include them as part of your regular treatments and teach you and your family how to use them at home.
Assistive devices
It may be necessary to use assistive devices such as crutches, a cane, or a walker in the short term. Your physiotherapist will make recommendations about which device is best for you and will instruct you on how to use it properly.
NMES
Your physiotherapist may use a treatment called Neuro-Muscular Electrical Stimulation (NMES). NMES uses electrical current to gently stimulate/contract the muscles around your knee to help improve their strength.
Your physiotherapist will design exercises to build and maintain your strength during recovery and help restore full movement to the knee. You will be given a home program of exercises that are specific to your condition. Here are a few examples of exercises for medial meniscus tears:
Quadriceps setting
Sit or lie flat on the ground, with the legs extended away from the body. Then, contract the quadriceps while using them to push the backs of the knees toward the floor. Hold this position for 10-20 seconds, then repeat with 2 sets of 10 contractions a day.
Straight leg raises
Lie on the floor with the left foot flat and the right leg extended. Keeping the back and pelvis in a neutral position, flex the right foot and tighten the right thigh muscles, slowly lifting the right leg off the floor. After lifting the right leg to around 45 degrees, slowly lower it back to the floor. Repeat this method with 2 sets of 10 repetitions a day.
Hamstring curls
Lie on the stomach, keeping the legs straight. Slowly bend the right knee, lifting the right foot toward the buttocks. Slowly lower the right foot, then repeat this with 2 sets of 8-10 repetitions a day.
Straight heel raises
Stand with the feet hip-width apart, with the hands resting on a heavy, solid piece of furniture for support. Slowly lift the heels off the floor as far as is comfortable. Pause in this position, then slowly lower the heels to the floor. Repeat this exercise with 3 sets of 8-10 repetitions.
Alternative & Homeopathic Treatment
Generally, you can treat the knee injury with alternative treatments such as the following:
- Medication – Anti-inflammatory medications taken by mouth or injected into the knee can both be useful to reduce the pain and swelling symptoms associated with meniscus tears.
- Rest – Limit activities to include walking if the knee is painful for days or weeks.
- Ice application – This is to help reduce pain and swelling. You can apply ice for 15-20 minutes every 3-4 hours a day until the pain and swelling are gone.
- Elevation – Elevate your knee by using an elastic bandage to control swelling.