Meniscal Tear

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Meniscal tears (also known as meniscus tears) are among the most common knee injuries. Athletes, particularly those who play certain contact sports, are at a higher risk for meniscal tears. However, anyone, in general, can tear a meniscus. When some individuals talk about torn cartilage in the knee, they are usually referring to a torn meniscus. Three bones met to form a knee joint which includes:

 

  • Thighbone (femur)
  • Shinbone (tibia)
  • Kneecap (patella)

 

Two pieces of cartilage between the thighbone and shinbone act as shock absorbers, which are called meniscus that help cushion the joint and keep it stable.

There are many types of meniscal tears. Tears are named by location and shape. Common tears include bucket handle, flap, and radial. Sports-related tears often occur in conjunction with other knee injuries, such as anterior crucial ligament tears or medial crucial ligament tears.

Causes

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A forceful twist or a 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 meniscus. This knee injury can also occur with deep squatting or kneeling, especially when lifting a heavy object. Meniscal tear injuries often occur during athletic activities, especially in contact sports like football and hockey. Motions that require pivoting and sudden stops, in sports such as tennis, basketball, and golf, can also cause meniscus damage.

Increasing body weight also puts more stress on the meniscus. Routine daily activities like walking and climbing stairs increase the potential for wear, degeneration, and tearing. Because some of the fibers of the cartilage are interconnected with those of the ligaments that surround the knee, meniscus injuries may be associated with tears of the collateral and crucial ligaments, depending upon the mechanism of injury.

In most cases, meniscal tears do not cause symptoms or problems. However, some patients with a torn meniscus understand exactly when they hurt their knees. There may be the acute onset of knee pain and the patient may actually hear or feel a pop in their knee. As with any injury, there is an inflammatory response, including pain and swelling. The swelling within the knee joint from a torn meniscus usually takes a few hours to develop and depending upon the amount of pain and fluid accumulation, the knee may become difficult to move. Whenever 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. In some situations, the amount of swelling may not necessarily be enough to notice. Sometimes, the patient is not aware of the initial injury but starts noting symptoms that may develop later. Moreover, there may not be an acute injury. The knee cartilage may become damaged as a consequence of aging, arthritis, and wearing away of the meniscus causing a degenerative meniscal tear.

After the injury, the knee joint irritation can gradually settle down and feel relatively normal as the initial inflammatory response resolves. However, other symptoms may develop over time and may include any or all of the following:

 

  • Pain with running or walking long distances.

 

  • Intermittent swelling of the knee joint. Many times, the knee with a torn meniscus will feel tight.

 

  • Popping, especially when climbing up or walking downstairs.

 

  • Giving away (the sensation that the knee is unstable and the feeling that the knee will give away). Less commonly, the knee actually will give way and cause the patient to fall.

 

  • Locking (A mechanical block where the knee cannot be fully extended or straightened). This occurs when a piece of torn meniscus folds on itself and blocks the full range of motion of the knee joint. The knee gets “stuck”, normally flexed between 15 and 30 degrees, and cannot bend or straighten from that position.

Who Gets a Meniscal Tear?

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As mentioned earlier, meniscal tears are most common in contact sports such as football as well as non-contact sports requiring jumping and cutting such as volleyball and soccer. They can happen when a person changes direction suddenly while running, and often occur at the same time as other knee injuries, like an anterior ligament (ACL) injury. Generally, meniscal tears may occur to either men and women equally, however, this condition can most likely occur to elders since the meniscus gradually weakens with age. More than 40% of people 65 or older have meniscal tears.

How Does It Affect You? How Serious Is It?

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Several studies have shown that a meniscal tear can lead to knee osteoarthritis (inflammation of the joint) which can affect the medial femoral, lateral femoral, or Patellofemoral. It typically starts in one compartment and can, over time, spread to others or even all of the femoral compartments. This form of arthritis tends to be more common in elders, as it represents an advanced progression of the disease.

In a normal knee joint, the cartilage allows for smooth movement within the joint, while in an arthritic knee, the cartilage becomes thinner or completely absent. The inflammation in the knee may damage the bone, causing it to become thicker around the edges of the joint and can possibly form bony spurs. It can also strain the ligaments in the knee, as well as cause chronic joint pain, stiffness, and restricted range of motion, which can intensify in cold, damp weather, or while exercising. There are several conservative treatments to help relieve knee osteoarthritis, such as medication, gentle stretching, and physical therapy. However, if these treatments are not effective, it is highly recommended to consider arthroscopic surgery or even an entire knee replacement. While surgery takes some time to recover and requires regular physical therapy sessions to rebuild strength and flexibility around the joints, increased mobility and comfort are restored after the knee has fully healed.

Recommended Treatment & Rehabilitation

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The best way to treat a meniscal tear depends on how severe the symptoms are. And whether the tear is from an injury or from wear and tear. Rest, Ice, Compression, and Elevation (RICE) is usually the first and most common step in most at-home treatments. It is best used in the first 24 to 72 hours after symptoms occurred. However, you can continue to use the RICE treatment method to avoid further pain and swelling. Below will be a quick description in regards to RICE treatment:

 

  • Rest the injury immediately.

 

  • Ice the area as soon as possible in order to reduce further swelling and inflammation.

 

  • Compress the area to limit swelling and bleeding.

 

  • Elevate the elbow above the heart to improve fluid drainage.

 

Primarily, taking over-the-counter medications can gradually help reduce a certain amount of pain while in the development of a meniscal tear. NSAIDs such as ibuprofen (Motrin, Advil) or naproxen (Aleve) can help. It is recommended to take them regularly to get any benefit and relief. Most commonly, 3 doses of ibuprofen a day or 2 doses of naproxen a day are enough for a good amount of short-term relief. If in case the pain does not lessen enough or only recover for a few days, it is best to speak with a doctor about a prescription NSAID. Wearing a knee brace can also be a helpful support for the affected joint, as it will address the pain, locking, and the knee giving away. Most off-the-self braces from a pharmacy may work well.

A torn meniscus often can be identified during a physical exam. Your doctor might move your knee and leg into different positions, watch you walk, and ask you to squat to help pinpoint the cause of your signs and symptoms. Two imaging tests from a doctor may also include the following:

 

  • X-rays – Because a torn meniscus is made of cartilage, it will not show any visibility on X-rays. Although, X-rays can help rule out other conditions with the knee that cause similar symptoms.

 

  • MRI – This uses radio waves and a strong magnetic field to produce detailed images of both hard and soft tissues within your knee. It is the best imaging study to help detect a meniscal tear.

 

If your knee remains painful despite rehabilitative therapy or if your knee locks, your doctor might recommend further surgery. It’s sometimes possible to repair a torn meniscus, especially in children and young adults. If you have advanced, degenerative arthritis, your doctor might recommend a knee replacement. For younger patients who have signs and symptoms after surgery but no advanced arthritis, a meniscus transplant may be necessary. The surgery involves transplanting a meniscus from a cadaver. If the tear cannot be repaired, the meniscus might be surgically trimmed, possibly through tiny incisions using an arthroscope. After surgery, you will need to perform exercises to increase and maintain knee strength and stability. If any exercise causes pain, however, it is best to stop performing them. Here are a few exercise methods to try at home or elsewhere:

 

Straight leg raises 

 

Lie on the floor with the left foot flat and the right leg extended. While 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. Perform 2 sets of 10 reps before switching onto the opposite leg.

 

Mini squats

 

Mini squats can help strengthen the quadriceps, Large muscles at the front of the thigh, without putting too much pressure onto the knees. In order to perform mini squats, you must first stand with the back, shoulders, and head against a wall. Afterward, the feet should be shoulder-width apart and about one foot away from the wall. Slightly bend the knees, bringing the buttocks towards the ground. At around 15 degrees of the bend, hold the current position for 10 seconds, then slowly bring the body back up to the starting position, keeping the back and shoulders against the wall. Perform 2 sets of 8-10 reps. It is recommended to rest for between 30 seconds to 1 minute before performing more sets.

Leg extensions

 

Leg extension exercises build strength in the thighs. A person can safely perform them more than one time a day. To perform leg extensions, firstly you must sit on a chair or on a bench with the feet flat on the floor. Secondly, flex the right foot then lift it, straightening the right leg. Finally, slowly lower the right foot back to the starting position. Repeat this procedure 10 times, then perform the same set with the opposite leg.

 

Straight heel raises

 

This exercise is necessary for building strength and the calf muscles. To perform standing 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 you feel comfortable enough. You then pause in this position, then slowly lower the heels to the floor. Perform 3 sets of 8-10 reps, resting for 30 seconds to 1 minute between sets.

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