Meniscal Tears
What is a Meniscal Tears?
There are two meniscal cartilages in the knee that act as shock-absorbers – one on the inner (medial meniscus) and one on the outer (lateral meniscus) side.
They are made up of a different type of cartilage to joint surface cartilage and sit between the femur and the tibia.
The menisci have a number of important functions within the knee:
•Shock absorbing function
• Load sharing within the knee
• They are secondary stabilisers, of particular importance in the ACL-deficient knee
• They probably contribute to proprioception (sensory feedback and reflexes) within the knee
• Provide lubrication of the joint, and they may play a part in nutrition of the articular cartilage
Loss of meniscal tissue means that there is uneven weight distribution and force between the joint surfaces in the knee, which can lead to arthritis.
Mechanism of Injury
Meniscal tears are among the most common injuries seen by an Orthopaedic Surgeon. The meniscal cartilages are at risk of tearing due to their constant exposure to repetitive loading during activities such as walking and running. In younger patients, meniscal tears normally occur as a result twisting on a loaded flexed knee with the knee then giving way.
Symptoms of Meniscal Tears
The typical symptoms of a meniscal tear are:
A patient with a meniscal tear may not necessarily experience all these symptoms but can have any combination of the above.
Treatment options
Initial treatment following the meniscal tear is based on the RICE protocol: rest, ice, compression, elevation. Additionally, simple analgesia with Paracetamol and/or non-steroidal anti-inflammatories may be required. Early physiotherapy review is important to address the swelling, improve the movement and maintain muscle function.
Acute tears: most acute meniscal tears that are the result of an injury are treated with arthroscopic (keyhole) surgery to repair the torn meniscus. It’s a complex procedure with a success rate of around 65% for a single tear and 80% where there are also ligament injuries. If it’s not possible to repair the tear, then you may require meniscal debridement to remove damaged fragments and preserve as much healthy tissue as possible so that the meniscus can still act as a shock-absorber
Degenerative tears: when these are caused by wear and tear, it is often not possible to repair the torn tissue. This type of injury doesn’t usually need surgery, and, in most cases, the symptoms settle down over time. However, if your knee continues to catch and cause problems then surgery can be very successful. In a degenerative tear where the meniscal root tears away at the back, causing extreme pain, root repair surgery which, although it is complex, is highly successful.
DOUBLE CHECK THE FOLLOWING.
Non-surgical options
Frequently Asked Questions (FAQ)
Diagnosis involves understanding a history of your symptoms, examining your knee, and using imaging such as X-rays to assess cartilage wear and joint alignment. In some cases, additional scans such as CT or MRI scans may be required to either exclude other conditions or quantify the degree of arthritis.Some patients develop patellofemoral pain syndrome in the absence of any bone, joint or soft tissue abnormalities. However, most patients with the syndrome present with one or more abnormalities related to bone anatomy, joint anatomy and/or soft tissue.
Diagnosis involves understanding a history of your symptoms, examining your knee, and using imaging such as X-rays to assess cartilage wear and joint alignment. In some cases, additional scans such as CT or MRI scans may be required to either exclude other conditions or quantify the degree of arthritis.Some patients develop patellofemoral pain syndrome in the absence of any bone, joint or soft tissue abnormalities. However, most patients with the syndrome present with one or more abnormalities related to bone anatomy, joint anatomy and/or soft tissue.
Although knee arthritis can affect anyone, there are several factors that can increase the risk of arthritis:
- Genetic predisposition
- Previous knee injury or surgery
- Other joint conditions such as rheumatoid arthritis or gout
- Occupations involving heavy manual work
- Age (over 40)
- Female gender
- Being overweight or obese
- Participation in high impact activities or sports (e.g. running, soccer or rugby)
Knee arthritis typically develops as a result of progressive cartilage wear within the joint. This process may occur naturally with age or be accelerated by factors such as previous injury, altered joint alignment, or increased mechanical load.
In some cases, inflammatory conditions such as rheumatoid arthritis can also contribute to joint degeneration.
