Injury and aging are two contributing factors that put stress, wear and tear on the meniscus of the knee joint. Injuring the knee from work or sport can accelerate the degenerative process to the joint. As we age, there is a normal but gradual degenerative change in all our joints. The gradual process allows the body to adapt to these changes. Joint degeneration can result in losing motion, stiffness and even mild aches and pains to the joint. This article addresses the gradual and traumatic causes of meniscus changes.
What Makes Up the Knee Joint?
The knee comprises the femur (thighbone), patella (kneecap), and tibia (shin), the larger of the two lower leg bones. There are ligaments and cartilage in the joint to help provide a cushion and stability when using the joint.
There are two menisci in the knee, one on the inside and the other on the outside of the joint. A function of the meniscus is to help evenly distribute your body weight over the knee. Each meniscus is C shaped, thicker on the outside and tapers to a thinner edge toward the middle of the knee. Without them your knee would rapidly deteriorate into osteoarthritis. The menisci help form a “cuplike” area on the tibia for the femur to help stabilize the joint. The inside of the knee is covered with cartilage to help the knee move smoothly when walking or running.
How is the Meniscus Injured?
Two common causes of meniscus tears and injury include:
- Athletics or Ankle Trauma – Tearing of the meniscus can occur when the knee is slightly flexed or bent and forcibly twisted in this position. When the knee is struck by contact and changing direction the stress on the meniscus can cause it to tear. This is more common in sports when the foot is planted on the ground and fails to turn with the knee. Footwear with spikes or cleats anchors the foot and may prevent the foot from turning with a change of direction when trying to avoid contact.
- Chronic or Degenerative – A literature review reported that up to 60+ percent of people over age 65 more than likely has some degree of degenerative tears in one or both of the meniscus. With the aging process, the meniscus loses some of its elasticity. There is a poor blood supply to the meniscus. This can slow the healing process and advance the degeneration. Many small traumatic episodes that occurred in the past can accelerate the knee degeneration. This process can be asymptomatic and go unnoticed over the years.
In traumatic instances, it is not uncommon for other internal structures to be injured in the knee along with the meniscus. This can include the anterior and posterior ligaments and the medial and lateral collateral ligaments. A serious injury can occur when the trauma is to the outside of the knee resulting in anterior cruciate, medial collateral and meniscus tear. This is called the “unhappy triad” in sport.
Symptoms of Meniscus Tearing
In addition to knee pain, the common meniscus tearing symptoms are:
- Clicking in the Knee
- Swelling around the Knee Joint
- Loss of Knee Motion
- Tenderness with Palpation along the Outside Area of the Meniscus
- Limping and Walking with Difficulty
Diagnosis of Meniscus Tear
History and physical examination will help differentiate a meniscus tear from other knee pathology. The doctor can perform specific tests in the clinic that are designed to determine if the meniscus is involved. X-rays of the knee and the use of a MRI are commonly used tools to make the diagnosis. The x-ray evaluates the knee for osteoarthritis and the MRI can view the soft tissue to include the meniscus.
Can a Meniscus Tear be Treated Conservatively?
The simple answer is yes; however, the extent of the damage determines if the knee problem can be managed conservatively or is a surgical issue. This article discusses only the conservative management of a tear of the meniscus. The key is to discover whether the injury is a stable or unstable tear. The unstable tear results in abnormal movement and the knee conditions will intensify unless surgically repaired.
How is it Treated?
One of the first goals of treatment is to reduce the pain and swelling from the injury. The following treatments and duration of care are only a guideline as each case is different and the care may vary. Professional advice is recommended before any self-start of care.
- Crutches – May be used for the first few days to help reduce the swelling of the knee and stress off the injured meniscus.
- RICE Principle – Rest, Ice, Compression, Elevate. Ice can be used for a week or more.
- Knee Motion Exercises – This includes passive and non-weight bearing motion within pain free limits. Passive exercises can begin within a few days. Your doctor or therapist will demonstrate a safe routine. Isometric contraction of the muscles of the thigh can begin.
- Knee Support – Adds stability and compression to the knee.
- Electrotherapy – Will be used in the office to help reduce pain and swelling.
- Resistance Exercises – Use of resistance bands, shallow squats and lunges. This may not begin until the 2nd week and all exercises should be to tolerance. If it hurts, do not do it. Swimming or pool therapy can begin in week 2. By the 3rd or 4th week, it is recommended that more aggressive activity to include biking and running on a flat surface such as a track be introduced (not the roadway). Performing more of the activities of your sport or work during this phase will help to improve your conditioning.
- Return to sports may take 6 weeks. The use of a knee brace is recommended during practice and competition. A brace maybe suggested hastening a return to work and minimize any reoccurrence. Ongoing rehabilitation is recommended during this return.
Not all knee injuries to the meniscus are surgical cases. In many instances, conservative management is as effective as trying to repair a mild tear and is significantly less costly. It is reasonable to try conservative management first. Surgical repair can always be considered if there is not lasting benefit from conservative care.
The doctors at Coon Rapids Chiropractic Office work with surgeons in the area should a surgical consultation be necessary.