What you might be feeling
A severe meniscal injury e.g. long radial tear called a “bucket handle” tear, can be severely painful and restrict range of motion. Intermittent locking may occur as a result of a torn flap impinging between the articular surfaces. This may unlock spontaneously with a clicking sensation.However other meniscal tears may have more subtle symptoms with more intermittent pain and almost no restriction. Pain is normally present with squatting.
Meniscal injuries often occur with ACL (anterior cruciate ligament) tears. The most common sign is tenderness along the knee joint line, presence of a joint effusion (swelling within the joint capsule). There is usually a restriction of range of motion in the knee joint, this can be due to the torn meniscal flap or the effusion.
Your physiotherapist will be able to perform a few tests to determine whether there is a meniscal injury. However not all meniscus injuries are positive on testing and an MRI scan may be necessary to diagnose the injury.
What’s really going on inside
In the knee there are two menisci (Cartilage pads) the medial (sitting on the inside of the knee) and the lateral meniscus (on the outer side of the knee joint). The medial meniscus is more commonly injured than the lateral meniscus.
The most common mechanism of injury is a twisting injury with the foot anchored on the ground, often by another player’s body. The twisting component may be a relatively slow speed. It is commonly seen in footballers, basketballers and netballers. The degree of pain associated with this injury varies, some people report a tearing sensation at the time of the injury, a small tear may cause no immediate symptoms but typically pain and swelling increases over time (24hrs). Small tears may also occur in the older population with only very minimal twisting or trauma as a result of degenerative changes to the Meniscus.
How a physi0 can help
The treatment of meniscal injuries varies considerably depending on the severity of the injury. Normally small tears or degenerative tears can be treated conservatively with physiotherapy this includes:
- Reducing the effusion using electrotherapeutic modalities, soft tissue techniques and compression.
- Restoring range of motion through manual techniques, gentle movement and stretching.
- Improve weight bearing ability/ gait.
- Guidance for strengthening surrounding muscles.
- Graduated return to running and agility work.
- Progressive return to sport.
If the meniscal injury is large and causing a locked knee it may require an arthroscope to preserve as much of the meniscus as possible; this can mean either suturing the tear or removing the torn flap depending of the location and severity of the tear.
Following surgery physiotherapy can assist in the following ways:
- Reduce pain and swelling.
- Restore range of motion in the joint.
- Graduated weight bearing exercises.
- Progressive strengthening
- Maintain strength and fitness of other parts of the body
- Return to function activities