Meniscal tear in the knee

FAQS on Meniscal tear in the Knee

 

Meniscal tear in the knee causes painful sensation, osteoarthritis, and leaves it unstable unless treated at the earliest. Though the torn meniscus risk is higher in athletes engaged in contact sports, it may affect any one at any point of time in life. Meniscus tear is common in 60 percent of people older than 65 years. With effective diagnosis, treatment, and follow up rehab, patients can overcome the injury and regain to their pre-injury knee strength.

What is a meniscal tear in the knee?

Meniscal tear in the knee refers to rupture in the menisci or cartilage, a C-shaped thick and fibrous tissue that connects the thighbone and shinbone beneath the knee cap. Such a tear can be of two types – the tear in the lateral meniscus located outside and tear in the medial meniscus in the interior of the knee.

How does meniscal tear in the knee occur?

There are two C-shaped cartilages or menisci in the knee. Positioned between tibia and femur, these cartilages act like shock absorbers, cushion the joint, and keep it stable. Due to their rubbery character, it allows both bones to slide at the knee joint as we bend or run and do not rub with each other. The stress generated during any such activity is absorbed by the cartilage and bones remain free from any injury.

However, forceful knee twisting or rotation under intense pressure leads to rupture in the cartilage or meniscal tear in the knee. The tear may be due to innocuous activities, traumatic injury, excessive force, or degenerative disorders. Torn meniscus accompanies pain, swelling, and stiffness in the knee restricting limiting the ability to extend your knee fully. It allows grinding of bones and development of spurs.

A meniscal tear can be longitudinal, bucket handle, an oblique tear, or complex. It can rip through the meniscus or split it into two. Athletes often suffer from meniscal tears following injury to the knee.

Minor tears may go in 2-3 weeks with insignificant pain. But moderate tears cause worsening pain and swelling that make the knee stiff and with limited range of motion. Such symptoms return when the knee is overused or subject to disproportionate weight. Sever tears may cause torn pieces enter the joint leading to catching or locking sensation. A stiffened knee is difficult to move.

What are the symptoms of meniscal tear in the knee? When to see a doctor?

  • Popping sensation when the meniscal tear occurs
  • Stiffness and swelling impacts the knee within 2-3 days
  • Pain in the knee joint
  • Limited knee movement ability
  • Felling of knee “giving way”
  • Difficulty in stretching the leg
  • Catching or locking of the knee joint
  • Gradual lessening or instability of the knee joint

What causes meniscal tear in the knee?

  • Forceful twist, rotation, or over-flexing of the knee
  • Sudden stops or turns
  • Kneeling for long or lifting weight disproportionately
  • Degeneration of cartilage with age
  • Meniscal wearing out
  • Sports that need swiveling and sudden stops
  • Damage to collateral and cruciate ligaments
  • Lack of blood supply to the cartilage

How is meniscal tear in the knee diagnosed?

  • A detailed physical examination of symptoms and knee joint and discoing patient history help the doctor zero on meniscal tear in the knee. Often the tenderness along the meniscus hints at a tear.
  • McMurray test or “bending- straightening-rotating” the knee may lead to a clicking sound. This may also indicate a torn meniscus.
  • X-ray is only used to rule out any other injury to the knee.
  • Ultrasound and MRI tests may help detect the damaged parts of the cartilage.
  • Arthroscopy allows to visualize the meniscal tear with real-time image.

What are the treatment methods available for Meniscal tear in the knee?

  • RICE Protocol: The non-surgical treatment protocol of meniscus tear is summed up as RICE – Rest, Ice, Compression, and Elevation. Take ample rest without putting stress on the injured knee joint. Ice it for 20 minutes and repeat it at regular intervals every day. Wearing an elastic compression bandage is suggested to avoid excessive loss of blood and reduce swelling. Keep your knee joint elevated, higher than your heart when sleeping to lessen swelling.
  • Surgical Treatment or Knee arthroscopy
  • Meniscectomy or trimming of the meniscus. The injured part is separated to reduce inflammation.
  • Meniscus repair or stitching of the torn meniscus.
  • Meniscus transplantation from a donor
  • Medication: Non-steroidal anti-inflammatory medicines are used to treat swelling and pain.
  • Anesthetic Injection: Anesthetic medications are injected to the injured area to keep the pain suppressed for weeks at a time while the healing takes place.
  • Cortisone Injection: These steroid injections help reduce inflammation and swelling associated with meniscal tear in the knee.
  • Regenerative Injections: Stem cell, prolotherapy, platelet rich plasma, and platelet lysate injections are administered in to the torn meniscus. These injections help retrieve the damaged tissues through the natural healing process of the body. An alternative to surgery, the process is formed outpatient and found to be highly effective.

What are the likely outcomes and chances of meniscal tear in the knee recovery? How long will the Meniscal tear in the knee take to heal?

Recovery time taken depends on age, medical condition, and the method of treatment adopted. However, the healing process is complete assuring return to pre-injury knee strength level.

References

Paxton ES, et al. (2011). Meniscal repair versus partial meniscectomy: A systematic review comparing reoperation rates and clinical outcomes. Arthroscopy, 27(9): 1275–1288.

Book: Mayo Clinic Family Health Book, 4th Edition

Rodkey WG. Basic biology of the meniscus and response to injury. Instr Course Lect. 2000;49:189-93.

University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner “Stem Cells Show Promise for Meniscal Tears,” MedPage Today; Feb 10, 2012;

Nicolas Pujol, MD, Olivier Barbier, MD, Philippe Boisrenoult, MD and Philippe Beaufils, MD, “Amount of Meniscal Resection After Failed Meniscal Repair,” The American Journal of Sports Medicine; August 2011; vol. 39 no. 8;

Bland-Sutton J. Ligaments: Their Nature and Morphology. 2nd ed. London, UK: HK Lewis; 1887.

Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. Apr 2004;20(4):373-8.

Shelbourne KD, Heinrich J. The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy. Apr 2004;20(4):346-51.

Nicholas SJ, Golant A, Schachter AK, Lee SJ. A new surgical technique for arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arthrosc. Dec 2009;17(12):1433-6.

Barber FA, Harding NR. Meniscal repair rehabilitation. Instr Course Lect. 2000;49:207-10.

Cox CL, Deangelis JP, Magnussen RA, Fitch RW, Spindler KP. Meniscal tears in athletes. J Surg Orthop Adv. Spring 2009;18(1):2-8.

Metcalf MH, Barrett GR. Prospective evaluation of 1485 meniscal tear patterns in patients with stable knees. Am J Sports Med. Apr-May 2004;32(3):675-80.

Uysal M, Akpinar S, Bolat F, et al. Apoptosis in the traumatic and degenerative tears of human meniscus. Knee Surg Sports Traumatol Arthrosc. Apr 30 2008;epub ahead of print.

Rodkey, WG. (2000). “Basic biology of the meniscus and response to injury.”. Instr Course Lect 49: 189–93.

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