The quick answer is the menisci; the medial meniscus and lateral meniscus - are crescent-shaped bands of thick, rubbery cartilage attached to the shinbone (tibia). They act as the major shock absorbers of the knee. The medial meniscus is located on the inside part of the knee joint. The lateral meniscus is located on the outside part of the knee. The menisci act to disperse the weight of the body and reduce friction during movement.
The meniscus can be torn during activities that cause direct contact or pressure from a forced twist or rotation. A sudden pivot or turn, deep squatting, or heavy lifting can all lead to meniscal tears. Many people of all shapes and sizes are prone to having meniscal tears. Athletes are more at risk of having meniscal tears due to the activities mentioned above. Athletes that play sports such as football, soccer, basketball, and tennis have these risks. If you have osteoarthritis, you’re at higher risk of injuring your knee or tearing your meniscus. Osteoarthritis is a common joint disorder involving pain and stiffness in your joints caused by aging and wear and tear of the knee.
When meniscal tears happens, you may hear a popping sound around your knee joint. Afterward, you may experience sudden pain, especially when the area is palpated to touch, increased swelling, difficulty moving your knee or inability to move it in a full range of motion due to pain, the feeling of your knee locking or catching, the feeling that your knee is giving way or unable to support you when standing or walking. It is advised to contact your medical provider if you have any of the symptoms mentioned above.
Diagnosing a meniscal tear is needed to determine first and foremost whether a tear is present, or whether the knee symptoms are caused by something else. Based on the findings, diagnostic tests will be performed to determine which meniscus is torn, how bad it is damaged, and what type of treatment is recommended. There are different types and severity of meniscal tears. Things that may be done are a patient history, physical exam and possible imaging such as an MRI may be completed.
These are the types of meniscal tears:
1. Intrasubstance/Incomplete Tear: An intrasubstance tear is a common finding on an MRI report, and typically looks normal at the time of surgery. Often these are a sign of early degenerative changes of the meniscus tissue. Incomplete and intrasubstance tears of the meniscus are stable injuries, and generally do not require any surgical treatment.
2. Radial Tear: Radial tears of the meniscus are the most common type of meniscus tear. These tears are within the area of the meniscus, where there is no blood supply, and therefore difficult for the tear to heal. Usually, these tears require some type of surgical treatment, and the only option is to shave out the damaged portion of the meniscus.
3. Horizontal Tear: A horizontal tear is a tear that most commonly requires a meniscus repair. Rather than removing the damaged portion of the meniscus, a horizontal tear may be able to be sewn together.
4. Flap Tear: A flap tear of the meniscus is an unusual pattern of a meniscal tear. In circumstances where the flap is causing symptoms of catching in the knee, the flap of the meniscus can usually be removed without removing much tissue at all.
5. Complex Tear: A complex tear means there is a combination of tear patterns. A complex tear often involves both radial and horizontal tear patterns. Typically complex tears are not treated with meniscus repair because of the complex nature of the tear.
6. Bucket-Handle Tear: A bucket-handle tear is a large type of horizontal tear of the meniscus. These types of tears often cause the knee to become stuck by causing the torn portion of the meniscus to block normal knee motion. Bucket-handle tears often require more surgical interventions in order to allow the knee to start bending again.
The type of the meniscal tear will determine the treatment protocol for your injury.
You are probably wondering how physical therapy can help meniscal tears. Meniscal tears can often be managed without surgery but also may be prescribed after meniscal surgery. A short course of treatment provided by a physical therapist can help with your recovery. Your physical therapist can help control pain and swelling in the knee area and work with you to restore full strength and mobility to your knee. A very common course of treatment may include:
Physical therapy will apply ice packs to the knee to help control any pain and swelling, and may instruct you to apply ice at home. Icing usually requires about 10-15 mins of time usually 2-5 times a day and other modalities can help control the pain and swelling.
Physical therapy may recommend the use of compression bandages, or stockings, to assist in the decrease of or prevent further accumulation of edema (swelling).
Your physical therapist may use a treatment called neuromuscular electrical stimulation (NMES). NMES uses electrical current to gently stimulate and contract the muscles around your knee to help improve their strength and quad control to help you stand and walk.
During physical therapy, it may be necessary to use assistive devices such as crutches, a cane, or a walker in the short term. Your physical therapist will make recommendations about which device is best for you and will instruct you in how to use it properly at home and out in the community.
Your physical therapist or an orthopedic MD will prescribe exercises to build and maintain your strength as well as stretching and range of motion exercises during recovery to help restore full movement to the knee. Again, the type of meniscal tear will determine the correct treatment protocol for your knee. Strengthening the muscles around the knee and throughout the leg helps ease pressure on the healing knee tissue as well as provide stability when standing and walking. Stretching exercises may include range of motion exercises to improve bending and straightening out the knee.
To schedule physical therapy at one of the 12 JOI Rehab Centers, please call 904-858-7045.
By: Chad Evans, PT
JOI currently has ASAP Injury and Fracture Care appointments so you can start on the road to recovery. There really is no need to wait to get your knee pain taken care of.
To schedule an appointment with a JOI Orthopaedic Knee Specialist, please call 904-JOI-2000, schedule online or click below.