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The meniscus is a C-shaped piece of cartilage, providing cushioning between your shin bone and thigh bone. The rubbery texture of the meniscus helps to absorb shock and provide lubrication to the knee joint. You are most at risk of injuring your meniscus when you apply direct force and twisting to your knee, demonstrating why these injuries are common amongst athletes, in particular footballers, basketballers, and skiers. The prevalence of meniscal tears is approximately 12% – 14%, with an approximate incidence of 61 cases in every 100,000 people. If left untreated, the frayed edges of the meniscus may become caught in the joint causing pain and swelling. The size of the tear to the meniscus can also increase without correct treatment leading to complications such as arthritis and damage to other soft tissue around the knee, highlighting the importance of appropriate rehabilitation.
What is a Meniscus Injury?
A meniscus tear is a common type of damage to the cartilage in the knee. There are many different types of meniscus tear, all of which usually occur when a twisting force is applied to a bent knee. Injury to the meniscus is also common in adults over the age of 40 after years of wear and tear causing the meniscus to weaken, with these making up 30% of meniscus tears.
Symptoms and Diagnosis
How each person experiences a meniscal tear will vary depending on the cause, severity, and area of injury. An athlete who has been involved in an accident with high force is likely to experience a more severe injury due to the likelihood of damage to other structures in the knee such as ligaments and tendons. This can result in an increase in pain, swelling, and reduced range of movement of the knee. Symptoms of a meniscal tear due to degenerative changes may appear more gradually but can equally result in pain, swelling, and reduced movement. Common signs and symptoms of a meniscus tear are:
If you experience any of these symptoms it is important to speak to your physiotherapist as soon as possible who will discuss your method of injury and thoroughly assess your knee to reach a diagnosis. In more serious cases, a physiotherapist may request imaging (such as an MRI) to help determine the severity of the injury.
Treatment of the injury depends on different factors including; the age of the patient, the severity of the damage, and the goals of the patient. Most cases can be managed conservatively through physiotherapy treatment, however, more severe cases can require arthroscopic surgery.
Rehabilitation and Recovery
Non-surgical treatment should begin by following the RICE (rest, ice, compression, and elevation) protocol to ease pain and reduce swelling. Rest involves avoiding activities that aggravate pain, and using crutches if required to avoid weight bearing. Ice, compression and elevation all help to reduce pain and swelling. Ice should be applied for 15 minutes at a time, every 2-3 hours where possible for the first few days after the injury occurred.
Following initial management, you should begin rehabilitation to restore function, based on your individual needs. There is strong evidence supporting the use of physical exercise to reduce symptoms and improve strength and mobility. The first phase of rehabilitation will include mobility exercises with low-level isometric exercises to restore range of movement and regain some strength. The next phase involves more complex hip and knee strengthening exercises to regain muscle strength and endurance, whilst re-establishing a full and pain-free range of movement. The final phase will aim to enhance muscle strength, maintain range of movement, and return to sport or full functional activities. This includes more dynamic and plyometric exercises along with sport-specific training.
Throughout your rehab, physiotherapists can offer hands-on treatment such as soft tissue massage, cupping therapy, acupuncture, and taping to help reduce pain and restore the function of the knee.
Patients are generally able to return to work after 1-2 weeks, return to sporting activities after 3-6 weeks, and to competition after 5-8 weeks of rehabilitation.
Prevention and Long-Term Knee Health
Whilst traumatic injuries can be difficult to avoid, there are certain things to do to reduce the chance of meniscus tears and maintain long-term knee health. Strengthening your legs and core muscles can reduce the amount of pressure absorbed by the meniscus. As well as strengthening it is important to include dynamic stretching using movements that replicate the movements performed in sports to help activate muscles and joints. It is vital to listen to your knees; feeling sore after activity is normal, but if you have persistent pain, it is best to speak to your physiotherapist. Finally, it is important to address any other injuries as this can reduce knee stability putting you at a greater risk of a meniscus tear.
Real-Life Success Story
Michael, a triathlon athlete woke up with pain and swelling in his knee, without suffering any trauma. After an MRI scan, it was revealed he had suffered a meniscus tear and after discussing a treatment plan decided to have arthroscopic surgery. After surgery, Michael was instructed to avoid weight bearing and begin his basic physiotherapy exercises. Now, two and a half weeks post-surgery, Michael completed his first run pain-free as he continues his rehabilitation.
To conclude, a meniscus injury is damage to the cartilage in the knee and is common amongst both the general public and athletes. This can present as pain and swelling in the knee and a crunching or clicking when moving. Treatment can be conservative or involve surgery with recovery time varying from a few weeks up to 2 months depending on the severity of the injury and following a patient-centred rehabilitation plan. Successful rehabilitation hinders patience and dedication during the recovery process.
If you have suffered a knee injury and would like some advice or have any questions, please do not hesitate to get in touch and book an appointment.
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