Meniscus tear

A meniscus tear occurs when the knee is twisted while under heavy strain. They are among the most common knee injuries in sports, especially in ball sports like soccer. As a result of acute injuries, meniscus tears mainly affect younger people. They are called traumatic meniscus tears, and undergo operation in most cases. Sometimes, however, they can be treated conservatively, for example, with strengthening exercises, painkillers, and bandages. Treatment depends on the size and type of tear, and the symptoms.

If the tear is an acute, injury-related meniscus tear, the knee hurts, in particular, when twisted and bent. It may also swell. Some people hear a pop or crack when the meniscus tears. The symptoms experienced depend on the type of the tear and how extensive it is.

Smaller meniscus tears are not always immediately noticeable. The knee often first hurts after a few hours or days. Some people do not even realize their knee is injured until weeks later. Larger meniscus tears often hurt more and cause the knee to swell. Furthermore, it is harder to move; it feels as if the knee is stuck.

Age-related meniscus tears and changes in the meniscus rarely cause discomfort. When examined, such tears or changes can be detected in about 20 percent of those over 40 years of age. Those affected do not notice anything. Meniscal changes or tears are even more common in knees with osteoarthritis. They occur in about 60 percent of people whose knee osteoarthritis is visible on an X-ray.

The meniscus consists of two crescent-shaped cartilage discs, the menisci, between the femur and tibia. The medial meniscus is located on the inside of the knee and the lateral meniscus is located on the outside. Both menisci stabilize the movements of the knee joint. They distribute the pressure and absorb impacts. They also provide nutrients and lubrication to the joint cartilage.

Both menisci are connected to the joint surface of the lower leg bone (tibia) and the joint capsule; the medial meniscus is connected to the medial ligament. The inner meniscus is therefore less mobile and can tear somewhat more easily than the outer meniscus.

The menisci are sometimes confused with joint cartilage because they are also made of cartilage. However, joint cartilage covers the joint surfaces of the upper and lower legs and the inside of the kneecap. The menisci, on the other hand, lie between the joint surfaces and protect the articular cartilage.

Acute meniscus tears can occur when the knee is twisted while bent, especially if the foot is flat on the ground while doing so. The forces acting on the meniscus can be so great that parts of the meniscus tear.

Acute meniscus tears are particularly common in sports that involve braking from a fast run while changing direction. This is the case with soccer, handball, tennis, basketball and so on. Another risk factor affects people who are missing the anterior cruciate ligament due to injury. Their knees are more unstable and therefore they are at a higher risk of meniscus damage.

People with occupations that require frequent bending or kneeling are prone to wear-related meniscus damage. The risk is also higher in people who are very overweight and those who have to climb a lot of stairs. Wear-related meniscus damage is more common in men than in women.

It is not known exactly how many cases of injury-related meniscus tears there are in Germany. According to estimates, about one in 1,000 people injures the meniscus every year. Age-related signs of wear and tear on the meniscus that do not require treatment are widespread.

How long it takes for the knee to move normally again depends on the type and size of the meniscus tear. It also depends on whether the ligaments in the knee were also injured. Furthermore, the type of treatment and the physical conditions of the patient play an important role.

If the damaged parts of the meniscus are removed, it takes about 6 weeks before the affected person can walk or jog longer distances again, for example. In many cases, however, it can take several months before the injured person feels comfortable and secure performing all activities. If the meniscus has sutures, recovery (rehabilitation) takes longer; about 4 to 6 months before most activities can be resumed.

Some of the symptoms, for example, mild pain when walking up stairs, squatting, or kneeling, may persist even after surgery.

If acute meniscus damage is not treated, it can cause severe pain, and lead to swelling that limits knee mobility. A meniscus tear increases the risk of a person developing knee osteoarthritis over the long term. The risk of knee osteoarthritis also increases if damaged parts of the meniscus have been surgically removed.

The doctor first asks how the injury occurred and what the symptoms are. The knee is then palpated to determine where it is painful or identify the parts of the meniscus that are protruding.

In addition, the knee is bent and rotated. While doing this, the doctor presses on the different areas that may hurt if the meniscus is injured. When the bent leg is extended, a snap is sometimes felt that may indicate loosened parts of the meniscus.

A magnetic resonance imaging (MRI) scan can provide an image of the meniscus. An MRI is useful if

• there is suspicion of other knee injuries.
• the meniscus is to be operated on.

Only the outer parts of the meniscus can be imaged with an ultrasound examination. X-rays are not helpful in cases of meniscal damage. However, if the doctor suspects bone injury as well, X-rays may be useful.

Those with a meniscus tear should initially immobilize the knee until the acute pain and swelling subside. To keep swelling down, the leg should be elevated and the knee cooled for the first few days after the injury. If possible, squatting, kneeling, twisting and major bending movements as well as other activities that put stress on the knee should be avoided until the symptoms subside.

If a meniscus tear does not cause incarceration of the meniscus or blockages in the knee, they can sometimes be treated conservatively, i.e., without surgery. The same applies to certain new injuries in which the meniscus only becomes temporarily inflamed and painful.

Conservative treatment options include:

• anti-inflammatory painkillers, such as diclofenac or ibuprofen
• knee bandages
• losing weight if very overweight
• exercises that strengthen muscles and improve stability, mobility and coordination.

Meniscus tears usually undergo operation if:

• the knee can no longer be fully extended, for example, a bucket handle tear.
• the symptoms are severe and frequent.
• damage to the meniscus could lead to secondary damage, such as knee osteoarthritis, or other parts of the knee, for example, the cruciate ligaments, have also been injured.

If the meniscus undergoes surgery, the damaged parts are removed by means of a joint endoscopy (arthroscopy). Frayed parts of the meniscus are cut away to smooth the surface of the meniscus. During the process, the doctor tries to preserve as much of the meniscus as possible.

For more detailed information, such as how to treat a meniscus tear, visit gesundheitsinformation.de.

For a knee to function well, the muscles must be well trained. Rehabilitation is therefore advisable after meniscus surgery. Under physiotherapeutic guidance, those affected first learn to train their muscles themselves in everyday life. Ideally, the doctors and physiotherapists agree on an individual treatment plan beforehand.

If the meniscus is partially removed, it takes about a week before the affected person can walk normally again. After about 6 weeks, sport activities can be resumed.

If the meniscus has sutures, the patient must wait 6 weeks before placing weight on the operated leg. Otherwise, the meniscus suture could easily tear. In these cases, jogging is usually possible again after 4 months, ball sports after about 6 months.