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Introduction

Knee Pain

Meniscus Tear

The meniscus, a c-shaped pad of cartilage in the knee, is a commonly injured structure. In younger people, tears usually occur due to a forceful twisting injury. In ageing adults, the meniscus is weaker and tears can result from more minor injuries, even squatting.

There are two menisci between the shinbone (tibia) and thighbone (femur) in the knee joint. They act like shock absorbers in the knee, helping spread out the forces that are transmitted across the joint. They also add stability to the knee joint by converting the surface of the shinbone into a shallow socket, which is more stable than its otherwise flat surface.

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Causes

Forceful twisting injuries. In younger people under 30 years old, the meniscus is a fairly tough and rubbery structure. Meniscus tears are usually caused by a sport activity. The entire inner rim of the medial meniscus can be torn (bucket handle tear). The meniscus can also have a flap torn from the inner rim.


Wear and tear. The menisci weakens with age, making them prone to degeneration and tearing. Degenerative tears cause the menisci to fray and become torn in many directions. Older people may tear their meniscus from minor injuries, such as from squatting. For this type of degenerative meniscus tear, there is usually no one specific injury which causes it. Rather, such tears are commonly part of knee osteoarthritis in ageing adults.

Symptoms
  • Pain in inside, outside or back of knee

  • Swelling, stiffness and tightness

  • Locking of the knee joint (inability to completely straighten out the knee). This can happen when a fragment of the meniscus tears free and gets caught in the hinge mechanism of the knee.

Diagnosis

Diagnosis begins with a history and physical exam. Your doctor will try to determine where the pain is located, whether you've had any locking, and if you have any clicks or pops with knee movement.

 

X-rays may be used to determine if other injuries are present.

 

Magnetic resonance imaging (MRI) is very good at showing the meniscus. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. Usually, this test is done to look for injuries, such as tears in the menisci or ligaments of the knee.  If there is uncertainty in the diagnosis following the history and physical examination, or if other injuries are suspected, the MRI scan may be suggested.

 

If the history and physical examination indicate a torn meniscus, arthroscopy may be suggested to confirm the diagnosis and treat the problem. Arthroscopy is an operation that involves inserting a miniature fiber-optic TV camera into the knee joint, allowing the orthopedic surgeon to look at the structures inside the joint directly. The arthroscope lets the surgeon see the condition of the articular cartilage, the ligaments, and the menisci.

Non-surgical treatments
  • Using the RICE (rest, ice, compression, elevation) method: The RICE method involves resting your knee, icing your knee, wearing an elastic bandage around your knee (compression) and elevating your knee while you’re resting. This helps to reduce pain and swelling.

  • Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.

  • Wearing a knee brace: Your provider may have you wear a knee brace that prevents your knee from moving side to side so that your meniscus can heal.

  • Using crutches: Your provider may have you use crutches to walk so that you can limit the amount of weight you put on your affected knee.

  • Doing physical therapy: Your provider will most likely have you do physical therapy exercises to improve your strength and range of motion in your knee.

Surgery