Meniscus Injury: Physiotherapy V’s Surgery

What is a Meniscus?

The menisci are two pieces of fibrous cartilage, like the cartilage found in your ears and nose. 

They are crescent or moon shaped tissues that lie between the knee between the bones of the thigh (femur) and shin (tibia).

Your meniscus acts like shock absorber and provides stability to the knee joint.

It absorbs and distributes the force and enables it to function under loads during walking, running, jumping, pivoting and making rapid direction changes.

It is a fantastic piece of tissue in your body!

How does a tear happen?

A meniscus is usually traumatically injured when someone has direction change with a slightly bent knee.

Younger patients will report this injury occurring traumatically either while playing sport, a slip/trip or contact with another person or object. 

Older patients may not notice a specific moment or incident. Like all our joints degeneration occurs naturally as we age and the meniscus is no different.

"Meniscal tears are common within older people, BUT are not always the the cause of your knee pain"

Kyle Wells: Fighting Fit Physiotherapist

What are the signs and symptoms?

The history of a painful twist with a bent knee can give a good indication of the likelihood of a meniscal tear.

Like most knee injuries, there will be symptoms of pain and swelling of the knee which you might notice the day after, or you might not be able to fully straighten or bend your knee after it.

There may also be experiences of popping, clicking or locking of the knee joint.

What type of Injury to the meniscus is this? READ ON TO FIND OUT!

A FightingFit physiotherapist will use a through history, assessment and special tests like Thessalays or McMurrays test to help confirm a meniscal tear diagnosis.

Types of Meniscus Injuries?

There are many types of meniscal injuries depending whether the initial injury was traumatic or degenerative.

Symptoms that develop 24-48 hours following the injury, may have minimal swelling, full range of movement and mild pain can be indicative of a minor/moderate injury.

Some meniscal injuries build up over time due to normal wear and tear as we age.

While a severe meniscal injury, ie one with a twisting injury can be more severe with pain, swelling and significant limitations in range of motion, even sometimes resulting in a locked knee need to be seen to immediately.

Some meniscal injuries have intermittent and spontaneous “locking”, this can be indicative of a bucket handle tear.

Kyle Wells: Physio

Do they heal?

There are two zones of blood supply for the meniscus. These are called the Red Zone and the White Zone

Red Zone – The outer zone has a good blood supply both from vessels and the fluid inside the knee, a disruption to the meniscus in this zone has a good chance of healing on its own or when surgery is done to repair it.

White Zone – This inner zone only gets nutrition from the fluid inside the knee. Therefore, it will not be effective healing on its own.

Surgical vs Physiotherapy Treatment?

Surgical 

The aim of surgical treatment is to preserve as much of the meniscus as possible and is based on multiple factors:

  1. Improvement with conservative management? If there has been little improvement in range of motion, pain and/or function with weeks of conservative management, then surgery maybe indicated (but be careful your previous therapist might have just sucked at their job)
  1. Is it a small tear?
    Meniscus tears that are less than 5mm, in the red zone have a good chance on healing on their own. Even if they aren’t in the red zone, white ones tend to just settle on their own too. So wait and see is the first option!
  2. How old are you?
    Younger patients will generally heal quicker and have better outcomes than older patients, but don’t stress older people with the right physio will get better too!
  3. Where is the tear?
    The location of the tear can affect healing times or surgical accessibility.
  4. What kind of tear is it? A longitudinal tear is easier to repair than both the radial tear or flap tears . A bucket handle tear with severe symptoms will be a more likely candidate for surgical repair

Good surgeons will opt for a period of Physiotherapy treatment to see whether surgery is appropriate.

Physiotherapy

Physiotherapy management of meniscal injuries has good success rates and improvement in function over six to eight weeks depending on the person and injury.

Fighting FitPhysiotherapy uses an individually tailored treatment to restore function.

When working alongside a Fighting Fit Physiotherapist we will:

  • Reduce pain and inflammation, normalise joint range of motion and muscle length
  • Begin a specific and graded exercise program to strengthen your knee muscles (especially the quadriceps and hamstrings)
  • Continually build on the strength of your core, gluteal, and lower limb muscles
  • Improve your proprioception, balance and function when walking, running, squatting or playing sports.
  • And most importantly, getting you back to what you want to do while minimising the chance of reinjury

Collaboration between your Physiotherapist, GP and Surgeon is the best way to determine whether surgical or non-surgical treatment of meniscal injuries is required

Final thoughts

Don’t rush into surgery.

It is an option that can always be used at a later date if conservative management is not reaping the outcomes you and your therapist want. 

As a physiotherapist I advocate a period individually tailored physiotherapy management first. 

In the long term a patient can have better results delaying or not messing the meniscus.

Kyle Wells is a Physiotherapist at Fighting Fit Physio.

He has a special interest in arthritis, neck pain and tendinopathy. Just to name a few.

Kyle loves cross fit and has an exceptional eye for technique and performing exercise correctly.

He use exercise to improve patient results and get them moving better for the long term.

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