Meniscal tear

knee anatomy

lateral meniscus 

meniscal tear

menisectomy

Meniscal tears are the most common knee injury.  The meniscus is a dense soft tissue in the knee which is largely made of type I cartilage.  The menicus provides shock absorption and attenuation of axial loads on the articular cartilage of the distal femur and proximal tibia. It also has secondary roles in knee stability, proprioception, joint lubrication and stress distribution.  

The meniscus is commonly injured in sporting activities and also frequently tears over time after years of use.   People with knee ligament injuries, especially ACL injuries are at higher risk of sustaining meniscal tears.  Meniscal tears are more common in men than women. Traumatic tears are most commonly caused by axial loading with rotation of a flexed knee.

Meniscal Tear Anatomy
There are two menisci in the knee.  One on the inside of the knee called the medial meniscus and one on the outside of the knee called the lateral meniscus.  The medial meniscus is C-shaped and the lateral Menisus is more or a semicircular shape.  The medial meniscus transmits 50% of the load in the medial compartment of the knee.  The lateral meniscus transmits 70% of the load in the lateral compartment.  Medial meniscal  tears are 3 times more common than lateral meniscal tears 

Most things in the body heal based on having a blood supply which provides the oxygen and nutrietns necassary for healing.  This presents a problem for healing of meniscal tears.  Because the menisci are inside the knee joint (intraarticular) the majority of the meniscus does not have a good blood supply and has very limited chance for healing.  Only the outer (peripheral) 20-30% of the medial meniscus and 10-25% of the lateral meniscus has blood suffiecient for healing after surgical repair.

Meniscal Tear Symptoms
Mensical tears generally cause pain and swelling in the knee.  There may be locking, catching or clicking sensations in the knee.  Some people with meniscal tears feel that the knee frequently gives way.  Often the pain in the knee is associated with a twisting injury or with twisting motions.  The pain may be localized along the joint line and there may be tenderness along the joint line as well.

Meniscal Tear Treatment
Meniscal Tears are diagnosed based on a detailed history, physical exam, xrays and often an MRI performed by an orthopaedic surgeon, or sports medicine specialist.    Initial treatment often centers around conservative treatments such as avoiding painful activities, ice, compression, and anti-inflammatory or analgesic medications. Weight loss is often effective in decreasing knee pain in overweight people with meniscal tears.  Soft, shock-absorbing shoes, medial-post orthotics, and valgus unloader bracing are sometimes effective.

Surgery is considered for traumatic meniscal tears, or for those with chronic tears who have failed to improve with conservative treatment.  Surgery generally involves knee arthroscopy with partial meniscetomy or meniscal repair.  During surgery the torn meniscal tissue is removed so that it is no longer getting caught in the knee.  If the meniscal tear is repairable it is repaired generally using suture or specially designed meniscal repair devices.  

Meniscal Tear Rehab Program

 

Meniscal Tear Prevention
There are no established braces or exercise programs that have been shown to prevent Meniscal Tears.  Maintaining strength and endurance around the knee with a consistent exercise program is important and can decrease the potential for knee injuries.   Training on level surfaces and avoiding overuse injury or participating when overly tired is important. Wear appropriate footwear for your sport and playing surface.   Warm up and stretch  the leg muscles, including hamstrings, quadriceps, and calf muscles before exercises or games.

Similar injuries that can be confused with Meniscal Tear include:

  • Knee arthritis
  • Lateral collateral ligament tear
  • Medial collateral ligament tear
  • Chondral injury
  • PCL tear
  • ACL tear
  • Patellar Dislocation
  • Popliteus avulsion
  • Knee Dislocation

 

 

 

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