What are the meniscii?
Our bodies are made up of different types of cartilage and the knee joint is composed of 2 different types:
- Articular cartilage lines the ends of the bones: the femur (thigh bone), the tibia (shin bone) and the back of the patella (knee- cap). It is designed to protect the bones against load and lubricate the joint surface to ensure it moves smoothly. Osteoarthritis involves a thinning of this structure and it starts to become rougher. This causes a reduction in the ability of the joint to tolerate load. Most of us will experience this process as we get older but not all of us suffer with the symptoms. It is still an area of extensive research.
- The tibia is relatively flat on its surface and the femur is rounded. To improve congruency between these two structures there are 2 crescent shaped menisci which sit between the bony surfaces. The meniscii are a different form of cartilage that act to distribute load more evenly across the joint surface. The meniscus can sustain various types of tear which can be degenerative or traumatic. In most cases symptoms caused by a meniscal tear can settle well through conservative treatment but in more severe cases the tear can cause the knee to lock which will require surgery.
How do meniscal tears present?
Symptoms associated with cartilage damage include joint swelling and stiffness. The knee can become sore to bend and rotation tends to cause sharp catches within the joint. There is often difficulty full straightening the knee when walking and when trying to bend or squat down or kneel.
How are tears to the meniscus treated?
Most meniscus tears that cause pain and swelling will not heal by themselves. The type of treatment will then be dependent on the severity and location of the tear. Initially treatment will focus on settling swelling and pain and exercises to restore range of movement gradually. The exercises can then be progressed as the knee settles to work on muscle activation patterns and balance control around the knee joint. Finally the treatment programme will involve a progressive return to impact and running before testing its ability to tolerate twisting and turning in the case of return to sport.
In the case of severe tears the knee can lock so it becomes impossible to bend of straighten the knee. In this case surgical intervention will be required.
What You Need To Know
- If your knee is locked i.e. you can’t bend or straighten the knee, you MUST see a healthcare professional, specialist orthoapedic consultant or sports doctor or go to A+E.
- Meniscal tears will commonly cause the knee to swell.
- These rarely settle by themselves so a guided treatment programme is advised.
- Only in severe cases will surgery be needed. Meniscal tears can settle very well with physiotherapy.