Meniscal injury of the knee
How do they occur?
In
the knee there are two menisci (Cartilage pads) the medial (sitting on the
inside of the knee) and the lateral meniscus (on the outer side of the knee
joint). The medial meniscus is more commonly injured than the lateral meniscus.
The
most common mechanism of injury is a twisting injury with the foot anchored on
the ground, often by another player’s body. The twisting component may be a
relatively slow speed. It is commonly seen in footballs, basketballers and
netballers. The degree of pain associated with this injury varies, some people
report a tearing sensation at the time of the injury, a small tear may cause no
immediate symptoms but typically pain and swelling increases over time (24hrs).
Small tears may also occur in the older population with only very minimal
twisting or trauma as a result of degenerative changes to the Meniscus.
A severe meniscal injury e.g. long
radial tear called a “bucket handle” tear, can be severely painful and restrict
range of motion. Intermittent locking may occur as a result of a torn flap
impinging between the articular surfaces. This may unlock spontaneously with a
clicking sensation.
Meniscal injuries often occur with
ACL tears. The most common sign is tenderness along the knee joint line,
presence of a joint effusion (swelling within the joint capsule). There is
usually a restriction of range of motion in the knee joint, this can be due to
the torn meniscal flap or the effusion. Pain is normally present with
squatting.
Your physiotherapist will be able to
perform a few tests to determine whether there is a meniscal injury. However
not all meniscus injuries are positive on testing and an MRI scan may be
necessary to diagnose the injury.
What can physiotherapy do?
The treatment of meniscal injuries
varies considerably depending on the severity of the injury. Normally small
tears or degenerative tears can be treated conservatively with physiotherapy
this includes:
- Reducing the effusion using
electrotherapeutic modalities, soft tissue techniques and compression.
- Restoring range of motion
through manual techniques, gentle movement and stretching.
- Improve weight bearing ability/
gait.
- Guidance for strengthening
surrounding muscles.
- Graduated return to running and
agility work.
- Progressive return to sport.
If the meniscal injury is large and
causing a locked knee it may require an arthroscope to preserve as much of the
meniscus as possible; this can mean either suturing the tear or removing the
torn flap depending of the location and severity of the tear.
Following surgery physiotherapy can
assist in the following ways:
- Reduce pain and swelling.
- Restore range of motion in the
joint.
- Graduated weight bearing
exercises.
- Progressive strengthening
- Maintain strength and fitness
of other parts of the body
- Return to function activities
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