Today in the blog we will present one of the most common knee injuries – Meniscus tear. We are seeing in the clinic a lot of patients that come with this injury. However there is a lot of uncertainty regarding this condition – Is the tear relevant ? Would physiotherapy be enough or should surgery be considered? Is it dangerous ? And many more questions that we will try to answer here.
Anatomy in a nutshell:
The meniscus is a cartilaginous tissue that sits inside the knee, we have 2 meniscus in each knee: Lateral in the external part and Medial in the internal part. When talking about meniscus injury, about 90% of the injuries are in the medial ( internal) meniscus.
Types of Tears
Roughly we can divide the tears in to two groups:
- Degenerative tears – what we call “wear and tear” conditions, age related issues, very common in the general healthy population. Almost never requires surgery.
- Acute tears: Tears that are more common in the young population, commonly the result of a sport related injury . These are the “ famous” tears that your favorite Hockey player might have . Surgeries are more common in this population, however far less popular than what it was just a few years ago.
There is a clear distinction between the 2 described conditions, maybe the clearest is a mechanism of injury. While degenerative tears have no mechanism of injury, acute tears will have a very clear one. I.e : twisting the knee while playing soccer. The classic mechanism of injury is rotation of the leg while the foot is implemented to the ground – A twisting mechanism.
On top of the mechanism of injury, we will have additional signs and symptoms : Swelling of the knee, pain, and limited range of movement are all very common.
Less common symptoms :
- Locked knee- literally the knee just can not move and it is locked in one position – It does not have to be painful, just locked
- Loud painful “click” sound with movements of the knee.
Imagine: The best image method to this issue by far is an MRI test. MRI can demonstrate the exact location and magnitude of the tear. X-RAY is borderline useless for this specific issue as its capability of demonstrating soft tissue injuries, such as meniscus tear, is extremely limited.
The superiority of MRI in this case raises an interesting question : “ Should we use an MRI on anyone with suspected meniscus tear?” the surprising answer is not at all from the following reasons:
- Only a minority of the meniscus tear will need surgical intervention, only for this small minority MRI is a necessity, therefore there is no point in doing it to everyone.
- Cost / Time – MRI is an expensive test – about 700-800 $ in the private sector. In the public sector waiting times can get to 6 months. It makes more sense to spend the money and time on treatments rather than waiting for an MRI.
- Psychological factors – We have significant evidence that unnecessary MRI can have a negative effect on recovery in patients with back pain . Although we do not have the same evidence regarding knee cases, it is reasonable to assume that the same effect is happening in cases of knee pain.
It is worthwhile to consider an MRI in cases of acute injury that does not get better within an acceptable timeframe.It is important to get an MRI when there is a case of locked knee and or loud painful “clicks” .
The “go to” treatment in case of knee injury / meniscus tear is physiotherapy. In the treatment, the physiotherapist will evaluate your range of movement, strength and function. Here at AMS clinic we also have sports doctors and orthopedic surgeons that will be able to see you if your therapist will find it necessary.
The treatment plan will be tailored to the status and severity of your injury, as well as to the function that you need to achieve. A rehabilitation program for a 25 years old soccer player will be very different from this of a 60 years old office worker. Big majority of meniscus tear patients can be treated successfully with physiotherapy.
I hope that this blog helped you understand better what are meniscus tears, how is it been diagnosed and what can be done in case of an injury.