The simple guide to Meniscal Tears

FAQs which will improve your understanding of Meniscal problems.

What is Meniscus?
Meniscus is a firm rubbery structure present in our knee joint between the Femur (Thigh bone) and Tibia(Shin Bone). There are 2 menisci(plural) in each knee joint: medial and lateral meniscus. Each meniscus is C shaped.
 
What is the importance of the menisci? Why do we need them?

• Menisci act as space fillers in the joint and help in absorbing forces. This prevents damage to the cartilage and bone.
• Menisci help lubricate the joint and promote smooth movement in the joint.

Hence damage to the menisci leads to more forces and friction in the joint, which causes excessive wear. The joint can become arthritic in future.

How do Meniscus Injuries happen?
A meniscus tear can occur when the knee is suddenly twisted while the foot is planted on the ground. A tear can also develop slowly as the meniscus loses resiliency and becomes weak in older individuals.
 
Which are the activities that increase risk of meniscus tears?

• Contact sports like football, non contact sports like basketball, racket sports which involve sudden cutting movements carry a risk of meniscal tears. They may occur at the same time as other knee injuries, like an anterior cruciate ligament (ACL) injury.
• Meniscal tears may occur sometimes while kneeling, deep squatting or lifting weights.
• They can occur in activities of daily living too.

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What are the symptoms of Meniscal Tears?

• Pain, swelling, popping sensation, clicks, locking of the joint are some of the common symptoms of meniscal tears.
• Pain may be sudden and sharp or chronic and reproducible whenever the knee joint is put into certain movements.
• Complete locking of the knee in a bent position and inability to straighten a knee which had normal mobility before is a symptom of a meniscal tear which has flipped.

 
What can I do at home or as First Aid?
Sports injuries are initially managed by the RICE protocol which is Rest, Icing, Compression (crepe bandage) and Elevating the affected joint(to prevent or reduce swelling). Seek medical attention at the earliest.

Read about details of RICE protocol here.
 
What should I not do?
Do not
Continue to play or exercise.
Massage or Manipulate the knee.
Avoid application of heat in acute injuries. It may lead to increased swelling and pain.

​When should I see a Orthopaedician or Sports Medicine specialist?
U should see a Doctor

• If there is excessive swelling
• Inability to bear weight on the knee
• Knee movement is restricted
• Pain persists in the knee in spite of rest and icing.
• There are clicks, sounds or abnormal sensations in the knee which were absent before.

 
What tests are required to diagnose meniscal tears?
1. Xrays: While xrays do not show the menisci, it is an important first test to evaluate the condition of the knee and to look for any other issues. A standing xray is useful to look at alignment of the knee and the space between the bones.
2. MRI: It is the best study to confirm the presence of a meniscal tear.

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How are meniscus tears treated?
Very small tears which are stable and do not interfere with joint movements may be treated with medicines to relieve pain and physiotherapy to strengthen muscles.
Arthroscopic surgery is recommended in young and athletic individuals, unstable tears and tears which are flipped and block knee movements. Persistent pain in small tears, not relieved by non surgical treatment, is also an indication for arthroscopy.

What is done during Meniscal surgery?
Meniscal repair is done in some tears which can be repaired.
Some tears which cant be repaired are trimmed and loose pieces removed (partial meniscectomy).
 
Are Meniscal surgeries major procedures?
Meniscal surgery is technically advanced, but a safe procedure. It is usually done arthroscopically (key hole surgery of joints). There are 2 very small incisions placed in the knee, each incision usually smaller than a centimeter. Surgery can be done as a day care procedure or as a 24 hr stay in hospital.

What are the restrictions and requirements after Meniscal surgery?
A knee brace is usually given after surgery, stitch removal of the small incisions if any is done after 10-12 days. You may be asked to walk with a walker/crutches support for 2-3 weeks. Physiotherapy exercises are started on second day onward.

When is Meniscal surgery not advisable?
If your knee is in a state of advanced arthritis, your doctor may recommend a knee replacement surgery as a better and reliable option.

Please feel to ask any doubts in the comments below.

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