Meniscus Tears

Acute injuries are sudden, forceful events that lead to meniscus tears. These injuries include:

• Sports Injuries: Sports that require forceful stops, pivots, changes in direction, and twisting movements, such as basketball, soccer, and tennis, can cause the meniscus to tear. Athletes are often at higher risk due to the intense physical demands and quick movements required in these sports.
• Traumatic Injuries: A direct impact to the knee, often from contact sports, accidents like falls or collisions, can lead to a meniscus tear. Such traumatic injuries usually involve a powerful force that impacts the knee joint.

These changes weaken the meniscus, making it more prone to tears from minor stresses and injuries.

• Ageing: The meniscus weakens and becomes more prone to tearing as people age. This happens because the cartilage gets thinner over time and loses its ability to stretch and bounce back. People over the age of 40 are more likely to have degenerative tears.
• Osteoarthritis: Conditions like osteoarthritis, where the cartilage and bone in the joints break down over time, can lead to meniscus tears. The weakened cartilage is more likely to be damaged from normal activities and minor injuries.

Certain risk factors, such as lifestyle, occupational activities, or previous medical history, can increase the likelihood of experiencing a meniscus tear.

• Occupations and Activities: Jobs or activities that require kneeling, squatting, or lifting large objects can cause meniscus tears. Jobs such as construction, carpentry, plumbing, and activities like gardening and cleaning can lead to meniscus deterioration over time. Repetitive knee strain might weaken the meniscus.
• Previous Knee Injuries: People with previous knee injuries, such as ligament tears, are at higher risk of developing meniscus tears. The knee joint may be less stable, making the meniscus more vulnerable to damage.

The diagnosis process begins with a thorough medical history. The knee specialist will inquire about the onset of symptoms, recent injuries, and activities that may have caused knee pain. Understanding the patient’s medical background, including any previous knee problems, helps evaluate the possibility of a meniscus tear.

During the physical examination, the knee specialist will perform various tests to evaluate the knee’s range of motion, stability, and areas of tenderness. Common tests include:

• McMurray Test: The McMurray test involves bending, straightening, and rotating the knee. If there is a clicking sound or pain during this manoeuvre, it may indicate a meniscus tear.
• Apley Grind Test: In this test, the patient lies face down, and the knee specialist bends the knee to 90 degrees, then applies downward pressure on the foot while rotating it. Pain or discomfort during this test may suggest a meniscus tear.
• Joint Line Tenderness: Pressing along the joint line of the knee may reveal tenderness, which is often associated with meniscus tears. This tenderness is usually localised to the side of the knee where the tear is present.

MRI provides detailed images of the soft tissues in the knee, including the meniscus, ligaments, and cartilage. It can also reveal the location and extent of the tear.

Non-surgical treatments are generally the first option for minor tears or for people who do not want to undergo surgery. The goal is to reduce pain and swelling, improve knee function, and prevent further injury.

Rest, Ice, Compression, Elevation (RICE)

The RICE method is a common initial treatment for meniscus tears:

• Rest: Avoid activities that cause pain or strain on the knee.
• Ice: Apply ice packs to the knee for 20 minutes at a time, several times daily, to reduce swelling.
• Compression: Use an elastic bandage or knee brace to provide support and reduce swelling.
• Elevation: Keep the knee elevated above heart level to decrease swelling.

Medications

Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage pain and reduce inflammation. Sometimes, the knee specialist prescribes stronger medications for more severe pain.

Injections

Injections can be used to reduce inflammation and pain in the knee. Common types of injections include:

• Corticosteroid Injections: These injections help reduce inflammation and provide pain relief. They are often used when other non-surgical treatments are ineffective.
• Hyaluronic Acid Injections: These injections supplement the natural lubricant in the knee joint, improving mobility and reducing pain. They are more commonly used in patients with degenerative meniscus tears.

Severe, non-healing, or tears with considerable symptoms may require surgery. The location and severity of the tear determine the need for surgery.

Meniscectomy

A meniscectomy involves removing the damaged part of the meniscus. Depending on the extent of the tear, this procedure can be partial or complete. It is often performed arthroscopically, which involves small incisions and a faster recovery time.

Meniscus Repair

The meniscus can be repaired rather than removed. This involves stitching the torn edges together. Meniscus repair is typically done arthroscopically and is preferred for tears that occur in the outer edge of the meniscus, where a good blood supply can facilitate healing.

Meniscus Transplant

For patients with substantial meniscus damage, a meniscus transplant may be an option. This procedure involves replacing the damaged meniscus with donor tissue. It is a less common procedure and is usually considered for younger patients without arthritis.

Regular exercise to strengthen the muscles around the knee and improve flexibility can reduce the risk of meniscus tears. Key exercises include:

• Strengthening Exercises: Focus on building the quadriceps, hamstrings, and calf muscles. Exercises such as squats or leg presses help support and stabilise the knee joint.
• Flexibility Exercises: Improve the flexibility of the knee-supporting muscles with stretches like hamstring, quadriceps, and calf stretches. These stretches make it easier to move and lower the risk of tears.

Using the correct techniques during sports and physical activities can help prevent meniscus tears:

• Warm-Up: Always start with a proper warm-up before engaging in any physical activity. This prepares the muscles and joints for exercise.
• Avoid Sudden Movements: Be mindful of sudden twisting, turning, or stopping movements, which can stress the meniscus. Practise controlled and gradual movements during activities.
• Use Appropriate Footwear: Wearing shoes that provide adequate support and cushioning can help absorb shock and reduce the strain on the knee joints.

Maintaining a healthy weight can reduce the stress on the knee joints. Excess weight increases the risk of knee injuries, including meniscus tears. Consuming a diet rich in fruits, vegetables, lean proteins, and whole grains can help maintain a healthy weight. Engaging in regular physical activity also helps to control weight and strengthen muscles around the knee, providing better support.

Repetitive strain on the knee joint can lead to wear and tear of the meniscus. It is important to avoid overuse by varying activities and allowing for rest and recovery time. Alternate between high-impact activities, like running, and low-impact activities, such as swimming or cycling, to give your knees a break. Include rest days in your workouts to protect your knees from overuse.