Meniscal injuries are a very common cause of knee pain. They can result in tears and are very common among sports injury. Meniscal tears can vary widely in severity and pain.
Meniscal tears are a particularly common injury among athletes playing contact sports, or any sport that involves twisting of the knee. Meniscal tears frequently occur alongside other knee injuries—most frequently along with an ACL tear.
The knee joint meniscus is a thick, rubbery, flexible piece of cartilage that provides cushioning between the bones in the knee, it’s also aids congruency of the joint. There are actually two menisci in each knee, as seen in the image above. Together, the meniscus functions to reduce shock and absorb the amount of impact on the leg and knee when in motion or standing, to provide stability to the knee, and to facilitate smooth motion between the surfaces of the knee. If a meniscus is torn or damaged and does not provide its function correctly, then more force is placed on the cartilage of the bones, which in turn makes it more prone to wearing and inflammation, a condition known as knee osteoarthritis.
Sports Injuries and Meniscal Tears
Common causes of a meniscal tear in sports include:
Impact on the knee can cause meniscus injury. Excessive rotation at the knee is the most common cause of meniscal injury. This type of injury is common in sports such as football, where the foot is often planted and the body is still moving. Injury can also occur where rapid stepping is required or squatting on an uneven surface. This can cause alteration in forces through the knees, leading to tears or ruptures of the meniscus. This movement might occur while running in cross country, sprinting drills, or falling awkwardly i sport. Unexpected, quick force can lead the knee joint to flex too far back and tear the meniscus. Occasionally the anterior cruciate ligament (ACL) can also be involved.
Degenerative Meniscal Tears of the Knee
As we age, the cartilage that the meniscus is made of becomes less resistant to excessive forces, allowing for injury, pain and inflammation even when there is less dramatic activity or impact. Individuals or professionals with a degenerative joint condition who engage in certain activities are susceptible to developing a meniscal tear.
Degenerative conditions, such as knee osteoarthritis, can also cause tears in the meniscus over time. In osteoarthritis the cartilage and the meniscus are weaker, allowing it to be torn with greater ease. Occupations or activities that involve repetitive stepping or squatting can strain the mesiscus, especially over time. For example, plumbers and carpet fitters are more susceptible to knee injuries such as a meniscal tear.
Common symptoms of a meniscal tear
Localised pain at site of the meniscus tear
Immediate pain after the injury (acute) - tearing of the meniscus may be associated with a pop sound within the leg during an overexerting twisting or stretching motion.
Slow onset of symptoms - in some cases the meniscus can tear without much of a sign or initial pain. This slow onset of symptoms is more common in older individuals with degenerative joints.
Pain with movement or locking
Swelling within the joint
Types of meniscus tears
Flap tear - tearing that occurs in the inner tissue away from the edge and causing a flap. Degenerative tear - with a degenerative tear, progressive damage to the meniscus over time.
Bucket handle tear - a bucket handle runs between the outer edge of the meniscus and the inner tissue. As the edge of the meniscus is separated from the rest of the cartilage, if the torn piece of cartilage were lifted up the shape of a bucket handle is formed.
Radial tear - here a tear occurs on one edge of the meniscus and moves into the tissue.
Treatment of Meniscus Tears
The severity and location of the tear will be of great importance in determining the correct treatment. For example, the outer third of the meniscus has a richer blood supply than the interior tissue, and injuries there will heal faster as the blood brings healing nutrients to the injured tissue. Furthermore the medical history of the individual’s level of athleticism and desire to return to sports will all be taken into consideration.
Common conservative treatments for meniscal tears
RICE Rest, ice, compression, elevation. This initial approach will help to reduce swelling few hours and days following the injury.
Anti-inflammatory medication A type of non-steroidal anti-inflammatory medication (NSAID) ,may be given to reduce swelling.
Physical rehabilitation therapy The goals to control pain and swelling, help restore the normal range of motion to the knee, improve strength in the muscles that support the knee.
Injections Corticosteroid injections into the knee joint may be used in order to relieve pain or inflammation in the soft tissue of the knee.
In some cases surgery may be required to remove damaged tissue or repairing it.
Meniscectomy - for most tears, the damaged portion of the meniscus will be removed and then sutures will be used to reaffix the disc together. This is referred to as a partial meniscectomy.
Menisci is an exquisitely complex structure and plays an essential role in weight-bearing of the knee joint. A torn meniscus is one of the most common knee injuries which can result in pain and mechanical abnormalities, resulting in dysfunction. As mentioned above the tear location is one aspect which determines natural healing. Tears that occur in the peripheral layers have the potential to heal better due to the region having a better blood supply, while the healing capacity is more limited in the inner areas due to having a poor blood supply. Meniscectomy was once widely performed, but led to poor radiographic and patient-reported mid-and long-term outcomes. After the advent of arthroscopy, orthopaedic opinion in the 1980s has been swaying toward salvaging or repairing the torn meniscus tissue to prevent the increased risk of joint degeneration and osteoarthritis, rather than performing meniscectomy. It is evident, the younger the individual the better.
Biological treatment and meniscus tissue engineering strategies are now frequently being used to enhance the rate of healing and repair the meniscus. Preclinical and clinical studies have shown that introduction of technique in regenerative medicine and related growth factors have the potential to enhance meniscus repair. The below article reviews the current state of clinical management of meniscus tears (primary repair) as well as biological techniques to improve healing by meniscus.
Is PRP an Effective Treatment for Meniscus Tears?
A recent study examined the effectiveness and safety of intrameniscal platelet rich plasma injections for chronic meniscal tears. It was a randomised, double-blinded, placebo-controled study that included 72 patients.
The mean followup was 92 weeks. An MRI was performed at 33 weeks. The key results:
Failure rate was lower in the PRP group (48%) versus the control group (70%). Meniscus healing was higher in the PRP group (52%) versus the control group (30%).The necessity for arthroscopy was decreased in the PRP injection group (8%) when compared to the control group (28%).
The below study assessed platelet-rich plasma therapy having a lower risk of meniscus repair, reporting that PRP preparations had a substantial protective effect on isolated meniscus repair failure risk over three years.
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