What is the Function of the Meniscus?
Each of your knees has two C-shaped menisci, one on the inner side – the medial meniscus and one on the outer side – the lateral meniscus. The menisci are fibrous cartilage that act to distribute force across the knee joint while you are weight bearing. In their absence, uneven weight distribution could cause the development of abnormal or excessive force and early damage of the knee joint. The menisci also contribute to joint stability, shock absorption, joint glide, prevention of hyperextension, and nutrition and lubrication of the articular cartilage.
What is a Meniscus Tear?
Meniscus tears are the most common intra-articular knee injury and are the most frequent cause of orthopaedic surgery. In younger populations, sports-related injuries are the most common cause of meniscal injuries accounting for more than 30% of all cases. Forceful twisting or sudden stops may cause pinching or potentially tearing of the cartilage of the meniscus. As a result, the mechanism of injury typically involves high-speed cutting or twisting or high force movements while weight-bearing on a bent knee.
Damage to the meniscus often occurs alongside other ligament injuries, especially when the medial meniscus is involved. Sports-related meniscal injuries are accompanied by ACL injuries in over 80% of cases. This is partly because your medial meniscus has attachments to other structures in your knee and partly due to high impact forces more often being directed towards the outside of your knee in sporting contexts. Lateral forces being applied to your knee causes your lower leg to externally rotate relative to your thigh and can place your medial meniscus in a vulnerable position. As such, injuries to the medial meniscus occur at a higher rate compared to the lateral meniscus.
Damage to the meniscus can also occur in a degenerative manner. Degenerative tears can occur with minor movements and patients typically experience repetitive swelling but can’t recall a specific injury. The risk of developing a torn meniscus increases with age as cartilage undergoes age-related changes in blood flow and resilience. Increasing body weight also increases the risk of degenerative tears. It is estimated that 60% of patients above the age of 65 years old have a degenerative meniscus tear, however more than 50% of meniscal tears are asymptomatic.
What are the Symptoms of a Torn Meniscus Perth?
After a meniscus tear the knee joint will typically be painful and swollen with some movement restrictions. As the irritation gradually settles after an initial inflammatory response, symptoms typically include:
- Swelling and a feeling of tightness in your knee
- A popping sensation, often when using stairs
- Pain with long distance running or walking
- A sensation of instability
- Catching/locking where the knee cannot be fully straightened.
What are the Different Types of Meniscal Injuries Perth?
A physical exam may be able to diagnose whether there is damage to the medial or the lateral meniscus, however further procedures like MRI or arthroscopy are needed to classify the specific location and type of tear. Tears in the meniscus are usually described based on their anatomical location and by their appearance. Most meniscal tears are classified as either: vertical, longitudinal (bucket-handle), transverse, or degenerative. Knowing the location of the tear is another important factor in deciding the best course of management. The meniscus has variable blood supply to different regions, with more blood supply being associated with higher potential for recovery. The meniscus is broken down into three different zones based on its vascularity.
- Red zone: the outer perimeter of the meniscus which receives adequate blood supply.
- Red-White zone: the mid-zone of the meniscus where blood supply is decreased.
- White zone: the innermost portion of the meniscus which has almost zero vascularity.
Lastly, meniscal tears are classified based on their thickness. A tear is considered complete if it goes all the way through the meniscus, if the tear is still attached to the body of the meniscus, it is considered incomplete. Complete tears are additionally subdivided into stable and unstable tears, a stable tear does not move and has an increased probability of healing on its own, unstable tears allow the meniscus to move abnormally and are more likely to require surgery.
What is the Best Treatment for Meniscus Tear Perth
When determining treatment for a meniscus injury factors that must be considered include:
- Activity level
- Location and type of tear
- Any other associated injuries (such as the ACL)
The primary options after a meniscus injury are non-operative rehab, surgery to trim out the area of the meniscus that is torn, and meniscal repair. There are other procedures such as trephination/abrasion to aid healing in the meniscus and meniscal replacement however these are rarely used and still require further long-term follow up studies.
Do you Need Surgery to Repair a Torn Meniscus Perth?
Most guidelines refrain from recommending surgery as the first-line treatment and instead prefer non-operative management such as Physiotherapy. Especially in degenerative tears. Patients who utilise exercise and Physiotherapy as a first-line treatment tend to have similar or better outcomes in terms of strength and perceived knee function compared to those who undergo surgery.
Many smaller tears in the meniscus will heal without surgical treatment. Partial tears, degenerative tears, and stable tears are typically treated with 2-3 months of supervised rehab, and if symptoms improve or disappear within 3 months then surgery is unnecessary. More recently, studies have compared APM to placebo surgery and have found no evidence to support the benefit of APM over non-operative management. Current best practice advocates for surgery only after a failed attempt of non-operative treatment.
Arthroscopic partial meniscectomy (APM) is typically used for tears in the inner portions of the meniscus where there is little-to-no blood supply. The goal is to stabalise the meniscus by removing the torn portion. Complete meniscectomy involves the full removal of the damaged meniscus. This is only done when deemed absolutely necessary as it associated with development of degenerative changes in the knee joint. Meniscal repair is performed on tears near the outer 1/3 of the meniscus where there is good blood supply, or on large tears that would otherwise require total removal. The torn portion is repaired using sutures or an absorbable fixation device that joins the torn edges of the meniscus allowing them to heal. There is a growing body of research that supports repair techniques for treating red zone tears. Successful outcomes in young individuals with stable knees are fairly frequent with success rates varying from 63-91%, however the successful application of repair in older populations is less promising.
How can Trained Physio help with a Torn Meniscus?
Rehab and Physiotherapy are necessary after a meniscal injury to restore range of motion, strength, movement control, and normal activity. There may be a period where range of motion is restricted, especially while weight bearing, in order to protect the recovering meniscus. Rehab focuses on regaining full range of motion and functional progression without aggravating symptoms associated with the injury. A supervised rehab program has been shown to significantly reduce the amount of time a patient spends on crutches and reduce losses in range of motion.
Most rehab protocols contain three phases. Time frames, restrictions, and precautions are included in each phase in order to allow for tissue healing. While general time frames are typically given for reference, rehab plans must be individualised based on your specific injury.
Phase one – aims to gradually wean you off of crutches while exercises aim to restore knee extension and leg control. This is considered a protective phase for your knee and typically involves gentle range of motion and quadricep exercises. Progression to phase two is typically around 4-6 weeks when you are able to walk pain-free without crutches and your knee is no longer swollen
Phase two – aims to establish single leg control and good biomechanics in functional movements, such as stairs and squats. Phase two consists of non-impact balance and proprioceptive drills, and strengthening of the core, hips and quadriceps. Progression requires the ability to carry out functional movements with good control and without pain or unloading of the affected leg.
Phase three – aims to develop neuromuscular control and tissue tolerance with sport specific movements, including impact. Movement drills progress to higher speed, multi-plane activities while strength and control drills become more difficult and sport specific.
How Trained Physio can Help
Trained Physio allows you to improve your body’s capacity to endure higher training and competitive loads as well as improve several markers of running performance. With stronger muscles, connective tissues, joints and more resilience to fatigue, you can spend more time on the road doing what you love and less time dealing with injuries. At Trained Physio Perth we have a special interest in meniscus repair surgery and conservative management. Not only do our Physio Perth have an eye for diagnosing and treating sport specific injuries, but we have a fully-equipped 24/7 gym to utilise for rehabilitation, injury prevention, and general strength & conditioning.
What you can expect from Trained Physio:
- Thorough assessment and treatment of your injury
- Comprehensive exercise rehab from the date of your injury, through to your return to full activity
- Assessment into why the injury occurred in the first place, and what can be done to keep you injury-free
- Manual therapy, dry needling and other treatment-specific techniques as needed
- Training modifications to keep you as active as possible whilst undergoing rehab (if necessary)
- Use of our fully equipped rehabilitation facility for exercise rehab
Patients who undergo non-operative management tend to have similar to better outcomes in terms of strength and perceived knee function compared to those who undergo APM. Current guidelines advocate for surgery only after a failed attempt of conservative treatment and there is currently no evidence to support the benefit of APM over non-operative management.
In surgical context, those who have meniscus repair have similar to better perception of their knee function, lower levels of activity loss, and higher rates of return to sport when compared to those who have APM.
Whether a patient undergoes surgery or non-operative management, rehab is absolutely necessary to obtain the best outcomes. A structured rehab program improves symptoms, range of motion, muscle function, coordination, and reduces the risk of further injury.
East Perth Trained Physio
East Perth Physio has several goals including promote healing, reduce pain, avoiding aggravation, optimising physical function and global strengthening to restore normal movement patterns. To see how we can help you BOOK ONLINE TODAY