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Meniscal Injury
Dr. Ambrose Yung
What is a Meniscal Injury?
A meniscal injury refers to damage to the meniscus, a C-shaped cartilage structure located in the knee joint.
The meniscus acts as a cushion between the femur (thigh bone) and the tibia (shin bone), helping to absorb shock and stabilise the knee. Meniscal injuries often result from twisting or sudden movements, particularly during physical activities like sports. These injuries can result in pain, swelling, and limited knee mobility.
Symptoms of Meniscal Injury
Meniscal injuries can cause noticeable symptoms, which may develop immediately after an injury or gradually over time. The severity of symptoms varies depending on the type and extent of the tear, however, common symptoms include:
- Knee Pain
When the meniscus is torn, it can no longer distribute weight evenly across the knee joint. This imbalance puts pressure on specific parts of the knee, causing pain, especially during activities that involve twisting, squatting, or rotating the knee. Pain is often felt on the inside or outside of the knee, depending on which meniscus is injured. - Swelling
Damage to the meniscus triggers inflammation in the knee joint. As part of the body’s healing response, fluid may accumulate around the injured area, causing noticeable swelling. This swelling usually appears within 24 hours of the injury but can persist for longer if the tear is not treated. - Restricted Movement
A torn meniscus can get caught between the bones of the knee joint, preventing it from moving smoothly. This can cause a locking sensation where the knee temporarily “freezes” and cannot be straightened or bent easily. The knee may also feel as if it is catching or grinding during movement. - Instability
The meniscus helps stabilise the knee by distributing weight and providing structural support. An injury can lead to a feeling of instability because the knee joint is no longer functioning smoothly, making the knee feel like it may give way, especially when walking or putting weight on the affected leg.
Causes of Meniscal Injury
Meniscal injuries can result from several common causes:
- Sudden Knee Twists: Quick changes in direction during activities such as football, basketball, or skiing can tear the meniscus, particularly when the foot is planted and the knee twists.
- Direct Impact or Trauma: A hard blow or collision to the knee, common in contact sports or accidents, can cause direct damage to the meniscus.
- Age-related Degeneration: As the meniscus weakens with age, it becomes more prone to tearing, even with minor movements. Degenerative tears are common in people over 40.
- Overuse from Repetitive Activities: Frequent knee stress from repetitive movements, such as squatting or kneeling, can wear down the meniscus over time.
- Pre-existing Knee Conditions: Osteoarthritis or previous knee injuries, such as ACL tears, increase the risk of meniscal injuries due to joint degeneration or instability.
Types of Meniscal Injury
Meniscal injuries can vary in severity, ranging from minor strains to full tears. The main types include:
Meniscus Strain
A mild injury where the meniscus fibres are overstretched but not torn. It may cause discomfort and inflammation without significant damage.
Partial Meniscus Tear
A more serious injury where part of the meniscus is torn but not completely separated. This can cause pain, swelling, and occasional knee locking or instability.
Full Meniscus Tear
A severe injury where the meniscus is completely torn. This results in significant pain, swelling, knee locking, and instability and often requires surgical intervention to restore knee function.
Diagnosis
Diagnosing a meniscal injury involves both clinical evaluation and imaging tests to confirm the severity and location of the injury.
- Physical Examination: The doctor assesses knee movement, stability, and tenderness around the joint. Specific manoeuvres may be used to rotate and bend the knee to check for pain, clicking, or locking, which can indicate a meniscal tear.
- Imaging Tests: An MRI is commonly used to provide detailed images of the knee’s soft tissues, helping to confirm the location and extent of the meniscal injury. X-rays may be used to check for other issues like fractures or arthritis, but they do not show the meniscus.
- Arthroscopy: In some cases, arthroscopy is used to diagnose and treat meniscal injuries. This minimally invasive procedure involves inserting a small camera (arthroscope) into the knee through a small incision, allowing the doctor to view and address the tear in real time. Arthroscopy can also treat additional issues such as ligament or cartilage damage.
Treatment Options
Non-Surgical Treatment
Non-surgical treatments aim to manage pain and inflammation while promoting natural healing. They are the first line of treatment, particularly for mild meniscal injuries or strains.
- Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen, are commonly used to reduce pain and swelling in the knee following a meniscal injury. These medications help manage discomfort, allowing patients to carry out daily activities more comfortably.
- Physical Therapy: Physical therapy strengthens the muscles around the knee, improving joint stability and mobility. By targeting specific muscle groups, it supports the healing process and helps prevent further injury. However, exercises that are too intense or performed incorrectly can worsen the injury, so it is necessary to follow a proper rehabilitation programme.
Surgical Treatment
Surgical treatments are considered when conservative measures fail or the injury is too severe to heal on its own. Procedures for meniscus injuries include:
Partial Meniscectomy
A partial meniscectomy involves removing only the damaged part of the meniscus. This procedure relieves pain and restores mobility, allowing the knee to function more normally. However, removing part of the meniscus reduces the cushioning in the knee, which can increase the chance of developing arthritis in the future.
Meniscal Repair
In meniscal repair, the torn portion of the meniscus is stitched back together. This approach preserves more of the meniscus, helping to maintain knee stability and reducing the chances of future joint problems, like arthritis.
Arthroscopy
Arthroscopy allows direct visualisation and treatment of meniscal injuries through small incisions. It offers a faster recovery and a reduced risk of infection compared to traditional open surgery.
Prevention of Meniscal Injury
While not all meniscal injuries can be prevented, certain measures can reduce the risk. Strengthening the muscles around the knee, especially the quadriceps and hamstrings, through regular exercise stabilises the joint and protects the meniscus. Stretching before physical activity improves flexibility and maintaining a healthy weight reduces stress on the knees, lowering the chance of injury.
For those recovering from a meniscal injury, managing the condition involves following a proper rehabilitation plan. Physical therapy helps rebuild knee strength and restore full mobility. Avoiding activities that put excessive stress on the knees helps prevent further damage. Wearing proper footwear and using knee braces during physical activities may also help prevent re-injury.
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Spire Hip & Knee Centre
6 Napier Road #08-04
Singapore 258499
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Spire Orthopaedic Physiotherapy & Rehab Centre
101 Irrawaddy Road, #18-03
Singapore 329565
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Saturday: 9.00am – 1.00pm
Sunday & PH: CLOSED
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Frequently Asked Questions (FAQ)
Can a meniscal tear heal on its own without surgery?
In some cases, especially with small tears located on the outer edge of the meniscus where there is more blood supply, the tear can heal on its own with rest, physical therapy, and treatments such as ice and compression. However, larger or more severe tears, particularly those in areas with poor blood flow, may require surgical intervention for proper healing.
How long does it take to recover from a meniscal injury?
Recovery time varies depending on the severity of the injury and the treatment method. Non-surgical recovery may take a few weeks to a couple of months with proper rehabilitation. Recovery from surgical treatments, such as meniscal repair, may take several months, as the meniscus needs time to heal and regain strength. Partial meniscectomy usually has a shorter recovery time, with many people resuming normal activities within a few weeks to a couple of months.
Can I still participate in sports after recovering from a meniscal injury?
Yes, many people can return to sports after recovering from a meniscal injury, but it depends on the severity of the injury and the type of treatment received. Physical therapy and proper rehabilitation are essential for restoring strength and mobility in the knee. High-impact sports, such as football or basketball, may take longer to resume, as they involve sudden movements that stress the knee. A physical therapist can guide you on when it is safe to resume sports and how to protect your knee from further injury.