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A meniscus tear or torn cartilage in the knee is one of the most commonly occurring knee injuries. It affects as many as six patients out of 10 over the age of 65, and is common among athletes who play football and other sports that require jumping and cutting, such as volleyball and soccer.
The largest joint in the body, the knee facilitates leg bending and the performance of a range of activities including walking, running, jumping and climbing. Cartilage in the knee stabilises and cushions the joint from the stress of these activities. The meniscus is part of the cartilage structure that protects the knee from injury.
Positioned at the top of the knee’s tibia bone, the meniscus can tear with a blow to the side of the knee or a sudden change of direction that causes the knee to twist.
Not necessarily confined to a single event, however, meniscus tears can occur as a result of overuse and ageing. Known as degenerative meniscal tearing, there may be no precipitating event that causes trauma to knee and it can instead be the result of an age-related decrease in both cartilage and blood supply to the joint.
A meniscal injury is often accompanied by a popping sensation. The onset of pain, swelling and joint stiffness/knee locking may not occur right away, and it is not uncommon for athletes, for instance, to be able to complete their activity before becoming aware of the damage.
Depending on the size and location of the tear, many meniscal tears do not cause any symptoms or problems.Diagnosing a meniscus tear
Your healthcare professional will initially carry out a physical examination of your knee. By assessing the knee’s range of motion, the stability of the ligaments and other diagnostics, they may be able to distinguish whether you are suffering from a torn meniscus.
The diagnosis can be confirmed with magnetic resonance imaging (MRI), a non-invasive procedure that provides an image of the inner structure of the knee including the cartilage, ligaments, muscles and tendons that surround the knee joint.
While traditional X-rays cannot identify meniscal tears, an X-ray may be done to assess cartilage wear and other possible causes of knee pain, including arthritis.
There are a number of factors that affect how the injury is treated. These include where the tear is and its size, as well as your age, level of activity and any related injuries. As a result, the treatment route is individualised or assessed on a case by case basis.
Small tears that occur on the outer part of the meniscus (sometimes referred to as the “red zone”) can often heal on their own because there is an ample blood supply. Injuries in the deeper structure of the meniscus, however, where there isn’t such a good blood supply, often require treatment including surgery.
For tears that do not require surgery, the RICE protocol is followed. The acronym stands for Rest, Ice, Compression and Elevation. You will be advised to rest your knee by limiting your physical activity to walking and possibly using a crutch to balance the pressure and relieve pain. Ice can be used to reduce swelling and the recommendation is that ice packs be used for a few days every 3-4 hours for 15-20 minutes at a time.
An elastic compression bandage is used to control swelling and prevent blood loss to the knee. Your health practitioner will suggest elevating your knee with a pillow under your heel when sitting or lying down. Non-steroidal anti-inflammatory medications (NSAIDS) like Nurofen and Aleve can help with pain and swelling once you are not at an increased risk of internal bleeding and ulcers. A physical therapist can give guidance on stretching and strengthening exercises to help support healing of your knee.
For large tears or when the stability of the knee is compromised, surgery may be required to repair the knee. Knee arthroscopy is the most common form of surgery, where a miniature camera is inserted through a small incision in the knee to get a clear view of its interior. Before the use of imaging scans like the MRI, arthroscopy was used to confirm the diagnosis of a meniscus tear. An orthopaedic surgeon uses miniature surgical instruments through other incisions to sew the torn edges together and trim the torn area, with a focus on maintaining as much cartilage as possible.
Another surgical option is Microfracture surgery, where holes are made on the surface of the bone to stimulate the growth of new cartilage.
In some cases, it becomes necessary to remove part of or the entire meniscus.
After surgery, the knee is put in a cast or brace and you may need crutches for up to a month to keep pressure off the knee.
For the large majority of people who have surgery for a meniscus tear, the short-term recovery is good, if not excellent. Those with large meniscal injuries that resist treatment though are at a greater risk of developing arthritis of the knee.
If a non-surgical approach to treatment has been taken, the pain and swelling from torn cartilage in the knee can subside within a few days. Ensuring joint stability will take longer, however, and you will be advised to maintain a healthy weight and to do activities such as swimming which don’t put a strain on the knees, but strengthen the surrounding muscles.
Full recovery from surgery can take 6 weeks to 3 months depending on which procedure is done. Physical therapy keeps the focus on returning the full range of motion to the knee and strengthening the muscles that surround the meniscus. It would be inadvisable to return to your old level of activity before the swelling is completely reduced and it is no longer painful to fully bend and straighten your knee or walk, jog and sprint.
Preventing torn cartilage in the knee can be difficult, especially in the case of unforeseen accidents. Maintaining a healthy weight, keeping your knees flexible and ensuring strong leg muscles, can alleviate the impact of decreased cartilage as you grow older. The same recommendations apply after a meniscal injury, as damaged cartilage never returns to its original form.
There are some precautions you can take to avoid knee injury, particularly when exercising. These include warming up sufficiently before strenuous exercise, slowly building on the intensity of your workout and allowing for breaks between workouts to rest fatigued muscles that are at greater risk of injury.