Meniscal Tear – Have You Torn Your Meniscus?

Meniscal tears are among the most common injuries to the knee. Tears happen with any of your two menisci are overly twisted or rotated. This causes stress to the menisci, the C shaped cartilage between your shin and thigh bone. The role of the menisci is to limit over manipulation and cushion the shin and thigh bone that lie on either side.

You can have tears in any muscle, cartilage, or ligaments in your body, but the limbs are most sensitive to tears due to these being connected by joints. Each joint (connection between two limbs) represents an area for potential breakage. Some of the most common trauma to the joints occur at the ankles, wrists, and knees.

What is a Meniscal Tear?

Between your thigh and shinbone are two C-shaped pieces of cartilage (menisci). They act as cushions and provide mobility to the knee.

  • The medial meniscus, which is located on the inside of the knee.
  • The lateral meniscus, located on the outer side of the knee.
Menisci of the Knee and Common Tear Patterns

Meniscal tears are mostly caused when the knee is severely twisted or overextended. This twisting is cushioned by the menisci, but when they are torn, the cushion is no longer there.

Meniscal tears happen when ligaments are twisted beyond their capacity. This may be caused by an awkward landing, moving around on an uneven surface, or anything that twists your knee, such as pivoting and tripping. Injuries can range from mild to severe and the next section outlines their categorical requirements.

How do you know if you have a meniscal tear?

The presenting signs and symptoms may vary depending on how severe the injury is.

  • Pain, swelling, or both of the knee
  • Difficulty extending or moving knee
  • Popping Sensation in knee
  • Swelling or Stiffness
  • Pain, especially from twisting or rotating knee
  • Too much
  • Decreased ability straighten knee fully
  • Related joint symptoms such as stiffness, numbness, etc.
  • Limited movement at the joint
  • Feeling as if your knee is about to give away
  • Feeling as though your knee is locked in place when you try to move it

Sprains can be classified into three Grades:

Grade 1 [Mild]:

  • The tear is minor localized to one area
  • Knee pain is tolerable when walking

Grade 2 [Moderate]:

  • there is an incomplete meniscal tear
  • there is moderate pain, swelling, and stiffness
  • limited range of knee motion

Grade 3 [Severe]:

  • the menisci are completely torn
  • there is severe pain, stiffness, and swelling
  • there is a complete block to knee motion, making walking an impossible
ParametersGrade IGrade IIGrade III
What happens to the ligament?Slight stretchingMinimal tearingComplete tearing
Loss of range of motionMildModerateComplete loss
Loss of Strength0 to 25%25 to 75%75 to 100%
SwellingMay not be present or slight swellingPresent (++)Extensively swollen (+++)
Table 1: Grades of Meniscal Tears

Medial meniscus tears appear in a variety of patterns:

  • Longitudinal
  • Bucket-handle
  • Displaced bucket handle
  • Root detachments
  • Parrot beak
  • Radial
  • Displaced flap
  • Horizontal
  • Degenerative
Types of Meniscus Tears

Diagnosis

A doctor does a physical exam, prior to diagnosis of meniscal injury. When you arrive,
you will be asked to rotate your knee and extend it as much as possible. This is so
that the doctor can check the extent to which your knee is injured.

Next, you will be asked to rate from 1-10. 1 being least painful and 10 being unbearable pain. After a physical exam, and questioning, the doctor will have a better idea of the location, nature, and extent of the damage. To aid in this, the doctor may request imaging from the lab. Some of these are listed below.

X-rays are used to examine the areas of the body and are particularly helpful in
looking at bones and joints. An X-ray is the simplest form of visualization, and can
usually show most tears, and breaks.

Magnetic Resonance Imaging or MRIs are used when the X-rays do not provide
clear or sufficient data. The MRI gives more specific imaging data, and shows soft
tissues, like meniscal disks, clearly. This produces clear imaging for tears and
severe joint damage.

Meniscal tear grading. The schematic diagrams on the top depict meniscal tear grades with corresponding sagittal MR images on the bottom. Grade 0, normal intact meniscus; Grade I, intrasubstance globular-appearing signal not extending to the articular surface; Grade II, linear increased signal patterns not extending to the articular surface; Grade III, abnormal signal intersects the superior and/or inferior articular surface of the meniscus, an arthroscopically confirmable tear. Red arrows indicate tear location.

[Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]

CT scans are ordered to visualized even more severe, or delicate damage. These
scans provide 3-d imaging of the bones and tissues in the body. This type of imaging
is usually reserved for the brain, as it is difficult to easily visualize brain and skull
trauma.

Treatment and Home Remedies

There are many ways to treat meniscal tears. The more severe the tear, the more invasive the medical attention that will be required to heal.

A Grade 1 meniscal tear can be managed using the RICE (Rest Ice Compression Elevation) method. More severe tears require medical attention.

RICE

Rest. Avoid moving the knee, specifically movements that cause any pain.

Ice. Ice you’re your knee 15 to 20 minutes, every 2 hours during the first 24 to 48 hours.

Compression. Use an elastic bandage to provide compression on the swollen knee. Start wrapping clockwise from the back of the knee. Loosen the wrap if necessary, to ensure that there is proper circulation. If pain increases, loosen the wrap even more.

Elevation. Position the knee above your chest. This will allow gravity to aid in the healing, by drawing the blood away from the injured area. This will reduce swelling and help to manage the pain.

Medications

Your doctor will prescribe you anti-inflammatory medication to manage pain and reduce swelling. Over-the-counter medication like NSAIDs, can also help, but may increase risk of bleeding and ulcers. Consult your doctor before taking any of these.

Therapy

A physical therapist can help with designing activities to help improve flexibility, stability, balance, and strength. You can also perform stretches and strengthening exercises on your own to aid in recovery.

Devices

Depending on the injury, your doctor may recommend you use crutches, wear splints or brace, elastic bandages, wraps, and tapes.

Prevention

  • Prevent re-injury. If you are involved with sports, appropriately wrap, tape, or splint to reduce the likelihood of reinjury. Avoid wearing high heels unless necessary.
  • Be active. Exercise regularly to maintain flexibility and muscle strength. Include balance exercises and stability training in your routine.
  • Be cautious. Be mindful of the surfaces you are walking on andperforming exercises on.
  • Do not skip on warm-ups. Make sure to do stretches to prepareyour body before a workout
  • Take breaks. When you anticipate working for long hours orperforming the repetitive motion, take a break if you feel tired and perform quick stretches when possible.
  • Invest in good gear. If you plan on exercising regularly or gettinginvolved in sports, invest in good sports gear and shoes. Worn-out and poorly made equipment do not provide stability and support that your knee needs.

Risk Factors

While anybody can have a meniscal tear at any point in their life, certain risk factors increase the chance of you getting a meniscal tear. These include:

  • Environmental Factors. Uneven and slippery surfaces increasethe risk of accidents and slips that might result in knee twisting.
  • Improper Footwear. Some shoes increase the risk of injury because they are ill suited for the activity the wearer is undergoing. Sometimes shoes lack the proper ankle support, which can increase the risk of knee injury.
  • Participating in Sports. Meniscal tears are very common in sports.Injury is common because many sports require repetitive pivoting movements, such as basketball, tennis, football, and soccer.
  • History of Knee Injury. If you’ve had a past injury to your knee,there’s a greater risk of future injury.
  • Lack of Warm-Up. Warming up prepares the body formovement and increases your body’s flexibility, which reduces the chance of injury. You can warm up by taking a quick stretch before a jog or exercise.  
  • Using Improper Gear or Equipment. Ill-ftting and worn-out gearor sporting equipment will increase your chance of injury.
  • Being Tired. Like lack of warm-up and poor conditioning, beingworn-out would likely lead to utilizing a poor form. Moving with poor form increases the chance of getting injured and putting undue stress on structures.
  • Age. The older you get, the more your risk your joints have of injury. As it relates to your knee, the meniscal tissue degenerates overtime. Thus, as you grow older you are at higher risk of injury.
  • Poor Conditioning. If you haven’t exercises or used your muscles and joints in certain ways before it means that these may not be prepared to support and meet your demands. This increases risk of injury. 

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