The meniscus is a cartilage disc that cushions your knee and aides to absorb shock and stabilize the knee joint. Each knee has 2 menisci; 1 on the medial (inner) part of the knee and 1 on the lateral (outer) part of the knee. Meniscal injuries may be either traumatic or degenerative in nature. In the acute phase of the injury, patients may have difficulty weight bearing through the injured leg, and pain with walking and squatting activities. Oftentimes, patients may experience a feeling of the knee “locking” or “giving out” along with audible “popping” sounds.
Meniscal injuries may be either, acute, degenerative, or traumatic in nature. Traumatic tears can happen when there is a high impact activity that could cause rapid movements and often involves bending or sudden twists. Degenerative Injuries are often the results of a gradual thinning of the meniscus, often followed by a relatively small force which can cause a tear.
When individuals suffer a meniscus tear, they often hear a popping sound at the injury location. After the injury has occurred, there is often swelling that can take place within the next 24 to 72 hours and over time the knee will become stiff or have a limited range of motion.
Just after a meniscus injury has occurred, some weight-bearing can take place but might fade with time and cause an unsteady feeling as the knee can “give way”. Additional symptoms that a patient could experience include a locking sensation where it appears that the knee will not be able to bend or straighten properly.
During your Physical Therapy evaluation, your physical therapist with conduct a thorough examination reviewing your injury and symptoms. They will also perform special tests that apply stress to the meniscus to determine if the meniscus is injured. Based on the results of the exam, a referral for further diagnostic testing may be indicated, such as magnetic resonance imaging (MRI) or a consultation with an orthopedic surgeon.
Patients with meniscal tears often benefit from physical therapy without requiring surgery. Initial treatment will focus on reducing pain and swelling, and restoring joint mobility using manual techniques and modalities such as, ultrasound and ice. NMES (neuromuscular electrical stimulation) may also be used to stimulate muscle activation and motor function.
Your therapist will also design a strengthening program specific to your condition as well as exercises to perform at home. These exercises will assist in keeping pressure off the healing meniscus. As you progress in your treatment, your physical therapist will design a fitness and conditioning program tailored to return you to your previous activity level.
For large tears, a surgeon may repair or remove the meniscal. The downside to surgical intervention is that it often speeds up degenerative changes in the knee and increases the likelihood of needing a total knee replacement later in life. Physical therapy intervention focuses on joint mobilization techniques aimed at restoring normal movement. Once this is achieved, further treatment strengthens the quadriceps, calf, hamstring and gluteal muscles to prevent recurrence and decrease further stress on the meniscal structures. Ultrasound, ice, and electrical-stimulation help decrease inflammation in the initial stages of treatment. A knee brace may provide additional support.
For more serious tears or patients who do not respond well to physical therapy initially, may require surgery to have the injured cartilage tissue removed, called a menisectomy, or may have the meniscus repaired. The downside to surgical intervention is that it often speeds up degenerative changes in the knee and increases the likelihood of needing a total knee replacement later in life.
This is a simple arthroscopic procedure in which the surgeon removes the injured meniscus tissue followed by a course of Physical Therapy. Treatment will focus on pain and swelling reduction, restoring joint mobility, strengthening, and normalizing your gait. Most patients are able to return to their prior level activities within 4 – 6 months of the surgery.
Depending on the size and location of the tear, your orthopedic surgeon may elect to repair the torn meniscus. This procedure may reduce the risk of developing knee arthritis later in life. The rehabilitation process is slower and more extensive in nature in order to allow the repaired tissue time to heal. During this time, your interventions will consist of pain and swelling reduction using manual techniques, compression wrapping and ice, in addition to restoring muscle strength and joint range of motion.
Your therapist will also be guiding you with weight allowance through your surgical knee during gait training and teaching you mobility strategies while using your crutches. Return to previous activity will be based on the extent of the surgery and the surgeon’s preference for progressing to full weight bearing without using crutches.
Currently, there is minimal research that suggests that exercises or other inventions, like bracing, will help prevent meniscus tears. However, it is suggested that you participate in routine strengthening and conditioning activities to keep your legs and knees healthy and strong. You will also want to avoid activities that involve planting your foot with sharp turning and twisting motions, movements that place stress on the meniscus.