If you suffer from ongoing knee stiffness and pain on twisting the knee, then the medial meniscus in your knee joint may be torn. The meniscus is a C-shaped wedge of fibrocartilage material that sits between the tibia and femur bones within the knee joint. Its job is to act as shock absorber between the femur and tibia bones in the knee joint by helping the joint to cope with the load pressure of the body during weight bearing movements of the knee. It also helps stabilise the knee joint.
Meniscus injuries can be either located on the periphery or outer area of the C-shaped meniscus or alternatively that can be found more centrally or deeper within the medial meniscus. Peripheral meniscus tears are more favourable due to the good blood supply in this area and thus can heal quicker, however central or deeper meniscus tears are located in a region of the meniscus that has no direct blood supply, hence it has poor healing qualities.
Actions that cause medial meniscus to tear:
Turning the foot outwards with the knee partially bent whilst receiving direct trauma to the outside of the knee
Hyper-flexion of knee such as squatting down on your knees, common amongst Miners and tradesmen working in confined spaces that require squatting such as attics. Older people can suffer meniscus injuries from continuous kneeling motions.
Signs & Symptoms
When the injury occurs, the patient feels that something had ‘given way’ in the knee joint often with accompanying sickening deep type of pain on the inside area of the knee.
After the initial injury, symptoms would include;
Walking or standing for short durations aggravate the knee pain
Temporary Locking of the knee joint can occur due to a torn particle of the meniscus becoming stuck in the knee joint.
Swelling may be present
Pain is increased by a) attempting to fully bend or straighten the knee, b) turning the foot outwards in a seated position (knee is bent to approx 90 degrees)
Wastage of quadriceps muscles overtime
If there is a suspected long-term medial meniscus tear the patient may complain of great difficulty when attempting to squat down on their knees, b) pain with changing direction when running at speed, c) a popping sensation can be felt in the knee with a conscious feeling that knee joint is unstable.
Treatment & Management
Medial meniscus tear will in the majority of cases require surgical resection by the Orthopaedic surgeon with every effort been made to minimise loss of any portion of the meniscus as this would lead to joint degeneration. Patient will be walking with the aid of crutches for the initial 7-14 days depending on the severity of the tear. Routine application of ice to reduce inflammation is essential. The patient is then introduced to a graded exercise program by the physical therapist with the goals of slowly achieving range of motion in the knee joint with progressive levels of strengthening & balance exercises gradually being introduced.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles. Contact Number: 0504 26672
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Physiotherapy & Injury Rehabilitation Clinic in Tipperary