Introduction:
Meniscus tear is one of the most common knee joint injuries. Athletes who play contact sports, such as wrestlers, footballers, boxers, and other forms of martial arts, are at a high risk of developing meniscus tears. However, this injury may occur to any individual of any age who may or may not be an athlete.
What Are the Constituents of the Knee Joint?
The knee joint consists of three main bony components and an array of ligaments, cartilage, blood, nerve, and muscle supply. The components can be sub-classified as follows;
Bony Components:
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The thigh bone or femur.
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The shin bone or tibia.
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The kneecap or patella.
Ligaments:
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Posterior cruciate ligament.
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Medial collateral ligament.
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Lateral collateral ligament.
Cartilage:
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Medial meniscus.
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Lateral meniscus.
The cartilage and joint cavity are outlined by a layer of a fluid-filled membrane known as the synovial membrane,
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Muscles.
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Blood vessels.
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Nerves.
What Are the Causes Behind a Meniscus Tear?
Meniscus tears can occur from acute trauma or part of the aging process that results in degenerative changes over time. Tears are noted by their appearance, as well as their location. The common site for such tears includes the bucket handle, the flap, and the radial. Injuries resulting from sports often occur along with other knee injuries, such as anterior cruciate ligament (ACL) tears.
How Does a Meniscus Tear Occur?
Acute meniscus tears usually result from sports-related injuries through contact or non-contact injuries. An example of this may be a pivoting or a cutting injury. Degenerative meniscus tears occur as people age since lean tissues are more prone to tears under regular stress caused by everyday activities. These may include an innocuous event, such as an awkward twist when getting up from a chair or climbing stairs.
What Are the Symptoms Seen in Cases of Torn Meniscus?
The feeling of pop may occur when a tear occurs in the meniscus. Although most people can walk on an injured knee, athletes are capable of playing their sport with a tear for two to three days, the knee gradually becomes stiff, and swelling may be seen. The symptoms noted in the case of a meniscus tear are as follows;
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Dull or excruciating pain at the affected site.
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Stiffness and swelling of the knee.
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Catching or locking of the knee.
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The sensation of the knee giving way.
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Inability to achieve full range of motion of the knee.
How Is a Meniscus Tear Diagnosed?
1. Physical Examination: After discussing the patient's symptoms and recording medical history, the doctor performs a clinical examination of the knee to evaluate tenderness along the joint line in the vicinity of the meniscus. This often signals a tear.
2. McMurray Test: The doctor bends the patient's knee and then straightens and rotates it putting tension on a torn meniscus. In the case of a meniscus tear, this movement causes excruciating pain, clicking, or a clunking sensation within the joint.
3. Diagnostic Imaging: A torn meniscus may mimic other knee injuries. Thus the doctor may order diagnostic imaging tests to confirm the diagnosis.
- X-rays: X-rays do not show a meniscus tear. However, the doctor may order one to rule out other probable causes, such as osteoarthritis.
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Magnetic Resonance Imaging: MRI scans can assess the soft tissues in the knee joint, including the menisci, cartilage, tendons, and ligaments.
How Is a Torn Meniscus Treated?
The treatment recommended depends on several factors, including the patient's age, symptoms, and activity level. In addition, the type of the injury, the size of the affected area, and the location of the damage are also taken into consideration.
The blood supply on the outer one-third of the meniscus is rich. This is known as the "red" zone and usually heals, seldom requiring surgical intervention. An example of this kind of tear is a longitudinal tear of the meniscus.
However, the inner two-thirds portion of the meniscus lacks a significant blood supply and is known as the "white" zone. With the limited blood flow, healing is less efficient than the earlier mentioned "red" zone. In addition, the pieces of the torn meniscus cannot grow back together. Thus symptomatic tears in this zone do not usually respond to conservative treatment if surgical intervention is necessary.
Non-surgical Treatment:
Many meniscus tears do not necessitate an immediate surgical intervention. However, asymptomatic cases and patients where symptoms do not persist for prolonged periods or have no locking or swelling of the knee joint require a non-surgical approach to treatment modality.
The RICE protocol:
The RICE protocol is an effective treatment method for most sports-related injuries. The term RICE (Rest, Ice, Compression, and Elevation).
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Rest: This requires taking a break from the activity responsible for the injury. Use of crutches or other orthopedic aids may be used to avoid putting weight on the knee joint.
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Ice: This requires using cold packs for about 20 minutes at a time, several times a day. Ice must not be directly applied to the bare skin.
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Compression: Additional swelling and blood loss can be prevented by wearing an elastic compression bandage over the affected area.
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Elevation: Reclining the patient when at rest and putting the leg up higher than the heart level.
Other treatment modalities include;
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Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Anti-inflammatory medications such as Aspirin, Ibuprofen, and Naproxen help reduce pain and swelling and must be taken when prescribed by a doctor.
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Steroid Injections: A corticosteroid medication may be injected into the knee joint to help eliminate pain and swelling.
Other non-surgical treatments include;
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Biologics injections.
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Platelet-rich plasma (PRP).
Surgical Treatment:
If the symptoms persist or aggravate with non-surgical treatments, the doctor may suggest an arthroscopic surgery, a partial meniscectomy, or meniscus repair surgeries.
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Knee Arthroscopy: Knee arthroscopy is a common surgical technique where a miniature camera is inserted through a small incision into the knee joint, providing a clear view of the joint cavity. Surgical instruments are then inserted through two or three small portals to trim or repair the tear.
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Partial Meniscectomy: This procedure aims to trim and reshape the damaged meniscus tissue. The method almost immediately allows for weight-bearing and a full range of motion with a short postoperative recovery period.
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Meniscus Repair: In a few cases, meniscus tears can be repaired by suturing. First, the torn pieces are sutured together. The success of a tear repair depends on the nature and extent of the tear, the location, the size of the affected area, and the overall condition of the injured meniscus due to medical conditions and age. Since the meniscus must heal back together after suturing, the recovery time for a repair is longer than for a meniscectomy.
How Long Does Postoperative Recovery Take?
Meniscus tears are among the most typical injuries to the knee joint. However, a proper diagnosis, treatment, and rehabilitation can lead the patients to often return to their pre-injury abilities. After the initial healing, the doctor will prescribe rehabilitation exercises. Regular exercises to restore knee mobility and strength is necessary to regain the original functionality of the joint. The activities also aim to improve the range of motion in the knee. Strengthening exercises are gradually added to the rehabilitation plan by a physical or occupational therapist. The postoperative rehabilitation phase for a meniscus repair is about three to six months, and severe cases may require up to a year. A meniscectomy requires approximately three to six weeks for healing.
Conclusion:
Meniscus tear s a common injury to the knee joint. Athletes or individuals who play contact sports are extremely prone to meniscus tears. However, most cases of meniscus tears do not require immediate surgical treatment. If the symptoms persist or aggravate with non-surgical treatments, the doctor may suggest surgery. The postoperative rehabilitation phase for a meniscus repair is about three to six months, and severe cases may require up to a year. A meniscectomy requires approximately three to six weeks for healing.
