Function of meniscus
The meniscus plays an essential role in dispersing body weight and reducing friction during movement. They also serve as a shock absorber during loading or weight-bearing at the knee joint (1,2).
Anatomy
The 2 cartilage-like menisci structures are located between the long upper bone of the leg (femur) and the shin bone (tibia) (1,2). The 2 menisci are located on either side of the knee. The meniscus on the inner side of the knee is attached to a ligament on the inside of the knee – the medial collateral ligament (MCL) (1). This limits the mobility of the MCL and increases the likelihood of its injury in comparison to the outer ligament/Lateral collateral ligament (LCL) (2). The blood supply to the meniscus is poor (2) and for this reason, healing is challenging to achieve.
Cause of meniscal injuries
Meniscal injuries are the 2nd most sustained knee injury (2). The most common mechanism of meniscal injury is twisting on a semi-bent weight-bearing/ loading knee (1,2). Quite often, this injury is associated with injuries to the anterior cruciate ligament and MCL (1). It is also possible for the meniscus to tear because of age-related degeneration, in the absence of trauma (5).
Clinical presentation for a traumatic meniscal injury
When injuring your meniscus, you may experience the following: Pain and swelling (2), a popping and/ or clicking sound at the knee (5), difficulty weight-bearing through the affected leg when walking, climbing stairs or squatting(1&2). Due to the difficulty of performing the aforementioned, you may adopt altered movement patterns (4), which could end up becoming habitual if not addressed.
Management
Depending on the severity, location and type of tear as well as other factors, surgical repair may be required (1). If your meniscal injury does not cause you pain and the tear is stable within a region where the blood supply is adequate for healing, we at Floyd Lebatie Physiotherapy will first look at treating it conservatively using the following principles:
The protection and symptomatic management principle will focus on reducing inflammation and pain through bracing and weight-bearing management, ensuring that the knee is not excessively loaded (1). We will also look at swelling and inflammation management by using neoprene stockings, providing advice regarding anti-inflammatory medication and ice application (2,3).
It is imperative that we help you maintain your joint movement and muscle strength (2,3) within the limits of your pain. Your attending physiotherapist will start you off on early isometric exercises (strengthening exercises that don’t require much movement/load) and range of motion exercises to prevent joint stiffness. From here, strengthening exercises can be progressed to also increase the loading capability of the knee joint. Stretches are also prescribed as required.
A meniscal injury will affect balance and proprioception (the body’s ability to determine where the leg is in space without having to look) and we thus look to retrain this as soon as symptoms allow (2,3).
At Floyd Lebatie Physiotherapy, we care about your holistic goals. We however want to ensure that you are in tip-top shape before giving you the green light to return to sport. In order for this to happen, certain criteria need to be met! If you are battling with knee pain and would like to find out the cause, don’t hesitate in scheduling an appointment by calling us on 011 027 2111.
References
1.Brindle, T., Nyland, J., & Johnson, D. (2001). The Meniscus: Review of Basic Principles With Application to Surgery and Rehabilitation. Journal of Athletic Training, 36(2), 160-169.
2.Frizziero, A., Ferrari, R., Giannotti, E., Ferroni, C., Poli, P., & Masiero, S. (2012). The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures. Muscle, Ligaments and Tendon Journal, 2(4), 295-301.
3.Katz, J., Brophy, R., Chaisson, C., & de Chaves, L. (2013). Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. The New England Journal of Medicine, 368(368), 1675-1684.
4.Naimark, M., Kegal, G., O'Donnell, T., Lavigne, S., Heveran, C., & Crawford, D. (2014). Knee Function Assessment in Patients With Meniscus Injury. Orthopaedic Journal of Sports Medicine, 2(9).
5.van de Graaf, V., Noorduyn, J., Willigenburg, N., Butter, I., de Gast, A., Mol, B., . . . Poolman, R. (2018). Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears The ESCAPE Randomized Clinical Trial. Ameican Medical Association, 320(13), 1328-1337.
