The knee joint is such a vital component to our existence. Without our knees we can’t move. Our knees allow us to walk, jump, run, twist, squat and even lunge… the knees do it all.
Granted, it’s not solely responsible for all these movements. But without a fully functioning set of knee joints all of the above would be near impossible to do.
Which brings us to our point, our knees are so crucial to our mobility that we don’t realize just how important they are until we end up getting hurt. Now the list of different knee injuries is quite extensive, so we’re going to place emphasis on a specific type of injury:
MENISCUS INJURIES
Now before we dive into this topic I think it’s only fair that we get some background on the meniscus, what it does, how it works and how it may get hurt.
What is a Meniscus?
The meniscus or menisci (plural) are C shaped tissues found within the knee capsule. They’re made of cartilage and sit between the condyles of the distal femur and proximal tibia. These structures essentially help fill the gap between your femur and your tibia. They’re like little cushions covering the ends of your thigh and shin bone at the knee joint.
Each knee joint has a medial and lateral meniscus, with the lateral meniscus usually being larger and thicker than the medial. The lateral meniscus also has the greater variance in size, mobility and shape.
Although they’re commonly C-shaped, the lateral men
The Functions of the Meniscus
The primary function of the meniscus is to act as the knee joint’s shock absorber. Almost like a set of suspension coil overs. This makes them absolutely vital in load bearing activities, load transmission, as well as lubricating the articular capsule within the knee.
In addition to all of this the meniscus also has a significant part to play in the overall stability of the knee joint. It does this by creating a cup for the distal femur to rest in.
And together, both menisci absorb 50-80% of the force transmitted through the knee joint. This assists in spreading these forces across the entire capsule to aid in healthy biomechanics.
Meniscus Injuries
Symptoms of meniscus injuries include:
Meniscus injuries are classified into two categories:
Now in addition to these two categories, each individual tear of the meniscus has a specific pattern. These patterns influence the recovery and treatment protocols.
These patterns include:
These essentially describe what the physical anatomy of the menisci would like after it is damaged. When one or more patterns are present the injury becomes a complex pattern and depending on the extent of the injury the classification can be named a complete tear.
Mechanism of Injury
Meniscus injuries rarely ever happen in isolation as more often than not meniscus injuries occur in unison with other traumatic injuries such as an anterior cruciate ligament strain or tear.
This is solely because of the most common mechanisms of injuries associated with acute meniscal tears.
These include:
In degenerative cases the mechanism of injury rarely involves any trauma or significant event as it usually occurs gradually over time.
Despite these structures rarely being injured in isolation, the treatment protocols are individualized to cater for the meniscus to successfully recover on its own or with surgical intervention. But we will discuss this later on in this article.
How to Confirm a Meniscal Injury
The gold standard for most orthopedic injuries is some form of radiological scan. In the case of meniscus injuries, magnetic resonance imaging (MRI) is the preferred method.
However, MRI’s remain extremely expensive making it inaccessible to most. Therefore, physical therapists, doctors and athletic trainers tend to lean towards special testing as a cost effective alternative to the MRI. Although most special tests do not provide 100% efficacy, they still hold value in most clinical settings.
The 3 most commonly used special tests for the confirmation of a meniscus injury are:
In my personal experience as a trainer all 3 of these tests have been helpful in determining whether or not a client or patient has hurt his or her meniscus.
However, if you require a quick and easy confirmation I’d suggest trying the Thessaly test. Simply because you can do it by yourself as it requires no assistance from a therapist.
How to perform the Thessaly test to confirm a meniscus injury:
Again, this IS NOT A DIAGNOSIS, but if you are experiencing any sort of discomfort this test or one of the others, chances are that you’ve hurt your meniscus.
If your pain is moderate to severe please seek out medical attention as soon as possible.
Treatment Options for Meniscus Injuries
For most meniscus injuries rest is the best treatment. Refraining from all activities that could potentially exacerbate the injury. Most meniscus tears will repair themselves if properly managed within 8 to 12 weeks.
Acute Treatment
Immediately after a suspected injury the RICE protocol should be followed. Yes, we know, it’s this again. But in all honesty the RICE protocol remains the “gold standard” when it comes to acute management.
Long term treatment
Physical therapy and rehabilitation of the meniscus is the best non-operative treatment option. But we will cover this in detail in the article of this series.
Surgery
The type of surgery you will need depends on the type of injury you have. For minor injuries an arthroscopic or Keyhole surgical approach will suffice as a treatment protocol.
However, for more serious injuries a more extensive surgical approach is required. This is to ensure that certain tears don’t worsen.
But sometimes the surgery isn’t a success as the integrity of the meniscus tissue continues to degrade. In which case the meniscus tissue will have to be removed entirely. Now in order to prevent osteoarthritis, a meniscus graft may be considered.
This procedure is called a Meniscal allograft transplantation and it’s shown great success in the treatment of severe meniscal injury.
Back in the day however, specialists believed that the meniscus wasn’t as important as its surrounding structures. Leading to many surgeons removing the meniscus entirely. This led to whole scale arthritic complications throughout those patients' lives. In some cases, total knee replacements had to be done as a direct result of this procedure.
However, luckily for us, in modern times this is not the case, as it has now been proven that the meniscus is vitally important to mobility.
Recovery
As we mentioned earlier in this article, non operative recovery of meniscus injuries may take up to 3 months to recover. However, in terms of post operative recovery, the timeline usually starts at 3 months and may take up to 6 months to have the meniscus functionality completely restored.
Again, your individual recovery timeline depends on your individual approach to rehabilitation. Following a proper rehab protocol supervised and or designed by a qualified therapist greatly lessens your recovery time. We will dive into more detail on this in our next article on this series.
In Conclusion
The meniscus or menisci (plural) are C shaped tissues found within the knee capsule. The primary function of the meniscus is to act as the knee joint’s shock absorber. Injuries may be acute and sudden or occur overtime in a degenerative fashion. Most meniscus light to moderate meniscus injuries will heal and repair on its own in 8-12 weeks. However, surgical intervention is needed for more serious cases. Recovery depends on the type or injury and the extent of the treatment protocol. All in all, meniscal injuries remain quite common and the majority of cases recover successfully.