What is Meniscus?
The meniscus is a cartilage cushion that lubricates and facilitates smooth movement between the upper leg bone (femur) and lower leg bone (tibia). The meniscus also plays an important role in creating stability in the knee joint. Each knee joint has two meniscus, the medial and the lateral.
What causes Meniscus Tears?
Meniscal tears occur due to a shear force between the femur and tibia.
It commonly occurs during activities that involve twisting or rotating the knee forcefully while the foot is planted, such as sudden stopping or deceleration, pivoting, or during deep squats.
The inside portion of each meniscus is known as the white zone and is not vascularized which prevents it from healing on its own. The outer portion of the meniscus is known as the red zone because it is vascularized which typically enables it to heal on its own.
Types of Meniscus Tears
1. Radial Tear
Radial tears extend from the inner edge of the meniscus to the outer edge in a straight line. These tears exist in the white zone and do not typically heal on their own.
Parrot Beak Tear: in severe cases, the tear occurs at an angle between the radial and horizontal planes of the meniscus and forms a “parrot beak”.
2. Longitudinal Tear
Longitudinal tears develop along the circular curve of the meniscus tissue.
Bucket Handle Tear: in severe cases, there is a displacement of the meniscus that can flip into the knee joint which may lock the knee during bending and straightening.
3. Horizontal Tear
Horizontal tears runs parallel to the joint surface of the meniscus.
Flap Tears: in severe cases, a portion of the meniscus is lifted or separated, forming a flap which can cause locking or clicking of the knee joint.
4. Root Tear
A root tear occurs when the attachment of the meniscus to the lower leg bone (tibia) is torn. It can disrupt the stability and function of the meniscus.
5. Peripheral Tear
Tears that are closer to the outer edge of the meniscus are known as peripheral tears. These tears occur in the red zone which is vascularized, and are therefore more likely to heal on their own.
6. Degenerative Tear
These tears are often associated with age-related changes and degeneration of the meniscus. They can occur without a specific traumatic event.
What are the symptoms of A Meniscus Tear?
1. Knee Pain
Pain along the joint line of the knee, either on the inner or outer side, where the meniscus is located may indicate a meniscus tear.
The pain may be sharp or dull and can worsen with knee bending, straightening, and/or twisting.
2. Knee Instability
The knee may buckle or give way unexpectedly, making it difficult to bear weight or maintain balance.
3. Swelling and Inflammation
Meniscus tears can lead to swelling or inflammation in the knee joint. The knee may appear larger or feel puffy, and there may be a sensation of tightness or stiffness.
4. Locking or Catching
In some cases, a torn meniscus can cause the knee joint to lock or catch, preventing smooth movement. This sensation can be quite uncomfortable and painful, and may require manual manipulation to unlock the joint.
How does physiotherapy Treat Meniscus Injuries
During the assessment, your therapist will determine how your meniscus tear is affecting your body. Your therapist will then provide treatments to manage inflammation and restore alignment, prescribe exercises, and educate you on how to improve your function.
1. Manual Therapy
Myofascial release: to alleviate pain, stiffness, and inflammation of the muscles, joints, nerves, and fascia around the hip, knee, and ankle.
Joint mobilization: to promote smooth joint movement and mobility of the knee joint.
2. Biomechanical Optimization
Lower extremity alignment conditioning: to improve the alignment and stability of the knee during weight bearing activities as it relates to the involvement of the pelvis, hip, knee, and foot.
Movement pattern conditioning: optimizing walking, running, and jumping mechanics by recruiting the appropriate hip, knee, and foot muscles.
3. Functional Rehabilitation
Individualized guidance through exercises and activities that mimic daily or sports-specific movements, to preserve and/or regain functional abilities and facilitate safe return to desired activities.
4. Exercise Therapy
Range of motion: to maintain and improve joint mobility of knee.
Stretching: to prevent stiffening of muscles around the knee and involves muscles.
Strengthening: to improve the strength and stability of the knee and hip, as well as preventing atrophy and compensations.
Home exercise program: individualized exercise prescription to restore optimal and balanced movement.
Bracing: to provide external knee stability support and prevent further meniscus injury.
Taping: to provide external knee stability support.
Acupuncture: use of thin needles to improve local and systemic function, regulate the nervous system, and promote the body’s natural healing processes.
Heat and cold therapy: to manage reduce pain and tension or control inflammation.
Electrostimulation: use of electrical currents to stimulate muscles and reduce pain.
Ultrasound: use of high-frequency sound waves to produce deep tissue heating to reduce muscle tension and inflammation.
Laser therapy: to improve blood flow, reduce pain and inflammation, and promote tissue healing.
Advice on activity modification, proper body mechanics, and self-management strategies to manage symptoms and reduce the risk of further injury.