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Torn Meniscus

Knee Tear Semilunar Cartilages

The term "torn meniscus” usually refers to the damage of meniscus of the knee joint.


Presentation

  • Mild to moderate pain in the knee
  • Swelling of the knee joint (intermittent, knee joint feels “tight”)
  • Knee “pop”
  • Skin over the involved knee is red, warm and tender
  • Restriction of movements at the knee joint
  • Knee “lock” (fixation of knee joint in semi-flexed position between 15° to 30° and cannot be moved from this position)
Swollen Knee
  • He missed time on the AAU circuit during his senior season due to swollen knees, which at the time he called “jumper’s knee.” Wiley logged 13.5 minutes per game as a freshman last season and averaged 4.1 points and 1.5 rebounds per game.[washingtonpost.com]
  • ., often resulting in a painful, swollen knee or the feeling that the knee catches or locks.[activeimplants.com]
Burning Pain
  • At other times, it’s a sharp stabbing or burning pain. Sometimes it feels as if someone has stuck a knife into the side of my knee and is twisting the knife blade. At times, my knee feels wobbly, like it’s going to buckle.[healdove.com]
Aspiration
  • Joint aspiration Removal of excess joint fluid can temporarily bring some relief from pain, but the meniscus will not heal and the fluid will usually reaccumulate.[orthop.washington.edu]
Vomiting
  • Jumping up and hobbling to the bathroom on a bad knee in order to vomit is no picnic. I also take aspirin, which seems to help with the inflammation. A couple of other Hubbers have suggested arnica gel, but I haven’t been able to locate any.[healdove.com]
Knee Pain
  • BACKGROUND: Knee pain has a lifetime prevalence of up to 45%, and as many as 31% of individuals with knee pain will consult a general practitioner.[ncbi.nlm.nih.gov]
  • Knee pain is all too common. Source Knee Pain Knee pain is a very common ailment. If you’re active in sports, or if you live long enough, you’ll probably experience knee pain at some point in your life.[healdove.com]
  • Fine sees patients with knee pain and meniscus tears, especially the degenerative type, he first treats them conservatively.[bottomlineinc.com]
  • If a meniscus injury isn’t sounding quite like your knee pain, visit the Knee Pain Diagnosis section for help working out what is wrong.[knee-pain-explained.com]
Joint Effusion
  • Examination of the knee may reveal a swelling of the joint (effusion), a 'crunching' of the joint (crepitus) or locking but these things can be caused by other conditions too.[patient.info]
  • On examination, there may be joint effusion, joint line tenderness, and the joint is held in a flexed position. 1 in late presentations, there may be significant quadriceps wasting.[racgp.org.au]
Shoulder Pain
  • If you've read my shoulder pain articles, you'll know how scar tissue can actually hamper the function of a joint. And third, the post-surgical treatment is rehabilitation.[drnickcampos.com]
Type A Personality
  • I know how much work he's put into his rehab, that's the type of person he is, that's the type of player he is. So concern for that, I feel for him because of all the things that he means to our team."[si.com]
Dizziness
  • And besides, taking hydrocodone often makes my dizzy and nauseous. Jumping up and hobbling to the bathroom on a bad knee in order to vomit is no picnic. I also take aspirin, which seems to help with the inflammation.[healdove.com]

Workup

Diagnosis is made on the basis of the following [3]:

  • Patient’s history and inquiring the detail of the injury.
  • Physical examination. The signs that are useful in diagnosing torn meniscus include McMurray test, Steinmann test, Apley test, Thessaly test, Bragard sign, Böhler sign, Payr sign, Merke sign, Childress sign and Finochietto sign [4] [5].

Additional investigations include:

  • X-rays of the knee (both anteroposterior and lateral views)
  • Knee arthroscopy (visualization of the joint with the help of an endoscope) [6]
  • Computerized tomography (CT) and magnetic resonance imaging (MRI) [7] [8]
  • Ultrasound of the knee joint

Treatment

Conservative treatment modalities for torn meniscus include the following.

  • Complete rest should be advised.
  • Ice packing should be done to prevent swelling and pain. Ideally, the packs should be applied every 6 hours.
  • Compression and elevation of the involved knee are also helpful.
  • Anti-inflammatory drugs (such as ibuprofen, naproxen) can be given. Other analgesics can also be used if the pain is severe.
  • Steroid injections (cortisone) are helpful in severe cases.
  • Electro-acupuncture can also be used to reduce the pain.
  • Physiotherapy consisting of exercises specially designed for strengthening and stabilizing the muscles (mainly the quadriceps and hamstrings) is highly recommended.

Surgical treatment consists of the following:

  • Arthroscopy guided meniscectomy (partial, total or subtotal removal of the menisci) [9]
  • Repair of the torn meniscus [10]
  • Micro fracture surgery
  • Joint replacement

Rehabilitation therapy includes:

  • Use of braces for weight bearing
  • Shoe orthotics

Prognosis

Prognosis of the condition after medical and surgical repair is good. Even the athletes and gymnasts, who are involved in excessive activity, achieve good level of healing and repair within 4 to 6 weeks. Healing time depends on dedication to physiotherapy and adherence to rehabilitation program.

Complications of meniscectomy are rare (2%) and rarely does the condition recur with proper care. However, lack of care can result in gross morbidities like deviated gait.

Etiology

  • Abnormal posture while squatting, kneeling or lifting heavy weight can lead to torn meniscus. People involved in sport activities like athletes are more prone to such injuries due to the degree of rotation, flexion and extension to which the knee is subjected.
  • Osteoarthritis: Degenerative changes in the meniscal cartilage with age that lead to wear and tear phenomenon.

Epidemiology

The prevalence rate of torn meniscus is 61:10,000. A male is to female predisposition of 2.5:1 has been found as males participate in sports more compared to females. No racial predisposition exists.

In males, menisci are prone to tears in the age of 31 to 40 years. Females are susceptible during 11 to 20 years of age. In children younger than 10 years of age, these injuries are rare due to more elasticity of the menisci.

It is common in individuals performing sports activities. Approximately 60% of the patients are prone to a torn meniscus over the age of 65.

Sex distribution
Age distribution

Pathophysiology

Meniscus is a fibrocartilaginous structure that partially covers the various joints of the body, including the knee joint. Knee menisci are two in number (lateral and medial) and are C-shaped flaps that function to reduce the friction between the femur and upper end of tibia by providing a cushioning effect.

Tears of menisci may occur due to excessive grinding of femur into the tibia or due to thinning of menisci with age. The medial meniscus is firmly attached to the cruciate ligament whereas the lateral meniscus is not and is relatively more mobile as compared to the medial meniscus. This accounts for tears of medial meniscus being more common as compared to the lateral meniscus.

Depending upon the morphology, tears are of various types including [2]:

  • Transverse
  • Longitudinal
  • Bucket handle
  • Parrot beak

If the injury occurs in well-perfused region of the joint, healing is more likely to occur as compared to scarcely perfused areas.

Prevention

  • Proper technique of sports should be followed while playing, overextending the joints beyond their normal range of motion should be avoided.
  • During the healing period, activities that are prone to put excessive strain on the concerned. Joint stability should be maintained.
  • Lifelong care must be exercised in an individual with history of torn meniscus as the fibrocartilaginous tissue is damaged once and does not regain same strength as before.

Summary

Torn meniscus refers to the tear in meniscus surrounding the knee joint as a result of direct trauma or as a progressive degenerative phenomenon [1]. Menisci are fibrocartilaginous structures that surround many joints of the body but the term “torn meniscus” conventionally refers to the damage of meniscus of the knee joint.

Inflammation and swelling of the knee joint are common symptoms of the disease. Conservative treatment modalities are employed for the relief of symptoms and surgical interventions are used for repair.

Patient Information

Torn meniscus refers to the condition when one of the protective cushioning layers around the knee joint known as “meniscus” gets torn. The cause of damage is excessive grinding of the joint while squatting, kneeling or while bearing heavy weights. Alternatively, the meniscus may also get torn in old age as a result of wear and tear changes that occur with age.

The affected knee becomes swollen and painful. The pain worsens on movement and the range of motion is decreased. The effective treatment plan is to rest the knee, apply cold packs and elevate the leg to avoid putting undue strain on the knee. Drugs are given for swelling and pain. In extreme cases, surgery is done for repair or removal of the damaged menisci.

Once repaired, care should be taken to avoid straining the already weakened menisci. With proper care and treatment, healing occurs within 4-6 weeks.

References

Article

  1. Sinton WA. Knee injuries. Part I: the torn meniscus. The Journal of sports medicine. Sep-Oct 1972;1(1):37-40.
  2. Mesiha M, Zurakowski D, Soriano J, Nielson JH, Zarins B, Murray MM. Pathologic characteristics of the torn human meniscus. The American journal of sports medicine. Jan 2007;35(1):103-112.
  3. Martin G, Connor AC. Diagnosis of torn meniscus. American journal of surgery. Oct 1961;102:573-575.
  4. Hegedus EJ, Cook C, Hasselblad V, Goode A, McCrory DC. Physical examination tests for assessing a torn meniscus in the knee: a systematic review with meta-analysis. The Journal of orthopaedic and sports physical therapy. Sep 2007;37(9):541-550.
  5. Solomon DH, Simel DL, Bates DW, Katz JN, Schaffer JL. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. Jama. Oct 3 2001;286(13):1610-1620.
  6. Freiberger RH. Arthrography of the knee for diagnosis of torn meniscus. The Journal of sports medicine. Sep-Oct 1972;1(1):24.
  7. DeRamos RK. CT diagnosis of torn meniscus. Computerized radiology : official journal of the Computerized Tomography Society. Sep-Oct 1982;6(5):263-264.
  8. Lee MH, Choi SH, Woo SY. Quantitative analysis of the difference between an intact complete discoid lateral meniscus and a torn complete discoid meniscus on MR imaging: a feasibility study for a new classification. Skeletal radiology. Dec 2010;39(12):1193-1197.
  9. Adachi N, Ochi M, Uchio Y, Kuriwaka M, Shinomiya R. Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. May 2004;20(5):536-542.
  10. Ahn JH, Chang MJ, Lee YS, Yoo JC, Pae YR. Arthroscopic split transpositional repair for torn complete discoid lateral meniscus. Orthopedics. Jul 2009;32(7):524.

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Last updated: 2019-07-11 22:15