The management of meniscus injuries

Gracefully moving on ice and spinning in the air, then landing perfectly with one leg bent. The motion seems effortless. As with ice skaters, professional netball and soccer players also display incredible agility.  These athletes sprint, jump and swerve, but these seemingly effortless twists and turns will come at a high cost if one move goes wrong. 

These types of movements may cause an injury to the meniscus in the knee. As a result, a meniscus injury is sudden and traumatic. Despite the high risk of a torn meniscus among athletes, especially those involved in contact sports, a torn meniscus is common amongst people of all ages and occupations regardless of their level of activity, and a large proportion of people over 40 will have a torn meniscus without symptoms. A meniscal injury, for them, is more a sign of degeneration than a distinct injury.

There are two types of meniscus injuries, acute tears and degenerative tears. Acute tears happen through bending and twisting the knee with force while in a weight bearing position. Often when the injury is a result of a trauma while playing sports, in addition to the meniscus being torn, there tend to be other knee injuries as well, like an ACL tear. Degenerative tears are more typical with older people as the meniscus weakens and becomes less elastic over time. 

Common symptoms of a meniscus tear include pain, swelling, catching of the knee, locking of the knee, instability of the knee and the incapability to use full range of motion. Pain to the touch of the meniscus is also a sign of a meniscus tear. Sometimes, you may still be able to stand and walk after the initial injury with only a bit of pain depending on the severity of the tear. This is however not an indication that the meniscus tear is a minor injury and that treatment can wait. It will not be wise to play through the pain.

If left untreated, part of the meniscus can slip into the joint and you may need surgery to restore your full knee function. Untreated meniscus tears can increase in size and lead to complications, such as arthritis over time.

Untreated, a meniscus tear can limit your ADL and ability to participate in exercise and sports. In serious cases, it can develop into long-term knee problems, like arthritis. In addition, moving around with a torn meniscus could pull fragments of the cartilage into the joint causing more serious knee issues which could require more significant surgery in the future.

Endurance is an important part of sports. For some athletes, playing through a little pain is a badge of honour. In the case of meniscus tears, some people think the injury will heal over time on its own. But the truth is that there are different types of meniscus tears — and some tears will not heal without treatment. If your tear is on the outer one-third of the meniscus, it may heal on its own or require surgical repair. This is because this area has blood supply and blood cells can heal meniscus tissue — or help it heal after surgical repair.

But if the tear is in the inner two-thirds, which lack blood flow, the tear cannot be repaired and may need to be trimmed or removed surgically.  The first step in treating a torn meniscus is getting the injury examined by an orthopaedic surgeon. During the exam, the orthopaedic surgeon may check the tenderness of your knee joint and move your leg to get a measure of your knee’s range of motion. The surgeon may also order imaging tests, such as a MRI or X-ray, to determine the exact location and severity of the tear.

The best course of treatment will be determined based on the location, degree, and type of tear, as well as your age and activity level.

Non-surgical treatment for tears that can heal on their own may include: physiotherapy; RICE: Rest, Ice, Compression, Elevation and anti-inflammatory medications.

For more severe tears, surgery is typically the best course of treatment. The goal of surgery is to preserve the meniscus by repairing or removing the torn part. During arthroscopic surgery, the orthopaedic surgeon inserts a camera into a small incision in the knee (keyhole surgery), which guides the surgeon in repairing or removing the tear with instruments inserted through another small incision. Following surgery, you will need to undergo physiotherapy to strengthen your knee, regain your range of motion, and get back to your daily activities.

Knee pain should not keep you from participating in your favourite sport and activities. Among the best places to treat knee injuries and meniscus tears is Dr. Hannes Jonker and the Centre for Sport Medicine and Orthopaedics.

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