Meniscal Injuries

MENISCAL INJURIES

The knee is lined with 2 types of cartilage. Articular cartilage covers the ends of the bones and there are also 2 menisci between the thigh bone (femur) and the shin bone (tibia). One is on the inside (medial) aspect of the knee and the other on the outside (lateral) aspect. The menisci act as shock absorbers in the knee and ensure the joint moves more smoothly. The meniscus on the inner aspect of the knee is the most commonly injured.

CAUSES OF MENISCAL INJURIES

Meniscal tears are very common knee injuries. With good advice and management most people are able to return to their pre-injury activities. The meniscus can be injured during sport or everyday activities where this is a sudden force through the knee or twisting injury.

The meniscus can be  injured more gradually also due to normal wear and tear changes, called a degenerative meniscus. This can be associated with Osteoarthritis of the knee.

SYMPTOMS

Can include:

  • Joint line pain, often on the inside area of the knee
  • Swelling which may not develop for several hours or days after the injury
  • A clicking or grinding sensation
  • Locking, sticking or giving way of the knee
  • Stiffness of the knee

DIAGNOSIS

  • diagnosis can be made by a combination of listening to your symptoms and examination by your GP or health care professional.
  • Your GP or health care professional may carry out ‘special examination tests’ to confirm the diagnosis, such as McMurrays  test, alongside checking for Joint line tenderness which is the most specific indicator of meniscal pain
  • Radiological investigations are not routinely required
  • X-ray may occasionally be recommended if underlying Osteoarthritis is suspected, to look at the joint space where the meniscus sits.
  • MRI may be needed if diagnosis is unclear but is not routinely required as meniscal tears can usually be diagnosed with a combination of accurate history taking and clinical examination.

MANAGEMENT

  • Regular exercise – Rest for 2-3 days then try to gradually return to light activity over the next few days/ weeks to prevent muscle weakness and strengthen the supporting muscles around the knee joint – Arthritis Research UK knee exercises 

  • Weight loss if overweight – check here to see whether you are within a healthy weight range – NHS BMI Checker

Being overweight increases the likelihood of developing OA of the knee. It is estimated that 4 x your bodyweight goes through the knee when walking. So for every 10lbs you are overweight an extra 40 pounds is being exerted through the knee! Weight loss will help to relieve knee pain symptoms, improve function and quality of life.

  • Using pain relief, anti-inflammatory cream, gels or tablets (see your GP or pharmacist for further advice about suitable medication)
  • See your GP to discuss referral to physiotherapy if symptoms are failing to improve
  • Steroid injection for persistent symptoms where there is degenerative meniscal pain and surgery is not indicated.
  • Arthroscopic Surgery may occasionally be recommended if your knee is locked or symptoms are persistent despite adequate non-surgical treatment.
  • Arthroscopic (keyhole) surgery is where a miniature camera and surgical instruments are inserted via small incisions into the knee.This enables the surgeon to see the inside of the knee clearly and trim or repair the meniscal tear.

USEFUL LINKS

www.sheffieldachesandpains.com– information about meniscal injuries

www.nhs.uk/Conditions/knee-pain – general advice about knee pain & link to meniscal injuries

www.knee-pain-explained.com – information about knee pain & meniscal injuries

https://www.nhsinform.Scot/injuries/muscle-bone-and-joint-injuries-problems – general advice about the management of knee pain