Treating Meniscus Injuries
The meniscus is the semi-circular shaped disc, or cushion, that functions as a load-sharing shock absorber for the knee joint during weight-bearing activities. It is a tough, rubber-like tissue that lines and cushions joints. There is a meniscus on the inner side of your knee (medial meniscus) and one on the outer side of your knee (lateral meniscus). Meniscus injuries can occur as the result of a single event or repetitive loading over time. As we age, the meniscus tissue loses its water content. As a result, it becomes more brittle and is therefore, easier to tear. Younger people usually tear the meniscus with a sudden twisting or forcible hyper-flexion injury. As people mature, meniscus injuries may come from minimal or no trauma, such as when you are squatting. It is not uncommon for patients to show up with signs and symptoms of meniscus injuries with no known prior injury, or with injuries sustained many years previously.
The most common symptom that people experience is pain, usually localized to the inside or outside aspect of the knee joint. There may be immediate swelling and restricted motion. Occasionally, patients may present with symptoms of “locking,” in which the meniscus displaces and gets stuck inside the knee joint. You may also hear a snap or pop at the time of the injury. Chronic tears may give people activity related, intermittent pain with or without swelling. Also, patients can sustain meniscus tears along with ligament injuries; about 70 percent of patients who sustain an ACL (anterior cruciate ligament) tear have a concomitant meniscus injury.
Meniscus injuries are easily diagnosedwith a sound physical examination. There tends to be joint line tenderness. The physician will also put your knee in certain positions that stress the meniscus and cause pain by flexing and rotating your knee. In addition, the physician may get x-rays to make sure there are no injuries to the bones of the knee. An MRI is also useful to diagnose meniscus tears as well as any additional pathology that may be occurring in the knee.
Most tears of the meniscus have limited healing ability, because the blood supply to the meniscus is limited to the peripheral 25-30 percent. Exceptions would include incomplete injuries to the outer border of the meniscus, especially in younger individuals. Although meniscus tears are not completely preventable, the best way to avoid meniscus tears is to have strong thighs and hips, along with flexible hamstrings.
Treatment for meniscal tears depends upon a person’s age, as well as the location, size, and chronicity of the tear. Incomplete tears in the peripheral border of the meniscus can often be managed with rehabilitation, short-term activity modification and anti-inflammatory medications. Nonoperative treatment includes standard R.I.C.E. therapy (Rest, Ice, Compression and Elevation). Occasionally, temporary crutch use is helpful to offload the stress on the knee. Anti-inflammatory medication use for a few days will decrease the pain that results from inflammation in the synovium or lining of the knee joint. Physical therapy can also be helpful to regain the strength and flexibility about the knee and hip. Steroid injections are helpful for nonoperative meniscus tears that are nonresponsive to a regimen of anti-inflammatories and therapy. Sometimes, getting over the acute flair of inflammation is all that is needed to get back to the pre-injury level of activity.
Meniscus injuries which block normal knee motion, causing persistent pain and functional limitations, are often best managed with knee arthroscopy – a minimally invasive technique for looking inside the knee joint. During arthroscopy, a physician places a small camera called anarthroscope into the knee to visualize any damage to the cartilage. Small instruments are then used to repair torn meniscus or shave down irreparable meniscus tears to a stable border so that the meniscus no longer catches in the knee. Following surgery, patients typically utilize crutches. Structured physical therapy,
together with a home exercise program, is often beneficial in facilitating your return to the court.
The following are common exercises that help with rehabilitation for both non-operative meniscus tears as well as following meniscal surgery. Start with the first 3 and move on to the second 3 when the pain has ceased.
1) Hamstring Stretch: While lying on your back with your buttock close to a doorway, place your injured leg up on the wall. Slowly move your buttock closer to the wall. You will feel the stretch of the hamstring increase. Move to a comfortable stretch and hold for 30-60 seconds. Repeat 3 times.
2) Straight Leg Raise: Sit on the floor with your uninjured leg bent and your injured leg straight. Press the back of your injured leg down, tightening the top part of your thigh (the quadriceps muscle). It is usually helpful to raise your toes toward your knee. Raise your leg about 6-8 inches from the ground and hold for 10-20 seconds. Repeat this 20 times. You can focus on different parts of your thigh by rotating your toes in or out.
3. Calf Stretch: Face a wall and place your hands against the wall at shoulder level. Place your injured leg back and your uninjured leg forward. The uninjured leg should be slightly flexed and the injured leg should be straight with your foot flat on the ground. As you lean forward, you should feel the calf muscle stretch. Hold for 30 seconds. Repeat 3-5 times.
4. Heel Slide: While sitting on the floor, slowly slide the heel of your injured knee toward your buttock, pulling your uninjured knee toward your chest. Return your leg to the extended position. Repeat 20 times.
5. Step-Ups: Stand with your injured leg on a block that is 3-5 inches high. Keep the foot of your uninjured leg flat on the floor. Shift your weight to the injured leg and straighten, lifting the uninjured leg off the floor. Return the uninjured leg to the floor. Repeat 10-20 times.
6. Wall Squat: Stand with your back up against the wall. Keep your feet shoulder width apart and your feet 1-2 feet from the wall. Place a rolled-up towel or pillow between your legs. Squat down until your thighs are parallel to the floor. Hold for 20 seconds and slowly stand up. Keep the pillow or towel squeezed between your legs. Repeat 10-20 times.
Dr. Steve Hamilton, of Beacon Orthopaedics & Sports Medicine, is an orthopaedic surgeon who specializes in arthroscopic surgery. If your are suffering from pain or swelling of the knee, please schedule an appointment with Dr. Hamilton now or call (513) 354-3700 to schedule 24/7 via phone.