Is your knee pain from a torn meniscus?
by Meghan Griech, PT, DPT, cert MDT, CKTP
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A torn meniscus is one of the most common knee injuries. The meniscus, especially the medial (inside) is prone to injury when a forceful twisting motion occurs at the knee, especially if you are standing on it when the twist occurs. That’s why meniscus is commonly torn during sports, while walking on ice or in the rain, or other activities like skiing, rollerskating, or hiking over rocks.
The meniscus is a c-shaped piece of cartilage that acts as a shock absorber in the knee. It’s located between the thigh bone (femur) and the shinbone (tibia). This type of tissue can become worn down, inflamed, or even tear as we age too. This can cause knee pain and make it difficult to weight-bear on the knee, causing limping.
The pain is typically felt on the inside of the knee and often radiates to the back of the knee and down to the calf. There may also be swelling and clicking sensations with some instability (feeling as though the knee is buckling or giving way in any direction). In some cases, the knee may even lock, making it difficult to bend or extend.
Meniscal tears can cause swelling of the knee, usually occurring a couple of hours after the initial injury. No bruising is typically seen initially.
There are many potential causes of meniscal pain that can affect people of all ages, so it’s important to recognize the possible signs and symptoms of a meniscal tear so you can reduce your knee inflammation and swelling.
Meniscal Tear Symptoms
The following signs and symptoms are typical in a torn meniscus
- Swelling on one side of the knee
- A popping sensation
- Pain, especially when twisting or rotating your knee (rolling in bed, turning in a different direction, getting out of the car
- Difficulty straightening your knee fully due to pain or swelling
- Feelings as though your knee is locked in place when you try to move it
- Feelings of your knee will buckle
Diagnosing a Meniscal Tear
Joint line tenderness, meaning the soreness at the edges of where the femur and tibia meet is the best way to ‘diagnose’ a torn meniscus without imaging. Another way to test for the possibility of a torn meniscus is to complete twisting movements while standing only on the painful leg with the knee bent slightly (about 30 degrees). If you have no pain with the twisting movement, then there is less of a chance the knee pain involves the meniscus. Pain with this movement would be indicative of a high chance of a meniscal tear.
Imaging, such as MRI(Magnetic Resonance Imaging) would be used by family physicians or orthopedic surgeons to confirm a meniscal tear.
What’s the Treatment for a Meniscus Tear?
To relieve pain, you should rest your leg as much as possible, especially after the initial pain and swelling are present. Applying ice packs for about 15 minutes every hour for at least the first four days after injury can help reduce the swelling, pain, and difficulty walking. You can also take anti-inflammatory medications such as ibuprofen or naproxen as prescribed on the label instructions as needed for pain relief.
The initial goal is the reduce the pain and inflammation in the knee joint, reduce swelling and avoid activities that increase irritation to the knee area. Equally important is to keep your leg muscles working. Swelling can make these muscles “shut down”, so doing isometric quadricep contractions with the knee straight and a towel roll under it is helpful.
After the beginning days of pain and swelling from the meniscal tear, treatment depends on the location of the tear, the size, activity level (like if you play sports, run), and your age.
Luckily meniscal tears don’t automatically mean you need surgery, and in fact, current research shows that most do not. The outer portion of the meniscus often referred to as the “red zone,” has a good blood supply and can sometimes heal on its own if the tear is small and body weight doesn’t impede the healing.
The inner two-thirds of the meniscus, known as the “white zone,” does not have a good blood supply and therefore cannot heal like the outer areas. Tears in this region will not heal on their own as this area lacks blood vessels to bring in healing nutrients.
How to Treat a Meniscal Tear on Your Own
While the knee is being rested and icing for swelling and pain control, maintaining movement in the knee is just as important. Moving the knee through the range that is comfortable, as straight as you can, and as flexed (bent) as you can without increasing pain will help maintain range of motion and reduce the risk of the knee becoming stiffer.
Using ice after attempts to move the knee or walk will help to reduce activity-related swelling. Avoiding adding stress to the knee also helps, avoid sitting in low chairs that cause added stress or pain to the knee when you try to stand. When going up the stairs, you should lead with the uninjured leg first and when going down the stairs the injured leg should go down first. This will help limit stress on the knee joint and be less painful.
After a couple of weeks, if pain and swelling continue or if walking continues to be painful and difficult then speaking to your physician or a physical therapist is a good idea. The first couple weeks after an initial injury should be focused on reducing swelling while maintaining movement of the knee. If that has occurred and issues with the knee are still present, then it’s time to seek medical attention.
Will you need Surgery?
If a meniscal tear is causing knee instability, prolonged pain, swelling, or causing locking symptoms surgery may be required to either repair or remove unstable edges of the meniscus. The surgery is completed by an orthopedic surgeon and is usually a same-day surgery, allowing you to go home the same day. You may need a brace afterward for protection if a repair is performed. Most use crutches or a walker for a couple of days to a week after surgery to reduce stress on the knee.
2 types of Meniscal Surgeries:
- Meniscus repair: The surgeon sews torn pieces of cartilage back together so they can heal on their own, yet due to blood supply, types of tears and locations of tears less than 10%of tears are repairable. The recovery from this surgery is slightly longer, and typically between 6 weeks and 3 months.
- Partial meniscectomy: The surgeon trims and removes the damaged cartilage and leaves healthy meniscus tissue in place. Recovery after this type of surgery is generally much shorter, with most returning to activity within 4 weeks.
Surgery is a common treatment of meniscal tears, especially if it is hindering mobility. Although surgery provides short-term improvements of knee pain and function, in the long term, people who have a larger meniscal injury may be at a higher risk of developing knee arthritis. due to the inflammatory process in the knee.
Whether healing on your own or pursuing surgery, don’t try to rush the healing process of your body.
As a rule of thumb, don’t try to return to your previous level of physical activity until:
- You can fully bend and straighten your knee without pain.
- You don’t have sensations of buckling or instability
- You feel no pain in your knee when you walk, jog, sprint, or jump.
- Your knee is no longer swollen during or after activity.
- Your injured knee is as strong as your uninjured knee.
How Can a Meniscus Tear be Prevented?
Meniscus tears are tough to prevent since they’re usually the result of an accident or unexpected movement. But some precautions might lower the risks of a meniscal tear. You should:
- Keep your thigh (quadriceps) muscles strong with regular exercises.
- Warm-up the muscles and joints to loosen any stiffness before sports or activity
- Give your body time to rest between workouts to rest and recover. Fatigued muscles can increase your risk of injury.
- Make sure your shoes have enough support and fit correctly, as shoes that don’t offer enough support and can change the way you stand leading to increased stress on the knees.
- Maintain flexibility so muscle tension doesn’t add stress to the joints.
- Increase the intensity of your workout slowly, allowing for muscles to acclimate and then recover to the changes in workload.
*Disclaimer: All information in this article is intended for instruction and informational purposes. The author(s) are not responsible for any harm or injury that may result. This information is used to supplement not replace any advice you were provided from your doctor or another medical health professional. No guarantees of specific results are expressly made or implied with this article.