Meniscus tear

Description

It’s a very important injury due to the role of the menisci. The menisci have an important role in absorbing force and assisting in the role of nourishing the knee joint is key when considering meniscal lesions. These pages will explore how and what happens when the menisci become injured.

Meniscal tears are the most commons lesions followed by the meniscal cyst. Both of them have 2 causes. The first one is traumatic and the second one is a degenerative meniscal tear.

A meniscal cyst may present with signs and symptoms consistent with typical meniscal pathology. The discoid meniscus is a rare congenital disorder where the lateral meniscus remains around instead of its usual cupped shape leading to instability of the lateral compartment. This condition is usually asymptomatic but may become symptomatic when a meniscal tear occurs.

A meniscus rupture is an injury that occurs when pieces of the meniscal cartilage are ruptured and when those pieces were injured by specific movements that rotate the knee with a lot of force, while the foot doesn’t rotate and is firmly planted on the floor. Meniscus injuries are often seen in athletes as a result of a sports injury and represent approximately 15 % of all cases sports injuries. There are partial or total ruptures of a lateral or medial meniscus.

Medial tears are reported more commonly than lateral tears. In addition to tears occurring in sports, osteoarthritis can also lead to a spontaneous meniscal tear through breakdown and weakening of the meniscal structure. Possible risk factors for meniscal tears are sports, older age, male sex, and pre-existing pathologies such as osteoarthritis.

Traumatic meniscal tear:

-There are 2 criteria to defined as meniscal lesion as traumatic. These two criteria must be met:

• The meniscal tissue must be healthy of normal macroscopic appearance.

• There must be have documented injury in the knee as result of a knee sprain or a forced movement.

- Most of the time a traumatic lesion is a vertical or a longitudinal tear.

Degenerative meniscal tear:

• A degenerative meniscal lesion occurs in the absence of a trauma.

• A degenerative tear is due to the age of the person and also due to all days’ activities.

• The meniscal tissue is deteriorated to a certain degree.

• Men are more often subjected to a degenerative tear than women.

• A degenerative tear can occur early in someone’s live, sometimes degenerative meniscus tear occurs to young athletes, but normally it occurs in the fourth of the fifth decade of life.

The meniscal tear is of following types:

• Longitudinal

• Radial

• Bucket handle

• Flap

• Horizontal cleavage

• Degenerative

There are two different types of meniscal tears:

• Acute tears:

These are commonly the result of a trauma or a sports injury (sports like tennis, jogging, soccer,…). Acute tears have different shapes (horizontal, vertical, radial, oblique and complex). They are often treated with surgery.

• Chronic tears:

These occur in elderly people and are degenerative meniscal tears that occur after a minimal trauma or stress on the knee. They are mostly treated with physical therapy and anti-inflammatory medication.

Important points in the therapy:

- Control the pain and inflammation - Cryotherapy, analgaesics, nsaids.

- To regain good knee control.

- Restore ROM (Range of motion)

- ROM exercises within any limits in range that the consultant has requested

- Restore the flexibility

- Restore muscle function - specific strengthening exercises including quadriceps (A medial meniscus lesion influences the strength of the M. Vastus medialis. hamstrings, calf, hip. The exercise program should consist of both concentric and eccentric exercises to receive muscular hypertrophy as well as neuromuscular function.

- Progress weight bearing - weight bearing and joint stress are necessary to enhance the functionality of the meniscal repair so should be progressed as indicated by the consultant. Excessive shear forces may be disruptive and should be avoided initially.

During the pre-operative phase of total knee replacements and anterior cruciate ligament reconstruction, it is proven that quadriceps strength training leads to improved knee function and a better quality of life after the operation.

Some examples of exercises are heel slides, flexion-extension exercises, but you have to put your involved leg on a bench, you can also make some cycling exercises at home. The first four weeks you are not allowed to make deep squats because the meniscus has to recover from the surgery.

Proprioceptive exercises are important to the balance. To do this, you can ask the patient to stand on the affected leg, and when this is good enough he can try to do this on an unstable bench.

Resources

physio-pedia / Meniscal_Lesions .