Imagine the following scene. Two people hobble into the clinic with knee injuries. Lucy, in her teens, has just twisted her leg playing football; now her knee is badly swollen, and she can barely walk on it. Jack is in his 70s. He hadn’t noticed a problem with his knee until a few days ago. Over the weekend, he did some weeding in the garden. Now it’s quite painful and he’s struggling to straighten it properly.
As it turns out, both Lucy and Jack are carrying the same problem. In fact, one of the most common types of knee injury there is: a torn meniscus.
Who-what-where is the meniscus?
The meniscus is a pad of cartilage that sits right in the middle of the knee, between the thighbone and shinbone. In fact, it’s two pads: an inner one, and an outer one. From a birds’ eye view, they look like crescent moons. Which is where the name comes from. Mene is the Greek for moon.
What does the meniscus do?
A helpful way to think of it is as a shock absorber. As we move and the knee bones come together – sometimes forcefully – the meniscus soaks up the energy and distributes it evenly across the joint. It also has an important stabilising role, reducing stress and pressure around the knee.
How do people tear them?
There are essentially two main ways that meniscus tears happen, as Lucy and Jack demonstrate.
Trauma – when you forcefully twist or rotate your knee joint, stretching the tissue fibres in the meniscal pad to breaking point. Traumatic tears can also happen in other ways, such as a blow to the front or side of the knee, or from stretching out the leg as you lift a heavy object
Degeneration – when the tissue becomes worn and weakened as we get older (about 40% of over 65s are thought to have some kind of meniscus tear). Over time, the tear evolves; eventually this becomes noticeable through pain or swelling – perhaps triggered by something innocuous, like Jack’s weeding
What do they look like inside?
Meniscus tears vary a lot in position, size and shape. The classic injury in a young person like Lucy is a “bucket-handle tear”, so-called because the inner portion of the meniscus rips dramatically apart from the outside of the crescent, leaving a handle-shaped gap. But there are several other types: horizontal, radial, and “flap” tears among them. Jack’s torn meniscus is more likely to be a small, frayed, flap-type tear which started at the back of the knee and slowly progressed forwards. Sometimes a little piece of cartilage can also break off and catch in the joint, leading to a locked knee.
What does a meniscus tear feel like?
Physically, the knee often reacts to a torn meniscus by swelling up to protect it. This can take a few hours or even days to emerge. The knee may feel stiff and tender, and it might be difficult to bend or straighten out the leg. It may even give way if you try to stand. Pain from a meniscus tear tends to be of the sharp catching variety, rather than the dull ache you get with arthritis (a different type of cartilage damage).
Does a torn meniscus automatically mean surgery?
No. In fact, to begin with, the treatment is usually conservative. That’s partly because minor tears can sometimes heal on their own, without further intervention. In fact, it’s worth remembering that many of us will find ourselves doing this from time to time, because minor meniscus tears are really very common. Here’s how the NHS advises people to handle the initial symptoms from a meniscus injury:
- stop any exercise or activities and rest your knee when you can during the first few days
- put an ice pack (or bag of frozen peas) wrapped in a towel on your knee for up to 20 minutes every 2 to 3 hours
- wrap a bandage around your knee or wear a knee support – remove it when you sleep
- keep your leg raised on a pillow as much as possible
- take paracetamol to ease pain
After doing this, you may be recommended for physiotherapy – to strengthen the surrounding muscles and stabilize the joint. Normally, the time to consider surgery is when the knee doesn’t improve after conservative treatment. In other words, the pain doesn’t go away, or you’re experiencing serious “mechanical” problems, such as knee locking.
What are the surgical options for a torn meniscus? You may like to read more about the potential approaches elsewhere on the blog. In particular, see How do you repair a torn meniscus? and Surgery for meniscal tears: new technology to preserve more tissue.
Are you suffering knee pain now? Or have you been diagnosed with a torn meniscus? We’re always happy to meet and talk through the best steps for you. Click here to book an appointment.
