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- What is a Meniscus Tear?
- What is Meniscus Anatomy?
- What are the symptoms of a Torn Meniscus?
- What Causes a Meniscus Tear?
- How is a Meniscus Tear Diagnosed?
- How to Heal a Torn Meniscus
Meniscus tears arise on the C-shaped disc that maintains and cushions the knee. When this structure is broken or torn, there may be swelling, stiffness, pain, and a reduced range of motion.
Twisting or turning improperly can bring on a meniscus tear or injury. Knee arthroscopy is a safe process the orthopedic specialist may execute to resect or heal a meniscus tear and diagnose the extent of the injury to the knee.
What is a Meniscus Tear?
The meniscus is a rubbery, C-shaped disc that maintains and cushions the knee. Damage to this part of the knee is common. There are two menisci in both knees. One is at the outer, or lateral side of the knee and the other is at the medial, or inner, side.
These structures keep the knee stable by allowing for a balance of weight across the knee. If one of these menisci is torn, the knee does not work properly and the torn meniscus can scrape and damage the surfaces of the knee causing in arthritis.
What is Meniscus Anatomy?
The menisci are "wedge-shaped" parts of cartilage that rest between the thigh bone ("femur") and lower leg bone ("tibia") in the knee joint.
There are two menisci, on the "inside" which is the medical one of the knee and on the "outside" which is the lateral one of the knee.
The medial meniscus is C-shaped, while the lateral meniscus is more semi-circular in shape. Both rest on the tibial surface and are attached to the bone at the front and back of the plateau ("meniscus roots").
Both menisci can be divided into portions based on (i) location within the knee, or (ii) blood supply. By location, the meniscus can be separated into an (i) posterior horn, (ii) body, and (iii) anterior horn.
These terms are useful to define the location of meniscus tears. Tears in the posterior horn are the most common.
The blood supply of the meniscus comes from the periphery where it connects to the lining of the knee joint ("capsule").
For this reason, the peripheral one-third of the menisci are usually well-perfused, while the inner aspects have a more restricted blood supply and similarly limited potential for healing.
These different locations moving from peripheral-to-central have been named the "red-red", "red-white", and "white-white" zones. This grouping becomes important when evaluating meniscus tears and considering their capacity for healing after a surgical repair.
What are the symptoms of a Torn Meniscus?
The symptoms related to meniscus tears vary greatly dependent on the severity. Minor tears may result in low pain and swelling. If there are no mechanical symptoms, such as catching or locking, these tears may cure on their own in around 2 or 3 weeks. Farther moderate tears can lead to pain at the side and back of the knee.
The swelling of a moderate tear gradually gets worse over a 2- or 3-day period. The knee will feel rigid with this type of damage and there will be restrictions on how far the knee can be bent. The signs may go away after a week or two but can arise back anytime there is re-injury or overuse of the knee. The pain of a moderate tear could go on for years if the tear is not treated appropriately.
The third type is more of a severe tear. With these, parts of the meniscus are torn and can displace into the joint space. This will make the knee catch, pop, or lock without notice. It will be difficult to straighten the knee as well. The knee may be defined as "wobbly" and give way without any warning. Most individuals who suffer a severe tear have pain, stiffness, and swelling immediately following the injury and it gets worse over the next few days.
What Causes a Meniscus Tear?
The Menisci can be injured in one of two ways usually speaking; sudden trauma or wear and tear.
In cases of sudden trauma, the most common means for injury is weight-bearing, with the foot fixed, rotational component, and the knee bent. Liken this to a rugby or football player with studs fixed into the ground who is trying to change direction. He or she is bearing weight, knee bent to lower the center of gravity, and foot fixed while turning to change direction.
These forces combine to destroy the cartilage in multiple ways. Of course, these factors can be caused in many sports or activities and are not only produced in football or rugby but the mechanism is similar.
General wear and tear can also cause meniscal damages and there is often little difference in the appearance between these and unexpected trauma tears. In fact, wear and tear are actually many small traumas occurrence over a long period of time.
How is a Meniscus Tear Diagnosed?
Most of the time, the orthopedic specialist questions with the patient regarding past damages and accidents. The doctor will also perform a physical check-up to help find out if the meniscus is torn and causes pain.
Testing may involve X-Rays and/or an MRI so the doctor can see if the meniscus is torn and how serious the damage actually is.
How to Heal a Torn Meniscus Naturally?
1.) “RICE”:
RICE stands for “Rest, Ice, Compress, & Elevate.” You’ll want to instantly take time to rest and recover if you’ve undergone a torn meniscus or another knee injury, starting by lifting up your affected leg above the level of your heart to ease swelling and icing to control pain. Use cold/ice packs for about 20 minutes, numerous times a day.
Your doctor might also recommend you use crutches wear an elastic compression bandage or wear a brace for a period of time in order to restrict weight-bearing, swelling, and movement of the knee.
2.) Physical Therapy:
Before surgery is performed to repair a meniscus, physical therapy is used as the first line of defense. Physical therapy for about 4–6 weeks (and occasionally longer) is recommended to help boost and stretch the muscles that support the knee, which will slowly rebuild and range of motion and functionality.
Working with a physical therapist is the best way to learn how to properly and safely perform meniscus tear exercises and stretches.
Physical therapy for a torn meniscus will focus on quietly stretching first, and then strengthening the hamstrings and quadriceps to help upkeep the knee and prevent muscle imbalances. Imbalances can cause pressure on the knees as your body overcompensates.
Over time and with recurrent repetitive movements, joints can be stretched out of place and misaligned. But studies have found that strengthening weak muscles in the legs will help evenly distribute your weight and build more stability, preventing pain.
During recovery, it’s highly suggested that someone with a torn meniscus avoid pivoting, squatting, and twisting that can aggravate symptoms. One objective initially should be to work on improving range of motion and keeping the quadricep muscles strong in order to aid increase knee stability.
At first, quadriceps setting exercises should be done with the knee mostly straight, such as with “mini-squats” or straight-leg raises that require bending the knee only to about 15 degrees.
3.) Meniscus Tear Exercises:
Below are some of the best meniscus tear exercises to rehearse in order to support recovery:
- Flexion/Extension Exercise: This can be done both standing or sitting; simply bend and straighten the knee as further as the range of motion and pain will allow you. Do 3 sets of 10–20 reps.
- Straight Leg raises: Lie on your back with one knee bent up while keeping the other leg straight and on the ground. Stiffen the muscles on your straight as you tighten your quadriceps, then slowly lift the leg about six inches off the floor. Keep contracting as you hold for several seconds, then gradually lower and repeat about 10 times.
- Heel slides: Lie on your back with one knee bent up while gliding the heel along the ground. The heel should slide as far as doable towards the buttocks repeating 10–20 times on each leg.
- Calf raises: Stand with feet wide apart and hold the wall if needed for balance. Lift heels upwards as high as possible off the floor and gently back down. Try for 2–3 sets of 15–20 repetitions.
- Hip abduction: Stand on undamaged leg only and take the injured leg out to the side as far away from the body as possible.
4.) Posture Correction and Soft Tissue Therapies:
Physiotherapy usually starts with a posture examination, followed by physiotherapy posture correction cures.
A number of different soft tissue therapies can help to increase flexibility and reduce pain while healing, such as myofascial massage, Rolfing, and stretching.
Many patients can benefit from visiting a chiropractor or Rolfing specialist for treatment, assessment, and management of soft tissue injury.
Not only can a postural specialist help to decrease pain and dysfunction, but they can reveal contributing problems that cause knee pain such as pronation abnormalities, which affect someone’s gait, hips and weak glutes, a weak core or iliotibial band syndrome.
Laser therapy can also be used as an effective, safe, non-invasive, painless substitute. It can reduce pain, strengthen the muscles around the knee joint, and improve the range of motion.
5.) Anti-Inflammatory Diet and Supplements:
You can help to lessen inflammation and boost your body’s capability to heal by eating a healthy diet and taking certain supplements.
Nutrient-filled, anti-inflammatory foods to emphasize include:
• A variety of fruits and vegetables, especially cruciferous veggies, leafy greens, berries, sea vegetables, etc.
• Quality proteins, including eggs, wild-caught fish, and grass-fed meat
• Seeds and Nuts
• Healthy fats such as olive oil, coconut oil, avocado, etc.
• Plenty of water, green tea, and bone broth
• Supplements that help keep the health of your joints and connective tissue as you get older, including turmeric, berry extracts, ginger, bromelain, and omega-3 fatty acids.
Increasing collagen consumption may benefit from tissue repair and have anti-aging effects.
In fact, 70 percent of each meniscus is built up of a network of type I collagen, which forms repairs wounds, connective tissue, and keeps joints strong.
Drinking bone broth is an amazing way to consume collagen and other beneficial compounds like chondroitin, glucosamine, and hyaluronic acid, which are supportive of connective tissue/joint health.
These conservative or natural treatments, however, aren't always enough.
If a tear is large, unbalanced, or causing locking symptoms, different types of surgery may be required to either repair or remove unstable edges.
So, here are some meniscus tear surgery options that you can try.
How to Treat a Meniscus Tear with Surgery?
Patients that fail to respond to conservative or natural treatment must think about surgical options for a reduction in pain and symptoms associated with a meniscal tear.
The majority of tears that need this next step are usually advanced in the severity of the tear or have plenty of scar tissue around the tear that has avoided the proper collagen tissue from being deposited.
Traditionally open knee surgery was the only option available for fractional or full meniscectomy (removal of the meniscus) surgeries.
State of the art standards of care now contains arthroscopic surgical intervention options.
The aim of all surgical options is to relieve pain and symptoms linked with the meniscal tear. Choosing the right surgical option is based on the severity and location of the meniscus tear.
How to Treat a Meniscus Tear with Arthroscopic Surgery?
Advances in arthroscopic processes have allowed the meniscus to be surgically cured by the use of a camera and endoscopic surgical instrumentation.
These surgeries are normally performed outpatient at a surgery center. The most usual surgery is an arthroscopic meniscal "shaving" method.
A scope is added into the knee joint and then the joint is filled with a saline solution.
The scope is attached to an intra-operative television monitor allowing the surgeon to view the inside of the knee joint.
Next, a shaver is inserted into the knee to shave off scar tissue and the uneven edges of the tear.
Again, this will allow the body to treat the tear with collagen. More broad surgery is needed for some full thickness and or broken parts that are 'free-floating.' For these severe cases, the use of a grasper is needed.
The surgeon will insert the grasper into the knee joint in the same way as the shaver.
Once the broken or floating piece of meniscus cartilage is recognized the grasper can settle it and the instrument is pulled from the knee removing the broken specimen.
More extensive arthroscopic surgery methods may include partial removal of the meniscus and/or arthroscopic sealing of the meniscal tear.
These methods are performed with the same setup and instrumentation.
The closure is minimal only needing a few sutures to close up in most cases only two or three small incisions measuring 4 mm.
How to Treat a Meniscus Tear with Open Knee Surgery?
Open knee surgery is the largest and invasive form of meniscus surgery and is used as a last resort.
Patients that fail to respond to arthroscopic surgery or have tremendously damaged meniscus will require open knee surgery in the possibilities of achieving a reduction of pain and symptoms associated with meniscal tears.
This surgery is usually done inpatient requiring at least one night in the hospital.
To expose the knee joint an incision from an inch or so above the patella (knee cap) to an inch or so below the patella.
The patella is moved to the side with retractors and then the surgeon will open the knee exposing the interior of the joint.
From this approach, a substantial portion of the meniscus can be visualized and removed. If the entire meniscus needs to be removed a meniscus transplant can be done.
A fresh meniscus is surgically recovered from a cadaveric (deceased) tissue donor.
The donor is tested for transmissible diseases such as HIV, HEP B, HEP C, Syphilis, etc. The transplanted graft is pre-sized based on the recipient's wants. The new meniscus is fixed with metal screws and synthetic monofilament sutures.
Infection and bio rejection are the leading reasons for failure for this surgery. The best results for this surgery have been stated in patients less than 40 years of age.
Lastly, for patients that fail to respond to open meniscus surgery or for elderly patients that have a severe meniscal injury due to arthritic changes a total knee arthroplasty (knee joint replacement) is the final step.
This surgery is completed with the same exposure technique. The ends of the tibia (shin bone) and the femur (thigh bone) are cautiously reshaped with an oscillating and then fitted with metal implants that are surfaced on.
A synthetic plastic spacer is used to change the meniscus. Closure of this incision that typically measures 6 inches will take several sutures.
How to Treat a Meniscus Tear Postoperatively?
Once the surgery is finished rehabilitative physical therapy is essential along with a knee brace. It is significant for the knee joint to be rehabilitated with the proper movement so that normal a body system can be realigned.
Returning to normal body procedures will ensure that the joint will function in the normal capacity and re-injury is reduced.
For arthroscopic patients, postoperative physical therapy exercises are alike to conservative management physical therapy. Usually, only a few appointments are needed with the physical therapist for training the patient.
The patient is encouraged to do the daily exercises at home once they have been trained on how to perform them. Typically, this regiment lasts for 6-9 weeks subject to how the patient responds to the post-operative treatment.
Patients that experience open knee surgery can expect a more severe form of postoperative physical therapy. In addition to general flexion and extension exercises, the patient must perform mobility exercises and walk as well.
Although some of the exercises are done at home the patient must go to numerous physical therapy appointments at the physical therapist’s facility. The physical therapist will closely oversee the progress and communicate the findings to the patient's physician.
This postoperative physical therapy program can last from 12-16 weeks depending on the progress of the patient.
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