What Is a Meniscus?
Your knee is a intricate joint that connects your thigh bone (femur) to your shin bone (tibia). In each knee, you have two menisci: a medial (or inner) meniscus and a lateral (or outer) meniscus. The medial meniscus is a C-shaped cartilage that safeguards the inside of your knee. The lateral meniscus is a C-shaped cartilage on the outer portion of your knee joint.
The menisci have two critical roles. They absorb shock between the thigh and shin bones and help provide some stability of the knee. The menisci are resilient and flexible, which allows them to aid in cushioning your knee joint.
Every time you take a step, your menisci absorb the majority of the weight placed on your leg. Without the menisci, your bones would rub against each other, causing discomfort and osteoarthritis over time.
What Causes a Meniscus Tear?
A torn meniscus is a frequent injury among athletes and nonathletes and can occur in different ways. A meniscus tear can arise due to an sudden injury or due to a degenerative process. Anyone can develop a meniscus tear, although it is less common in children below age 10.
Typically, a torn meniscus is caused by forceful twisting or rotation of your knee when your foot is anchored to the ground. For instance, abrupt pivots or contact from being tackled can cause a tear. A tear can also occur when the knee is hyper-flexed such as during a deep squat, lifting something heavy, or even kneeling.
Sports-related tears are typically acute and due to sudden motions or impact when playing a sport or practicing.
As a consequence, you frequently have a precise awareness of when the harm transpired. Individuals who engage in collision sports and sports involving pivoting movements, like basketball, tennis, or golf, face an elevated vulnerability to experiencing a torn meniscus.
However, the chance of a meniscus rupture also increases with age due to the deterioration of the cartilage. Over time, the cartilage gradually weakens and has diminished blood supply, making the meniscus more susceptible to a tear.
Individuals with osteoarthritis, a history of knee injuries, or obesity are also at a higher risk for a meniscus tear. In this scenario, a tear can occur during everyday activities, like exiting a vehicle. The cause of the injury may be unknown. Occasionally, a torn meniscus due to deterioration can happen without any trauma.
Are There Different Types of Tears?
The menisci can be torn in various locations. Understanding the type of tear and how it happened assists in determining potential options for treating a meniscus tear.
Tears are categorized based on their appearance and the site of the injury in the cartilage. The doctor will investigate whether the injury is stable or unstable, the location, the pattern, and the severity.
Tears in the outer one-third of the meniscus may heal on their own or can be repaired surgically. This is because that area of the menisci, often referred to as the red zone, has a sufficient blood supply. Damage to the inner two-thirds of the meniscus cannot heal naturally. This part of the meniscus, called the white zone, lacks a blood supply.
What Are the Symptoms of a Torn Meniscus?
When a meniscus tears, you may hear or feel a popping sensation in your knee. However, some individuals report not noticing or experiencing symptoms at the time of the knee injury.
Initial symptoms, including swelling and pain, will occur in the knee joint. The pain typically manifests on the inner or outer side of the knee rather than the kneecap. That being said, the swelling and pain may develop gradually over a few hours, particularly if the tear is less severe. Tears caused by degenerative processes may not result in much, if any, pain and can go unnoticed.
If you have a minor tear, you typically will experience slight pain and swelling that often resolves in 2 or 3 weeks. Swelling often worsens over 2 to 3 days with a moderate tear. Additionally, you may feel a sharp pain when you squat down or twist your knee. With a severe tear, you often struggle to fully extend your knee. You may feel as though your knee might give way or become locked. Swelling may begin shortly after the injury and escalate over the next 2 or 3 days.
Other symptoms may include:
- Difficulty moving your knee or having a complete range of motion,
- Sensation of your knee getting locked,
- Sensation of your knee giving way.
After the initial inflammatory response subsides, other symptoms may develop over time, such as:
- Intermittent swelling of the knee with no known cause,
- Hearing or sensing the knee popping when going up stairs,
- Pain when running or walking long distances,
- Excessive fluid in the knee joint,
- Persistent limited range of motion in the knee.
When the knee feels locked and unable to fully extend, it may be due to a portion of the meniscus becoming trapped in the knee joint. It is crucial to have the knee evaluated in this situation to prevent further long-term damage.
How Is a Tear to the Meniscus Diagnosed?
If you suspect a meniscus tear, a doctor can determine whether a nonsurgical or surgical approach is necessary.
Your doctor will begin by collecting a complete medical history. Your doctor will want to know:
- When the injury occurred and the activity you were engaged in if it was a sudden injury,
- Your symptoms,
- Any other longstanding knee issues or injuries,
- The types of exercise or sports you participate in,
- Your overall level of activity.
During the physical examination, your doctor will assess the joint for areas of tenderness and warmth. Tenderness along the joint line can sometimes indicate a tear. They will evaluate the stability of your ligaments and test the range of motion in your knee. They may also examine your quadriceps and hamstring muscles.
During the examination, your doctor may perform the McMurray test, which is one of the primary tests used to identify a meniscus tear. During this test, your doctor will flex, then extend, and finally rotate your knee. These movements create tension on the menisci and produce a clicking sound if a tear is present.
Imaging can confirm the diagnosis and identify any additional knee problems, such as degeneration or ligament tears like ACL.
Magnetic Resonance Imaging (MRI). MRI is employed to confirm a diagnosis of a meniscus tear. This noninvasive tool provides detailed images of the knee’s inner structures, including cartilage, ligaments, tendons, and muscles. These images can help determine if the issue is solely a meniscus tear or if there are other injuries involved. This is important because ACL tears often occur alongside certain types of meniscus tears. Additionally, the imaging can assist a surgeon in deciding if surgery is necessary and in planning the procedure.
X-ray. Meniscus tears are not visible on X-rays, but this tool serves other purposes.
X-rays can assist in determining any breaks, arthritic changes, or unattached bits of bone that may be causing irritation within the joint. It also illustrates the extent of cartilage deterioration. X-rays unveil the volume of room occupied by the cartilage within the joint. The more restricted the space, the higher the probability of diminished cartilage due to factors such as a degenerative procedure.
What Are the Treatment Options For a Torn Meniscus?
The assessment by the doctor and potential imaging will assist in determining if surgery is necessary or if the tear can resolve itself. Additional factors, such as age, level of activity, and any concurrent injuries like a torn ACL, will also be taken into account.
Based on the type of injury, you may initially choose a more conservative, non-surgical approach and then consider surgical options if that proves ineffective. The exception is if your knee is experiencing locking due to a torn meniscus, in which case surgical repair is necessary.
Non-surgical Treatment Options
Surgery may not be required if the tear is small and located in the outer, or red zone, portion of the meniscus. Other factors include the stability of your knee and if symptoms do not persist over a prolonged period. In this scenario, non-surgical options like rest and exercises specifically for a torn meniscus may be sufficient for recovery.
The RICE protocol—Rest, Ice, Compression, Elevation—is often suggested as an effective method to rest and treat a meniscus tear that does not necessitate surgery.
Rest. You may need to limit or cease certain activities, particularly those that exert pressure on the knee or require rotational movement until the tear is healed. Additionally, your doctor may recommend the use of crutches to avoid putting weight on your leg.
Ice. Apply cold packs multiple times a day as instructed by your doctor. Ensure that the cold pack does not come into direct contact with your skin.
Compression. Using an elastic compression bandage or a knee brace specifically designed for meniscus tears may aid in reducing swelling and providing added stability to your knee. Prior to using a brace, consult your doctor to ensure it is appropriate for your type of meniscus tear.
Elevation. When resting or reclining, elevate your leg above the level of your heart to help diminish swelling.
Over-the-counter pain medications, such as aspirin, can help alleviate swelling and pain. Discuss with your doctor which medication might be most effective for you.
Surgical Treatment Options
Arthroscopic knee surgery is commonly employed for meniscus tears. The objective of the procedure is to preserve as much of the meniscus as possible. Although uncommon, certain tears may require open knee surgery.
Procedure. During arthroscopic surgery, a surgeon inserts a small scope into your knee through a small incision. This scope allows for visualization of the internal structures of your knee. Miniature surgical instruments are then inserted through another small incision to perform the operation. Typically, the procedure lasts around an hour, and the patient is usually discharged on the same day.
Types of Surgeries. The specific type of surgery necessary will depend on the nature of the tear.
To remedy the wound, your surgeon might execute a:
by eliminating the damaged parts of your meniscus and smoothing worn-out edges,
where the surgeon stitches the torn meniscus pieces together,
which involves removing the entire meniscus.
In general, arthroscopic surgery carries a low level of risk. Complications are rare, although all operations have some degree of risk.
If surgery is necessary, your doctor may recommend physical therapy before the procedure to strengthen your knee in preparation for post-surgery rehabilitation. You may also be provided with crutches prior to surgery.
Is Physical Therapy Required for a Meniscus Tear?
Physical therapy or rehabilitation exercises at home are frequently suggested. Physical therapy can accelerate recovery and minimize complications, particularly if you undergo surgery.
Rehabilitation exercises for a torn meniscus help increase the strength of your knee, the surrounding leg muscles, and aid in achieving full range of motion. Moreover, physical therapy may be as effective as surgery for tears caused by degeneration or osteoarthritis.
A physical therapist can ensure you are performing the appropriate exercises for your stage of recovery and assist in monitoring your progress. The exercises will primarily focus on helping you regain a complete range of motion, including flexing and extending your knee, stretching your leg muscles, and building strength.
The specific types of exercises may vary depending on your individual situation. Throughout this process, it is crucial to pay attention to the signals of pain that your body sends. Healing your injury takes time, and pushing yourself too hard may impede your progress.
What Is the Recovery Period Following a Meniscus Tear?
It is important not to rush through your recovery. Your menisci require time to heal, regardless of whether you undergo surgery or not. Just like in physical therapy, it is important to be aware of symptoms such as pain and swelling.
Giving your knee sufficient time to heal will provide you with the best chance of returning to full functionality. Returning to your regular activity levels too soon could result in further injury.
Recovery Period Without Surgery
For most individuals, a meniscus tear in the red zone will take 6 to 8 weeks to fully heal. During this time, you may need crutches for part of the duration to minimize weight-bearing on the leg. Additionally, your doctor or physical therapist may assign you rehabilitation exercises for a torn meniscus to enhance strength.
Recovery Period With Surgery
The recovery relies on the kind of surgery and the severity of your rip. Majority of individuals return to regular functioning following arthroscopic surgery to eliminate the torn meniscal fragments in 3 to 6 weeks.
If you necessitate a meniscus repair (suturing), the recovery time is usually longer. A meniscus repair can take up to 3 months to heal.
Do You Require a Knee Brace for Meniscus Tear?
Knee braces for meniscus tears can aid in providing support and stability. Nevertheless, knee braces do not heal or treat the tear.
It is crucial to comprehend the type of injury you possess and the desired function of the knee brace to choose the appropriate knee brace for you. Seeking advice from your doctor or physical therapist can assist you in determining what you require from a knee brace for meniscus tear.
Certain knee braces will aid in preventing your knee from excessively rotating, and other braces can assist in reducing the amount of weight that specific parts of the meniscus need to bear. Other kinds of braces might be utilized when participating in sports to help prevent a tear.
What Characteristics Should You Seek in a Knee Brace for Meniscus Tear?
When searching for a knee brace, consider the type of injury you have, the type of surgery, and whether you require a brace for daily use.
Mild Meniscus Tear or Degenerative Tear
A knee sleeve that provides mild compression may assist in offering some additional support during recovery. The compression can provide warmth around your knee, resulting in improved comfort. Additionally, the brace can serve as a reminder that your knee is recuperating to prevent premature overuse.
Search for a knee sleeve that fits comfortably yet doesn’t exert excessive pressure on your knee. Excessive pressure can impede full knee extension and may not adequately support your knee during recovery.
Materials such as neoprene are typically lightweight and comfortable for extended wear. Some sleeves may feature a cutout around the kneecap region, which can enhance comfort.
If a sleeve is challenging to put on, there are wrap-around options available that can provide mild compression. The advantage of a wrap-around style is that it can be worn comfortably over pants if desired and may be more manageable for individuals who have difficulty bending over. However, this style may loosen while being worn and may require occasional adjustment throughout the day.
Meniscus Tear on One Side
If the meniscus is torn on one side or you have osteoarthritis due to bone-on-bone friction, an unloader knee brace can be beneficial. An unloader knee brace offers additional support by reducing the load or weight that the injured or weakened meniscus bears. The brace redistributes the weight to another unaffected area of the meniscus. This approach can help alleviate pain and enhance comfort during your regular activities.
Ideally, search for a knee brace that fits snugly but without exerting pressure on your knee. To guarantee a complete range of motion, search for designs that feature a flexible, frequently stretchy, joint mechanism that permits easy movement while still delivering support.
Some knee braces for unloading are designed with a web-like structure. This structure can provide stability and support while enhancing comfort and promoting airflow.
Tear in Both Sides of the Meniscus
If the meniscus is torn on both sides, a ligament brace or hinged brace may provide the optimal support. This kind of brace can offer general knee support, which can be particularly beneficial if you have osteoarthritis as well. Moreover, if you have a torn ACL, this style of brace may assist in supporting both your ACL and menisci.
There are various styles available to accommodate different requirements. Seek a knee brace that has hinges on both sides to provide support. You will desire a brace that fits snugly without exerting pressure on your knee joint.
Some braces come with a back opening known as an open popliteal. This opening can enhance comfort by preventing the brace material from bunching at the back of your knee when bending the joint. It also allows for improved airflow.
If you are seeking a brace that offers more warmth and compression, you may prefer a neoprene fabric. However, another material utilized in certain braces, Drytex, can provide some compression while offering greater breathability. This material may be advantageous for individuals residing in warmer climates.
How Can You Avoid a Meniscus Tear?
Preventing meniscus tears can be challenging since they can occur unexpectedly, even during everyday activities. However, to minimize your risk, consider:
- Performing warm-up exercises and stretches before participating in exercise or sports,
- Maintaining strength in your leg muscles, particularly your thigh muscles, through regular exercise,
- Consulting with your doctor about utilizing a protective sleeve or knee brace as a preventive measure if you engage in sports that involve pivoting or contact,
- Incorporating regular stretching to maintain flexibility,
- Wearing supportive footwear.
What Is the Long-Term Prognosis After a Meniscus Tear?
With rest, appropriate treatment, and rehabilitation exercises for a torn meniscus, most individuals regain full functionality of their knee following a meniscus tear. A knee brace for a meniscus tear can be a valuable tool in providing stability to your knee during recovery or as a preventive measure.