Meniscal injuries

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Meniscal injuries can be painful and debilitating. They are one of the most common cartilage injuries that occur in the knee.

The meniscus is the cartilage that helps to stabilise the knee joint. Cartilage is a flexible, rubbery material that cushions the ends of the bones, preventing them from rubbing against one another and helping to stabilise the joint. The menisci are crescent-shaped sections of cartilage that support the knee joint to move smoothly and absorb the impact of the upper leg on the lower leg. When you injure the meniscus it can become torn, sometimes severely.

Causes of meniscal injuries

Tears to the meniscus can occur as the result of a sporting injury or due to age-related wear and tear. The menisci may tear due to a sudden twisting movement of the knee, particularly during high impact sports like football or volleyball. In older people, even a simple movement like twisting awkwardly as you stand can result in an injured meniscus. These are called degenerative tears as they are due to wear and tear linked to ageing. Older athletes are particularly at risk of meniscal injuries as the meniscus naturally weakens with age.

Meniscal tears can sometimes be accompanied by damage to other parts of the knee, such as injuries to the anterior cruciate ligament. You may be able to reduce your risk of meniscal tears by keeping the thigh muscles strong and warming up properly before workouts. Taking adequate rest between workouts is also important.

Symptoms of meniscal injuries

Initially, you may still be able to walk with a torn meniscus, however it may become increasingly swollen and stiff within days of the injury. Other common symptoms include:

  • A popping sensation at the time of the injury and when you bend and straighten the injured knee.
  • Pain in the knee, which may be mild or come and go.
  • The knee joint feels loose, as though it might give way.
  • Swelling and an increasing feeling of stiffness in the knee.
  • Tenderness in the knee joint.
  • Being unable to bend or straighten the knee fully.
  • A catching or locking sensation in the knee, which may be caused by a section of loose cartilage in the joint.

Diagnosis of meniscal injuries

To diagnose a meniscal injury, the doctor will carry out a physical examination of the affected knee. You may be given an X-ray to rule out fractures and an MRI scan which can show the extent of damage to the meniscus.

Treatment of meniscal injuries

The treatment for meniscal tears will depend on the extent and severity of the tear, as well as how old you are, how active you are and what caused the injury. Initially, you may be able manage some of the symptoms using the RICE method – rest, ice to control swelling, compression and elevating the knee above the level of the heart. It is important to rest the injured knee and not to continue exercising or to apply heat to the affected area as this can increase swelling.

Most meniscal tears will not heal by themselves, unless they are in the outer section of the meniscus which has a good blood supply. Elsewhere, the cartilage lacks sufficient blood vessels to provide healing nutrients so you will need some type of treatment. This might include:

  • Medication – such as painkillers and anti-inflammatories. If over the counter painkillers don’t provide sufficient pain relief you may need prescription painkillers.
  • Physiotherapy – can help to improve stability and strength in your knee joint and enable you to recover a greater range of movement.
  • Walking aids – you may need to use crutches or wear a brace if you are unable to put weight on your injured knee.
  • Surgery – may be necessary for severe meniscal tears. It is normally performed arthroscopically (keyhole surgery). After making a small incision in your knee, the surgeon inserts an arthroscope, which is a thin, flexible tube with a camera at one end that enables the surgeon to see inside the joint. Tiny surgical instruments can then be inserted through small incisions in your knee to repair or removed damaged parts of the meniscus. Recovery from surgery normally takes four to six weeks and it is important not to return to physical activities too soon as this can slow your recovery.

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