Damage to the meniscus can occur as a result of sports injuries. When your meniscus is damaged the knee often gives swelling within hours in most cases. The pain may be on either the inside or the outside. This is because the meniscus is made up of two moon-shaped rings. One on the inside(medial meniscus) and one on the outside(lateral meniscus). In recent years much research has been published that surgery after meniscus injury is not always necessary. In fact, in most cases, it is not! In this blog, we will discuss what meniscus injury entails and what the options are for the rehabilitation process. 

What is the meniscus?

The meniscus forms two crescents made up of cartilage. In the knee, there is an inner and outer meniscus. The meniscus has several functions. The main functions of the meniscus are:

  • Steering of the knee especially during flexion and extension
  • Agility, suppleness
  • Protective effect; protecting cartilage 
  • Caring function
  • Stabilizing function 
  • Pressure distribution in the knee

When a meniscus injury occurs, one or more of these functions may be affected.

inversion trauma

What happens during meniscus injury (genesis)

A meniscus injury often occurs during an "acute" (sudden) moment. During this moment, the knee rotates while it is loaded with the foot remaining on the ground. Within Physical Therapy, we refer to this as a traumatic moment. Meniscus injuries often occur in contact sports. Especially in sports that involve a lot of rotational movements (pivoting). Some examples are soccer, field hockey and handball. When the forces on the knee are too great, a possible bruise or possible tear of the softer parts in the knee occurs. 

Degenerative injury of the meniscus

In some cases, this can also occur as a result of an aging process. We call this degeneration. Just as we get gray hair or wrinkles, our bodies are also subject to aging inside. This aging is a normal process that occurs biologically in each individual person, starting at a certain age. The quality of the tissue so also the meniscus decreases. This increases the risk of injury. The symptoms often occur gradually and increase over time. Because the quality of the meniscus decreases at a later age, the chance of an acute injury may also increase, especially when one still plays fanatical sports or does physically demanding work.

Complaints associated with meniscus injury

The knee can often move less smoothly with meniscus injury. Because the meniscus is inside the capsule of the joint, there may be fluid in the knee. We call this hydrops in the medical world. Bending the knee often causes symptoms. We also see that activities such as climbing stairs or squatting deeply trigger the symptoms. 

 Other symptoms that can occur with meniscus injury include:

  • Pain in knee; nagging/stinging/burning
  • Instability complaints 
  • Obvious pain localization (clearly identifiable), at the level of joint gap of knee. 
  • Unstable feeling or uncertainty in movement 
  • Decrease in muscle mass, we then speak of muscle atrophy. Especially in the quadriceps

Does surgery make sense? 

Research has shown that physical therapy is as effective as surgery for a meniscus tear. Thus, physical therapy is a good first choice to improve meniscus pain. Physical therapy actually has an edge in this sense because we see that in those individuals who have undergone surgery of the meniscus develop wear and tear in the knee more quickly. This will require further study. Because of this development, we see that meniscus complaints are often treated conservatively first. That is, without surgery. The only exception is with structural lock complaints. It is possible that a large tear in the meniscus causes the knee to lock. Thus, it cannot be moved. The meniscus is trapped between the two parts of the bone. This must be treated surgically. The stuck part of the meniscus is removed or stitched back into place. The chance of natural recovery also depends in part on where the tear is located in the meniscus. We distinguish between three different zones. The outer zone we call the red zone. This part of the meniscus is well supplied with blood. For this reason, the chance of recovery is greatest here. The middle zone is the red-white zone. Here there is blood supply but a lot less than in the outer zone. The inner zone is called the white zone. Here the blood supply is the least and therefore the chance of recovery is also minimal. The better the blood supply to a structure, the better nutrients can be transported to it. With these nutrients, new cells can repair the damaged tissue. Thus, the final recovery of the meniscus also depends on where the injury is located. 

 

Conclusion

Conservative treatment of a meniscus tear is always preferred initially. Natural recovery often occurs within a few weeks to months. An average rehabilitation of a meniscus tear takes 12-16 weeks. During this time, there should be a noticeable reduction in symptoms. During this treatment, the focus is placed on muscle function, gait and mobility of the knee. Should there be no structural improvement after this period, further examination of the knee is necessary. A keyhole surgery or MRI can be used to determine the extent of the injury. Suturing of the meniscus is preferred in order to preserve as much function as possible. If this is not possible, the damaged part of the meniscus can be cut away. Physical therapy is also recommended after surgery to promote recovery. 

 

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