Meniscus injury

Training with knee pain

The fast facts:

  • The meniscus is a cartilage-like structure that provides guidance to the knee joint.
  • The meniscus is also a pressure divider in the knee joint.
  • Meniscus injuries are relatively common in soccer players.
  • In sports often you have to turn a lot under load, the risk of a meniscus injury is greatest.
  • Suturing the meniscus in surgery gives better long-term results.
  • More than 90% of athletes achieve their former level of sport after a meniscus injury.

Meniscus injury

The knee has a medial (inner) meniscus and a lateral (outer) meniscus. The meniscus looks like two half-shaped moons that sit on the lower leg. When the knee has to make a quick and powerful twisting motion during sports, a meniscus injury can occur. Because inner meniscus is attached to the capsule of the knee, it gets damaged much faster. When the knee is placed in a vulnerable position, the inner meniscus is much less flexible and therefore much greater forces are released on the inner meniscus. In addition to this acute form of meniscus injury, the injury can also develop gradually. Minor damage can also cause long-term symptoms. Also, like other structures in our body, the meniscus is subject to natural aging, which in time can lead to complaints.

Cruciate ligament injury

Symptoms in a meniscus injury:

    • Pain is often on the side of the knee(inside or outside).
    • Squatting, climbing stairs and standing for long periods of time are often painful.
    • Often the knee will give swelling after loading. 
    • Sometimes lock symptoms occur, the knee suddenly cannot be bent or extended properly.
    • All of these symptoms may occur immediately after the injury moment or gradually increase.

How to diagnose a meniscus injury

When your knee is swollen the next day after exercise or after an injury moment, it may be that the meniscus is affected. Often you can no longer bend and stretch properly. You may also experience an unstable feeling and the knee may sometimes lock up. The diagnosis is only official after an MRI or even keyhole surgery. If your knee is really locked up and you can't get it out of this position, you will need surgery sooner to remove this limitation.

Physical testing of the humanoid

Often the diagnosis is already fairly clear when the previously mentioned symptoms are present. To confirm this suspicion, various physical tests are performed where the recognizable symptoms are provoked. 

  • McMurray 
    From a maximally flexed position, the knee is rotated outward by means of the foot. The space between the joint crevices is reduced to a minimum, which causes irritation of the meniscus between two parts of the bone. The test with the foot rotated outward is described for the inner meniscus. This test is also performed with the foot rotated inward for the outer meniscus. 

  • Joint line tenderness
    With the knee in a 90-degree flexed position, the joint gap is palpated both inside and outside by the examiner. The test is positive when the recognizable symptoms are elicited. The result of this test should always be combined with the other test results. A recognizable pain with only this test cannot give a definite answer about meniscus complaints. 

Surgical intervention or conservative treatment

    In general, a conservative policy is used when there are no extensive lock complaints. If there is no structural improvement within 3-6 months, surgery may be considered. 

    Surgical intervention for a meniscus injury is done in almost all cases through keyhole surgery (arthroscopy). Whenever possible, the meniscus will be sutured in order to preserve as much as possible of the original functions of the meniscus. Suturing of the meniscus leads to better long-term results. The further the tear is to the outer edge of the meniscus the better the recovery. This is because the edges of the meniscus are best supplied with blood. So also more likely to recover. The meniscus is schematically divided into several zones: 

    • Red-red zone, good blood supply
    • Red-white zone, intermittent blood supply
    • White-white zone, little blood supply

    So despite the fact that suturing of the meniscus does ensure better preservation of the meniscus, this procedure does have a higher chance of reoperation. 16.5% of the people will undergo reoperation within 4 years. This compares to 1.4% with a meniscectomy. In a meniscectomy, they remove the part of the tear in the meniscus. The choice of suturing or cutting depends on the type of tear but also the location of the tear the chances of recovery in this must be high enough. This again has mainly to do with the different zones in the meniscus.

    Knee Osteoarthritis
    Kevin van Geel

    Knee & Sport rehabilitation specialist Fleur Prins

    The different phases in the treatment of meniscus

    Successful rehabilitation consists of several phases and steps. Good strength, stability and control of the knee is necessary to safely return to your sport. Both after an operative procedure and with a conservative policy.

    Acute phase:
    In this phase, we focus primarily on symptom reduction. There is often swelling, pain and reduced mobility of the knee. In addition, it is important to regain good control of your quadriceps (thigh muscle). After an injury to the meniscus or after surgery on that knee, we often see a decrease in strength and mass of the quadriceps. It is therefore important to quickly regain proper function of the knee. In addition, it is important to get back to a normal walking pattern.

    Strength and stabilization phase:
    In this phase there is more of a build up in strength. Stabilizing exercises are also discussed. How fast this is built up depends on the reaction of the knee to the given load. This is always personally tailored to the current status of the knee. 

    Sport-specific phase:
    The final phase focuses particularly on maximum strength, jumping power and explosiveness. This is all necessary to be able to change direction quickly within your sport. We also work towards a competition condition so that you can continue to perform under fatigue. The quality of movement must remain good under these conditions. 

    Rehabilitation at Fysio Fitaal

    During rehabilitation, there will always be small and sometimes big setbacks coming your way. Especially in certain phases, things will go slower than you had thought beforehand. Patience is necessary. Our specialists will guide you through this process as best as they can and motivate you where necessary. Fysio Fitaal works with specialists in the field of knee and sports rehabilitation. Because of this combination of expertise, extensive facilities and passion for sports, you have come to the right place.

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