Meniscal Tears – What has Changed?
Believe it or not, meniscal tears are quite a common occurrence in active and inactive people alike. Historically, they’ve often been operated on and “tidied up” or “cleaned out”. More recently, the mentality towards meniscal tears has shifted somewhat and here’s why…
What are the Menisci?
As the “shock absorbers” of the knee, the menisci are elliptically shaped portions of cartilage that sit on the top plateau of your shin bone, the tibia. There’s 2 in each knee, with a medial (on the inner side) and a lateral (on the outer side). The medial one has a very close relationship with the medial collateral ligament of the knee, which can sometimes confuse diagnoses when they get injured, but we’ll come to that later.
The thigh bone (femur) slots down onto the menisci and compresses them when you weight-bear. They act as cushioning between the toe bones when walking and running etc.
How do they get injured?
There are a number of different ways you can tear a meniscus. Typically it involves a weight-bearing “twist” of the knee. In effect, the weight bearing squeezes the tibia and femur together, engaging the meniscus, and then the twist causes the tear.
In these instances, you will often experience pain, swelling and immobility of the knee joint. Depending on the mechanism of injury, there can also be other structures involved. The cruciate ligaments or collateral ligaments are potential victims as they can also get injured during loaded, twisting movements.
As mentioned earlier, the medial meniscus has a close relationship, and in fact, a direct attachment to the medial collateral ligament (unlike the lateral side) so often injury to the medial meniscus and MCL come as a pair.
However, there’s another very common way to tear a meniscus and you’ll often have no idea you’ve done it!
Degenerative meniscal tears are much more common than previously appreciated. They can happen as a result of repetitive loading that eventually culminates in a tear and often they are completely symptom free!
This is one of the reasons why treatment attitudes have changed in recent years.
How do I fix it and how long does it take?
The menisci have a notoriously bad blood and nerve supply, which means they often don’t heal. This was the early reasoning behind most meniscal surgeries. In essence, “If they don’t heal by themselves, let’s go and stitch or trim the torn bit.”
The question more recently asked is, do they need to heal?
As previously mentioned, some meniscal tears can have occurred and show no symptoms or consequences to the patient at all! As a result, surgeons and other practitioners started asking whether they needed to be operating on people as much?
Interestingly, they found that a lot of meniscal injuries, with the right conservative treatment, will settle down and allow the person to get back to all of their previous sport as normal.
This can take a little time (approximately 8 weeks) and some hard work in terms of rehabilitation and strengthening, but it’s a much more preferable recovery than going under the knife!
So why might surgery have been recommended to me?
Due to the type and position of certain meniscal tears, some can be seen as “unstable tears”. In these instances there can be a section of the torn meniscus that is moving around in the knee causing the joint to “lock” or “give way”. It is this type of tear that could potentially still require some surgical intervention.
In other cases fit for surgery, it may be that the meniscus is trimmed as part of a surgery to reconstruct a ruptured ACL or MCL, so injuries to other structures might also need to be taken into account.
As with any injury, the most important thing is that the full extent of the issue is assessed and rehabilitation is started as early as possible. Where only conservative treatment is necessary, you will be in safe hands to guide you through it and in cases where surgery may be necessary, you will receive all the help and advice you need prior to the surgery itself.
Do you have questions about Meniscal injuries? Call us on 01628639532 and our friendly team will be on hand to help!Categories: All Articles / Injuries
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