Meniscus
What is a meniscus?
The menisci are two crescent-shaped cartilage discs that sit between the femur and the lower leg. One meniscus on the inside of the knee and one on the outside of the knee. Its function in the knee is to be shock-absorbing, to equalize pressure and to contribute to the stability of the knee.
Why do you get a meniscus injury?
This is a common injury. Over 30,000 meniscus surgeries are performed in Sweden annually. Injury to the inner meniscus is clearly more common than injury to the outer meniscus.
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There are two types of meniscus injuries. One type occurs acutely in connection with an accident, which often involves strain in combination with a twisting of the knee, for example during football, floorball or running. The injury may be limited to the meniscus alone. However, it can also involve a combination of injuries to the meniscus, collateral ligament and anterior cruciate ligament, an “unhappy triad”.
The second and most common type of meniscus injury occurs through gradual wear and tear of the meniscus. Over the years, the meniscus gradually becomes more fragile, can crack and tear more easily. The pain then often comes gradually, or through the knee starting to hurt after a seemingly light load that causes the worn meniscus to eventually tear, for example when squatting or sitting in a tailor's position.
Symptoms of meniscus injury?
Symptoms of acute meniscus injury are often sudden pain on the outside or inside of the knee. The knee can "lock", hook up, often in combination with pain, which then releases. Limited movement and pain when trying to squat are common. Some swelling may occur on the side of the injury. If it is a triad of injuries to the knee, the swelling may be more extensive.
Symptoms of gradual wear and tear are often not as acute, but come on more gradually. However, the type of symptoms are the same as with an acute injury.
A meniscus injury can be diagnosed with the help of tests and ultrasound diagnostics . With ultrasound diagnostics, we can in many cases see the extent of the damage to the knee.
Treatment of acute meniscal injury?
If the injury occurs acutely, it is good to wrap the knee for compression, with the aim of keeping down any swelling. Relief of the leg with an elevated position, i.e. the knee above heart level. Cold can be used for pain relief, if necessary.
Most menisci do not have a blood supply, but receive their nutrition from the synovial fluid in the joint. This means that a torn meniscus in most cases does not heal. However, the injury can be so severe that once the acute condition has subsided, the knee functions well.
Treatment for meniscus injury?
Physiotherapy can use manual treatments, mobilizations and shock wave therapy to soften the joint capsule that surrounds the knee. This way, there is a possibility of getting the meniscus to slide in a more beneficial way, for some the pain then disappears completely.
Also important is a gradual rehabilitation training to optimize the knee's load tolerance, mobility, strength and coordination. Here our physiotherapists can help so that the rehabilitation starts at the right level and is increased, to optimize the possibility of you being able to return to the activity you wish to perform.
If the injury is extensive, with recurring locking and increased pain when loading, despite treatment and rehabilitation attempts, we will refer you to a doctor for a decision on possible arthroscopy (keyhole surgery). To optimize the outcome of an operation for acute meniscus injury, it should be performed within 3 months of the injury. In such an operation, the torn part is removed and the remaining part is smoothed out. After this, it is again important that a gradual rehabilitation training is carried out to optimize the knee's mobility, strength and coordination.
Prognosis for injured meniscus
The prognosis is very dependent on where the injury is located and how big the injury is. If the pain is not too severe and if you do not have knee locking, the prognosis is good. In surgery where part of the meniscus is removed, the prognosis is good. Nowadays, as little of the meniscus as possible is removed. This is because there has been a clearly increased risk of osteoarthritis if the entire meniscus is removed.
Differential diagnoses
Pain on the inside of the knee can also be caused by a medial collateral ligament injury (lateral ligament on the inside of the knee) that runs just above the meniscus on the inside of the knee. An injury to the pes anserinus (duck's foot, muscle tendons) that runs behind the medial collateral ligament can also cause pain on the inside of the knee.
Pain on the outside of the knee can be caused by damage to the lateral collateral ligament (the ligament on the outside of the knee). There is also a tendon on the outside of the knee called the iliotibial tract. Damage to this tendon can cause runner's knee, a symptom of which is pain on the outside of the knee.
