Meniscal Injuries (Injuries to the Menisci)

Meniscal Injuries (Injuries to the Menisci)
The menisci can be easily injured by the force of rotating the
knee while bearing weight. A partial or total tear may occur
when a person quickly twists or rotates the upper leg while
the foot stays still (for example, when dribbling a basketball
around an opponent or turning to hit a tennis ball). If the
tear is tiny, the meniscus stays connected to the front and
back of the knee; if the tear is large, the meniscus may be
left hanging by a thread of cartilage. The seriousness of a
tear depends on its location and extent.
Symptoms
Generally, when people injure a meniscus, they feel some
pain, particularly when the knee is straightened. If the
pain is mild, the person may continue moving. Severe
pain may occur if a fragment of the meniscus catches
between the femur and the tibia. Swelling may occur soon
after injury if there is damage to blood vessels. Swelling
may also occur several hours later if there is inflammation
of the joint lining (synovium). Sometimes, an injury that
occurred in the past but was not treated becomes painful
months or years later, particularly if the knee is injured a
second time. After any injury, the knee may click, lock, feel
weak, or give way. Although symptoms of meniscal injury
may disappear on their own, they frequently persist or return
and require treatment.
Diagnosis
In addition to listening to your description of the onset of pain
and swelling, the doctor may perform a physical examination
and take x rays of the knee. An MRI may be recommended to
confirm the diagnosis. Occasionally, the doctor may use
arthroscopy to help diagnose a meniscal tear.
Treatment
If the tear is minor and the pain and other symptoms go
away, the doctor may recommend a muscle-strengthening
program. The following exercises after injury to the meniscus
are designed to build up the quadriceps and hamstring
muscles and increase flexibility and strength:
• warming up the joint by riding a stationary bicycle,
then straightening and raising the leg (but not
straightening it too much)
• extending the leg while sitting (a weight may be
worn on the ankle for this exercise)
• raising the leg while lying on the stomach
• exercising in a pool (walking as fast as possible in
chest-deep water, performing small flutter kicks
while holding onto the side of the pool, and raising
each leg to 90 degrees in chest-deep water while
pressing the back against the side of the pool).
Before beginning any type of exercise program, consult
your doctor or physical therapist to learn which exercises are
appropriate for you and how to do them correctly, because
doing the wrong exercise or exercising improperly can cause
problems. A health care professional can also advise you on
how to warm up safely and when to avoid exercising a joint
affected by arthritis.
If your lifestyle is limited by the symptoms or the problem,
the doctor may perform arthroscopic or open surgery to
see the extent of injury and to remove or repair the tear.
Most young athletes are able to return to active sports after
meniscus repair.
Recovery after surgical repair takes several weeks. The best
results of treatment for meniscal injury are obtained in people
who do not show articular cartilage changes and who
have an intact anterior cruciate ligament.