Torn Meniscus: What it is, Causes, Symptoms and Treatments

• A meniscus tear is an injury to the cartilage of the knee that usually occurs in athletes and older people.
• Symptoms of a meniscus tear include pain in the knee when walking, going up and down stairs.
• Treatment will vary depending on the cause of the meniscus tear and the cartilage tissue affected.

A meniscus tear can be caused by injury or by wear and tear on the joint over the years. Although it most commonly affects older people, meniscus tears are the most common injury in the world of sport.

Symptoms vary depending on the cause of the injury. In the case of a traumatic tear, pain and swelling are most common. If the tear occurs due to cartilage wear and tear, the pain will increase the more the joint is strained.

Similarly, the specialist will recommend the appropriate treatment, depending on the type of tear, the severity of the tear and the symptoms you have.

Although it is not usual to recommend surgery as the first and only option, if conservative non-surgical treatment is not sufficient, meniscus surgery will become the most appropriate option.

A meniscus tear is an injury to the cartilage discs of the knee. This tear can be caused by trauma (accident, blow or sudden twist, etc.), or by wear and tear of the cartilage, which is associated with older people.

It is important not to confuse menisciitis with meniscal tears. While menisciitis is a severe contusion of the meniscus that generates inflammation and normally heals over time without sequelae, a meniscal tear is a more severe type of injury that will require treatment for repair.

The meniscus is made up of a cartilaginous tissue called fibrocartilage. Each knee has two menisci: the medial meniscus, on the inside of the knee (inner meniscus) and shaped like a C or crescent, and the lateral meniscus, located on the outside of the knee (outer meniscus), which is almost circular in shape.

Both are inserted between the tibia and the femur. Their function is to distribute the force on the articular surfaces and to protect the cartilage from excessive wear.

The meniscus bears 40 % of the load on the knee.

So if a meniscus tear occurs, the cartilage will no longer perform its functions properly:

Functions of the meniscus

In addition to bringing the flat surface of the tibia into contact with the rounded surface of the femur and forming a mobile joint, the menisci have the following functions:

• Reduce the impact of the shock between the femur and tibia. The meniscus is capable of absorbing almost 20% of the shock waves produced when walking.
• Stabilise the knee. The upper part of the tibia and the lower part of the femur do not fit together on their own, so the menisci allow the two parts to join together, increasing the bearing surface.
• Load distribution. The fibres of the meniscus allow 50% of the load to be transmitted with the leg extended and up to 90% with the knee flexed. But what does this mean?

People who have had the meniscus removed have 50% less joint contact, i.e. when there is pressure on the knee, the cartilage of the femur rubs more against the cartilage of the tibia, which can lead to degenerative osteoarthritis.

• Reduce wear and tear of the cartilage. The meniscus acts as a kind of cushion that protects the cartilage from pressure and stabilises the joint. In addition, given the high water content of the meniscus, it lubricates the joint and contributes to joint gliding.

In addition, without menisci, the joint friction between the tibia and femur would cause severe wear and tear on the cartilage covering the knee bones, leading to premature onset of osteoarthritis of the knee.

A meniscus tear is usually caused by a sudden twist of the knee during sports. Although this injury can occur at any age and for a variety of reasons, sports such as football, basketball or tennis increase the risk of it happening.

Meniscus tears are the most common injury in athletes.

For, in the sports mentioned, it is common to start and stop very abruptly, which makes meniscus tears particularly likely to occur.

On the other hand, when we do not kneel, lift or squat, it can lead to abrupt hyperflexion or hyperextension (backward extension of the joint beyond its normal range) of the knee.

A meniscal tear may be of one type or another depending on the amount of meniscus torn and the direction of the tear, relative to the meniscal structure.

• Parameniscal injury is a less severe type of injury. This type of tear occurs around the meniscus, without being a complete tear, so it can be treated with a method of rest and medication, without the need for surgery.
• On the other hand, a meniscal tear, also known as a meniscal pullout, is a complete tear and is usually treated with surgery.

One of the most common meniscal tears is an injury to the posterior horn of the inner meniscus.

This type of injury usually occurs in older people who play some kind of sport.

However, there are several types of meniscus tears that can occur. Here are some of the types of meniscus tears that exist:

• Longitudinal tear. This meniscus injury is usually caused by trauma and can affect part of the meniscus or, in the worst case, the entire meniscus.

The tear is parallel to the edge of the meniscus and, when complete, produces what is known as a bucket handle: formation of a fragment that dislocates and interposes itself between the femur and the tibia.

• Parrot's beak break. Two breaks occur horizontally, forming a sort of tongue between them.
• Radial tear. In this case the tear runs from the inner edge to the periphery of the meniscus.
• Complex meniscus injury. This type of tear has more than one pattern, direction and cause of injury.

Each of them is associated with a series of symptoms and, of course, a type of treatment.

The causes of meniscus tears vary depending on the age and state of health of the affected person:

• This type of tear is related to age and the micro-traumas that arise over the years. In addition, over time, the meniscus loses moisture and dries out, making tears more likely to occur.
• Traumatic. A sharp twist or movement of the knee, such as pivoting, braking or turning aggressively and suddenly, can cause the meniscus to tear. On the other hand, simple acts such as kneeling, squatting or lifting can also cause this type of traumatic injury.
• Mechanical. This occurs when the joint does not function properly. The knee joint may present some deformity or malfunction such as excessive rotation, hyperextension or adopt a bad angle, which can cause an injury or meniscus tear.

The symptoms of a meniscus tear will vary depending on the type of injury and the cause of the tear. So, if you have torn your meniscus, you are likely to have some of these symptoms:

• A snapping sound when the tear occurs.
• Pain in the knee when you try to walk after the injury.
• Intense pain when pressing on the affected area.
• Pain when bending or extending the knee, especially in the last range of motion.
• Feeling of weakness in the joint
• Pinching in the knee
• Swelling and stiffness in the knee
• Difficulty in starting to walk after prolonged sitting.
• Sensation of locking of the joint

When menisci suffer a tear, the specialist will take into account the type of injury that has occurred (internal or external meniscus), the amount of cartilage involved and the symptoms you present to recommend one treatment or another.

In any case, damaged or deteriorated menisci no longer function efficiently and, as a result, the articular surfaces begin to take over responsibilities previously performed by the menisci. This leads to wear and tear of the articular cartilage and often results in the well-known osteoarthritis of the knee.

For this reason, the specialist will indicate the appropriate treatment to avoid major consequences such as osteoarthritis and alleviate the symptoms associated with the tear:

Non-surgical treatment for torn meniscus

When the meniscus tear is small and can regenerate itself, the doctor will resort to conservative treatment, which may include Rest, Ice, Compression and Elevation of the leg, commonly known as the RICE protocol.

In mild meniscal tears, conservative treatment is sufficient to allow the injury to heal on its own.

In addition, the specialist may recommend the following:

• Use of crutches to prevent weight bearing on the knee.
• Physiotherapy sessions to strengthen the muscles.
• Intake of medication to combat pain and inflammation (non-cortisone medication).
• Infiltration of the knee for meniscus tears when the pain is very severe.

Surgical treatment

When conservative treatment is insufficient or has been resorted to too late and cartilage degeneration or damage is more severe, surgery is almost obligatory.

Nowadays, advances in medicine make it possible to perform meniscus surgery with a minimally invasive intervention.

 Arthroscopy is the technique par excellence for treating meniscus tears, avoiding open surgery and a prolonged hospital stay.

Thus, there are several types of surgical treatment, among which we can distinguish:

• Partial removal of the meniscus: This option is the most common and consists of removing all the damaged or destroyed parts of the meniscus. If there is instability in the joint, the surgeon may use artificial ligaments or even correct the bones by osteotomy.
• Meniscus suture: the meniscus is restored, preserving the cartilage completely. To do this, the surgeon smooths the edges of the affected area and sutures the meniscus while preserving the original shape.

This method is mostly recommended for young patients who do not have significant wear and tear on the cartilage.

In most cases, a combination of both treatments is used, i.e. removing the affected parts and suturing the rest to keep as much of the meniscus tissue intact and healthy as possible.

In cases where there has been a previous meniscus removal and post-meniscectomy syndrome develops, meniscal transplantation may be used. However, not everyone can undergo this surgery.

Since recovery is slower, this surgery is only performed on patients under 55 years of age, with pain and with one of the knees healthy, stable and with a good axis.

If you have torn your meniscus and you have your doctor's approval to undergo surgery, at Operarme we offer you an initial surgical assessment consultation with the specialist to assess your case and you can start treatment as soon as possible.

To ask any questions you may have about this, you can call us on +34 91 141 33 56, or fill in the contact form.

• Orthoinfo. (2012, 1 octubre). Desgarros de los meniscus (Meniscus Tears). Recuperado de https://orthoinfo.aaos.org/es/diseases--conditions/desgarros-de-los-meniscus-meniscus-tears
• Álvarez López, A., Ricardo Soto-Carrasco, S., & De la Caridad García Lorenzo, Y. (2018, 25 mayo). Lesiones degenerativas del menisco. Recuperado de http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-215X2018000100002&lng=pt&nrm=iso
• Busto Villarreal, J. M., Liberato González, I., & Vargas Sánchez, G. (2019, 1 marzo). Lesiones meniscales. Recuperado de https://www.medigraphic.com/pdfs/orthotips/ot-2009/ot091d.pdf