Now, if you think ACL injuries and surgeries are common in the community, Meniscal injuries appear to be vastly more common. And when it comes to meniscal surgery, often referred to as a Meniscectomy, Arthroscopy, or Knee “Scope”, they are a dime a dozen. It is a part of the knee that is readily referred for surgery. However, this isn’t always necessary, and not always the best option.
Of course, being the conservative and open minded Physio that I am, I will definitely say there are times when a meniscal surgery is required. In fact, I have had one myself. I just like to preface this topic by acknowledging that surgery is not always the best solution, and Meniscal Tear does not automatically mean Surgery.
So let’s take a look at what the meniscus is, what it does and where you will find it.
THE MENISCUS OF THE KNEE
If you ever spent any time in a Chemistry Lab, you may remember the term Meniscus made in reference to the lipping effect of liquid against the edge of a graduated cylinder.
The phenomenon caused by surface tension in this case doesn’t do a lot to describe the nature of your knee meniscus, but it does give an impression of the shape effect the meniscus has in your knee joint.
Both of your knees have two menisci each. A medial (on the inside) and a lateral (on the outside) meniscus. They are made of the same sort of cartilage you find in your nose and ear. It’s white and soft and pliable to a degree. It doesn’t have a lot of blood supply, hence the colour, but this also means the meniscus doesn’t do particularly well when it comes to healing.
The shape of the structures is important, as the menisci help to provide structural integrity to your knee joint. Basically, the top of you tibia is flat and the end of you femur is round. The menisci help to bridge this incongruence and provide a more stable platform for your femur to sit within.
The softer meniscal cartilage allows for a degree of shock absorption also. In this manner, it helps to protect the harder cartilage on the end of your bones. So all in all a very important component of your knee anatomy.
HOW DO YOU DAMAGE A MENISCUS?
Just like there’s more than one way to skin a cat, there are also several ways the meniscus or menisci can be injured. It is more commonly the medial meniscus that is injured based on the anatomy of your knee and the way forces go through it.
1. Typically rotation injuries are the most common. Many people who injure their ACL will injure their medial meniscus at the same time. The twisting, bending and shearing forces are likely to load the meniscus and may damage or tear the tissue. Of course, you can injure the meniscus without damaging the ACL.
2. Hyperextension of the knee occurs when the knee is forced backwards and straightened under force. This movement can be responsible for meniscal injuries.
3. Wear and Tear. We hear this all the time. Meniscal cartilage, like anything, can change with time. Often there are tears without us even knowing it – there isn’t always a forceful injury and they don’t always cause a problem, but sometimes they do. Or otherwise, a less robust meniscus may be more easily injured.
Sometimes the meniscal tissue is effectively bruised or contused from a mechanism or movement like these, and sometimes the tissue is actually torn.
- Pain with weight-bearing
- Painful clicking
- Catching and locking in the injured knee
- Giving way of the injured knee
As mentioned earlier, the meniscus doesn’t heal particularly well, which may mean a tear remains in the tissue. However, the pain and dysfunction that might be there early, can actually improve even if the tear doesn’t.
Here is an outline of the different classifications of meniscal tears;
TO SURGERY OR NOT TO SURGERY?
As you will always hear me say, this is a very individual decision, which depends on the type of injury, extent of injury, pain, lifestyle impact and many other considerations. With this sort of injury, there is no hard and fast black and white in regards to surgery. Typically, a significant tear that is causing a lot of pain or dysfunction, may be considered more of a surgical priority. However, once again, there may be improvement without surgery.
Here is an animated video of what you might expect. Your surgeon will make the decision of whether the tear should be cut out, or stitched together. Typically, the lateral meniscus will be repaired by stitching more commonly than the medial meniscus.
A good thorough diagnosis from a skillful professional and a good thorough understanding of the problem and what it means for you is critical in the decision making process.
Don’t forget that MRIs may well show a meniscal tear that has been present for some time. If you are undertaking an MRI or CT Scan, make sure you speak with a well-informed professional before venturing for surgery. Your pain may have nothing to do with what you see on MRI.