Degenerative meniscal tear

What is a meniscal tear?

The menisci are two semi-circular discs of cartilage that cushion and support the knee joint. One meniscus lies on the inside of your knee (medial meniscus) and the other on the outside (lateral meniscus).

You can tear your meniscus completely or partially (known as a meniscal tear).

Meniscal tears most commonly occur when you suddenly twist your knee while playing a sport (known as an acute tear). They can also happen from natural wear and tear over time (degenerative tear). Acute tears tend to be more common among younger people, while degenerative tears are more common in those aged above 40 years.

In many cases, meniscal tears can be managed initially with self-care techniques, such as resting and applying ice to your knee. But in some cases, surgery may be needed to repair a torn meniscus. If you have injured your knee, see your doctor or go to your local hospital to find out the best treatment for your injury.

Symptoms

Symptoms of a meniscal tear can include:

• knee pain
• knee swelling
• knee stiffness - being unable to bend and extend your knee fully
• feeling like your knee ‘locks’ or catches
• feeling like your knee may give way on weight bearing
• clicking and popping sounds when you move your knee
• pain and tenderness when you touch your knee

Causes

There are two types of meniscal tears: acute and degenerative tears.

Acute meniscal tears

Acute meniscal tears are often caused by making twisting or pivoting movements during sports, such as football, rugby and skiing.

Degenerative meniscal tears

Degenerative meniscal tears tend to happen slowly over time. They can be caused by repeated small injuries to the cartilage or by age-related wear and tear.

Diagnosis

Your doctor may be able to make a diagnosis of meniscal tear based on your symptoms and an examination alone. During the examination, your doctor may move your leg and knee to assess your injury.

Sometimes, you may need an MRI scan to confirm the diagnosis. Your doctor may also recommend an X-ray to check for other bone conditions, like arthritis or an associated fracture in an acute injury.

In some cases, your doctor may refer you to a bone specialist (orthopaedic surgeon) for a keyhole procedure called an

. This procedure can be used to confirm the diagnosis and treat your knee at the same time.

Treatment

If you have injured your knee, you should see your doctor. They will be able to advise you on the best treatment. The treatment you may need for a meniscal tear will depend on several factors, including how big the tear is, how old you are, and the part of your meniscus that is damaged.

The following self-help techniques may be recommended by your doctor to help treat the injury.

Self-Help: PRICE therapy

PRICE therapy for the first 48-72 hours involves:

• Protection – protect your knee from further injury with a knee support
• Rest – avoid exercise and reduce your daily activities. Use crutches to walk if you have severe pain
• Ice – apply ice to your knee for 15-20 minutes every two to three hours during the day. Protect your skin by wrapping the ice in a damp towel or using a bag of frozen peas
• Compression – compress the knee with an elasticated bandage to reduce any swelling and keep your knee joint still. The bandage should be snug but not so tight that it restricts blood flow. Remove the bandage before you go to sleep
• Elevation – keep your knee raised above the level of your heart by propping it up on a pillow, for example. This may help to reduce swelling.

Self-Help: Avoiding HARM

Avoid HARM for 72 hours after the injury. This involves staying away from:

• Heat – hot baths, saunas or heat packs may encourage bleeding
• Alcohol – drinking alcohol may increase bleeding and swelling, and slow down healing
• Running – or any other form of exercise that could cause more damage to your knee
• Massage – may increase bleeding and swelling

Painkillers

Paracetamol and other painkillers can be used to help ease any pain.

Ibuprofen and other non-prescription

may help to relieve pain and limit inflammation and swelling. Some guidelines suggest you should avoid taking NSAIDs for the first 48 hours after a meniscal tear and that you should only take them for a short time period. This is because it is thought that NSAIDs may slow down the healing process. However, this is a theory that needs further research. At present, there is no conclusive evidence that proves that NSAIDs should not be taken soon after an injury.

Check with your doctor, nurse, or pharmacist if non-prescription painkillers are not improving the pain. Your doctor may be able to prescribe stronger NSAIDs or painkillers if you have a serious injury. It may not be safe to take NSAIDs if you have certain conditions (such as asthma, high blood pressure, kidney failure, indigestion, or heart failure) or if you are allergic to NSAIDS. Always check with your doctor or pharmacist before taking new medicines after an injury.

Physiotherapy

Your doctor may refer you to a physiotherapist to help you to improve the strength of the muscles around your knee and the stability of your knee joint. Physiotherapy may help you to recover the full range of knee movements. Your physiotherapist will usually design an exercise programme for you to follow.

You may also need to use crutches or wear a knee brace for a while if putting weight on your knee is painful or difficult.

Surgery

Some meniscal tear injuries need surgery to repair the damage. Surgery usually involves an

and it may include repairing the tear or removing all or part of your meniscus. If your doctor thinks you need surgery, they will usually refer you to an orthopaedic surgeon to discuss your options.

In some cases, you may be offered a meniscal transplant. This is when missing pieces of meniscal tissue in your knee are replaced with meniscal cartilage from a human donor. The tissue will be taken from someone who has been screened and identified as a match for you.

You are more likely to have surgery if:

• the tear is large
• your symptoms have not improved with self-care, painkillers, and physiotherapy
• you have injured a specific part of your meniscus called the root

Current research suggests that for degenerative tears, surgery may not produce better outcomes than self-help and physiotherapy.

If you have surgery, you will most likely need a programme of rehabilitation (

) to help you strengthen your knee. The exact rehabilitation plan you receive should depend on your specific circumstances because there is no specific programme for recovering from meniscal tear surgery.

Outlook

Meniscal tears can take several weeks to heal. How soon you recover fully can depend on:

• the type of tear
• if you have any other medical conditions
• your age
• the condition of your knee joint, such as if you’ve had previous meniscal tears or other damage to your knee

If you had surgery to repair the tear, you usually should be able to return to your normal daily activities and running once your injury has healed. Please check with your doctor before resuming normal daily activities and running. How long this takes will most likely depend on the condition of your knee joint and your general health.

If you have had surgery to repair the tear, healing can take up to six months.

Acute meniscal tears tend to heal better than degenerative tears. Tears that respond well to self-care and physiotherapy usually have a good outcome.

If you have had a meniscal tear, you may have a higher risk of developing

later in life.

You can reduce the risk of tearing your meniscus again in the future by taking precautions when exercising. Suggestions include:

• choosing low-impact sports such as swimming, walking, and cycling where possible
• wearing proper sports shoes for exercise, such as well-fitting running shoes
• exercising on suitable surfaces.