Anatomy and Function of the Meniscus:
Within the knee, there are two C-shaped cartilage structures called the medial and the lateral meniscus, which lie on the top of the bone of the lower leg called the tibia. This cartilage provides many aspects of knee function such as cushioning, stability, shock absorption, load transmission, nutrition, lubrication and joint stress reduction. If the medial or lateral meniscus are torn, the knee would lose that support and protection, causing changes within the joint space and on the bony surfaces, eventually leading to possible knee osteoarthritis (OA).
How can a tear occur?
A tear in the medial or lateral meniscus can occur by either sudden trauma or gradual degeneration. Traumatic meniscus injuries usually occur when the foot is planted on the ground while the knee is bent, rotated, and compressed all at once. This type of injury to the meniscus is more common to occur in a younger population. Degenerative tears tend to occur in individuals older than 40 years of age. If the cartilage has weakened or worn thin over time, the meniscus can be injured very easily. All it takes is an awkward twist of the knee by any type of insignificant activity such as squatting, getting out of a car or up from a chair, and results in pain, swelling and locking of the knee.
Risk Factors for Degenerative tears:
- Age (> 60 years of age)
- Gender (male)
- Work-related kneeling, squatting and climbing stairs (> 30 flights)
Signs and Symptoms of Meniscal tears:
If you have a history of some sort of twisting injury, followed by pain, swelling, locking or catching, you could possibly have a torn meniscus. You may also have pain along the joint line with forced hyperextension (straightening the knee fully) or maximum flexion (bending the knee fully). One of the main symptoms that would stand out as a possible meniscal tear involve locking and/or catching. You may also experience increased pain with weight-bearing activities such as walking or standing, or experience your leg “giving way”, causing safety problems.
What do I do if I think I have a meniscal tear?
If you suspect you have a tear in the meniscus of your knee, it is encouraged to see your primary physician or an orthopaedic doctor. The doctor will then perform a manual test to see if there is a possible tear. One of the manual tests done is the McMurray test where the doctor will bend the knee, then straighten and rotate it, putting tension on the torn meniscus, and eliciting a clicking sound or sensation. To confirm the diagnosis, the doctor may request diagnostic testing, including an X-ray and/or MRI. Depending on the extent of the injury to the meniscus, as well as the location of the tear, recovery could include either surgery or a non-operative approach, which includes physical therapy. Types of surgeries involving the meniscus include total meniscectomy, partial meniscectomy, and meniscal repair or transplant. In the U.S., arthroscopic partial meniscectomy after meniscal tear is the most frequent orthopaedic surgical procedure.
How can Physical Therapy help a meniscal tear?
At your first visit, your physical therapist will perform an Initial Evaluation to determine an appropriate treatment plan, addressing your symptoms, to help you return to your prior level of function. At the beginning stages of your injury, you may experience swelling and pain, which your physical therapist can help ease with use of modalities, including ice, electric stimulation and ultrasound, as well as manual therapy techniques such as retrograde massage, passive range of motion and light stretching. After acute symptoms have subsided, the physical therapist will prescribe the appropriate therapeutic exercises to improve strength and endurance in isolated muscle groups, progressing you towards a safe return to performing functional activities, including driving, walking and stair negotiation, as well as recreational and work-related activities.
Can I receive physical therapy after surgery?
The answer is Yes! If deemed appropriate for your recovery, your surgeon will recommend to start physical therapy along with protocol guidelines to follow as your knee heals week to week. Your physical therapist will guide you through the appropriate steps of each recovery phase, with the use of therapeutic exercise, modalities, manual therapy techniques and a home exercise program, including any precautions or specific care instructions after your surgery.
At All-Care Physical Therapy, we specialize in the treatment of meniscal tears and post-operative meniscal recovery. Our skilled physical therapist will develop an individualized treatment plan, specific to your injury, in order to make your recovery as comfortable and pain-free as possible. To schedule an appointment at our Manchester facility, please call 732-657-7900.
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