Bodyworks: Meniscal Injuries

How to recognise them, how to overcome them


Posted: 5 June 2000
by Patrick Milroy

Half-moon snap-in cartilages form a buffer in the centre of the knee joint and allow some rotation. These are known as menisci and are placed either medially or laterally.

Injury can occur to normal and ageing menisci; it tends to occur in the posterior portion and is seven times more common on the medial side, which bears the brunt of your weight. There are various types of tear to the menisci, depending on the cause, but the effect is usually the same – pain and disability.

Symptoms
You will be lucky if a suddenly-torn meniscus doesn’t cause intense pain, probably following a twisting injury, but not uncommonly after full bending of the knee. The pain is usually on the joint line and the knee may feel unstable. It is realised now that a meniscus tear frequently occurs in conjunction with other damage to the collateral or cruciate ligaments, so the knee may swell with an effusion of clear serum and/or blood, and a tear which twists on itself can cause the joint to lock. You may well have been a rugby or football player in the past, and have suffered previous knee injury.

Signs
Your doctor will be able to demonstrate your knee tenderness and find swelling. The McMurray test involves flexing and extending the knee slowly, while rotating the limb below the knee. If positive, it will hurt you. Quadriceps wasting rapidly occurs with disuse.

Medical investigation
The diagnosis is not always clear-cut, so an x-ray will help to eliminate complications and arthrography with a dye injection into the knee can improve diagnostic accuracy.

What else could it be?
Even the most experienced practitioners may have difficulty in excluding an anterior cruciate ligament tear, a collateral ligament tear or arthritis. Also, loose tissue that may float off within the damaged joint, – there’s quite a choice.

Self-treatment
Although RICE and a change of activity could ease the symptoms, self-help is probably not going to relieve any but the most minor and trivial of meniscal injuries.

Medical treatment
With the advent of arthroscopy, in which a tiny fibre-optic television camera can be used to examine a joint, the diagnosis and treatment of meniscal injuries has been transformed. No longer is the whole knee joint exposed at operation, and all the cartilage removed, but two tiny incisions are made, one for the arthroscope and the other to stretch and fill the joint with sterile water, allowing accurate visualisation of the injury. Delicate snipping away of as little of the injured meniscus as possible limits the advance of degenerative changes in following years. In some individuals it has been shown that the meniscus has the ability to repair itself, and meniscal replacement and regrowth are potential treatments for the next millennium. After surgery, physiotherapy and rehabilitation are vital to gain full, pain-free function.

Can you run through it?/Recovery time
Running through a meniscal injury is an open invitation to long-term disability. Following arthroscopic treatment you would hope to be fully rehabilitated and running freely, even if not racing fit, well inside three months.


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Discuss this article

I've had a recent opp on my knee. Cartiliage problems. It's only been a week, but I want to get running again! Any good advise out there from fellow runners on rehabilitation. I know it will take time.
Posted: 02/04/2003 at 12:24

HI
after having a cartilage and an acl replacement i did the following:
am and pm and after exercise..bag of ice/frozen peas
running in the pool
swimming on back in the pool doing a streight leg kick
cycling with a recumbant bike in the gymn
and outside with a standard bike
walking
exercise program in the gymn under supervision of personal trainer.
take devils claw and glucosalamine sulphate.
knee is now great, apart from scars and slight loss of flexability (replaced by increased strength)

best of luck

fergal k


Posted: 02/04/2003 at 16:20

Any advise would be appreciated...I have a meniscule cartlidge tear, no real problems so long as I don't run or squat...if I ride the bike 4 days out of 7 it's fine, I can walk as I wish, including up and down some serious mountains with no problems. It doesn't give way, nor swell, no lock. BUT if I run at all seriously it becomes very uncomfortable and takes a few days to calm down again, quicker if I ride the bike! I don't want to have surgery unless it becomes necessary, but I do want to be able to run as I please, even if I can't race. Any serious advise? At 54 are my running days over and am going to have to satisfy my competitive urges by trying to keep up with the kids on my mountain bike?!!!

Geoff


Posted: 18/09/2008 at 19:51

Hi, Geoffers

Can't offer advice, but as I seem in a similar (but not exactly the same) situation, you may find this of some help.

I too am 54; have 23 years running experience, average 40MPW over the 23 yrs. I have had pain in anterior ligament of knee for 5 years, since first injuring. Had this diagnosed as a minute tear, had option of arthroscopy, but decided to leave, as I could live with the discomfort, and like you regarded surgery as a last resort. This was about 4 years back, but recently the pain has worsened, and is limiting me to about 20MPW. If I run longer than 7 or 8 miles, then pain will keep me awake that night (oddly enough it is mostly tolerable whilst running). Have seen consultant again, and this time have decided to go ahead with arthroscopy. He assured me (and I have backed this up with my own research) that the risk is minimal. I was encouraged by the diagnosis that my knees (apart from this injury) are in good shape(9 out of 10 knees said the chap) for a man my age. The clincher - and this may be relevant to you - is that he said there is no reason I can't return to the level of training/competition I have previously enjoyed. So, Op probably in November, until then ticking over and "managing" the thing as best I can. Good luck with your decison.


Posted: 19/09/2008 at 13:02

Any Advise..i too have torn my knee cartlidge at the start of December at the age of 33.  I need to know if this feeling of tightness and stiffness will ease, i too stuggle if i need to quat or if i attempt to stretch my quads with my foot towards my bum - it  causes a deep throbbing pain thats unbearable.  should i be persistent with my doctor to get an mri scan to see if i need the operation or give it more time. 

The knee still swells when i've been at work due to sitting down at a pc but strangley i too find running on it loosens my knee up and reduces the swelling? i have no pain at all from running and i'm slowly getting my confidence back again .

The doctor has stated it will get better with time..Diclofenac..and no running!!

what do you think?


Posted: 23/02/2009 at 22:03

Cool, a thread about knee cartilage problems.  I've got my op scheduled for 26th March, to trim off a frayed bit of cartilage.  My doc says that I should be walking around straight away (well, as soon as I wake up) and he suggests 3-4 week recovery.

    

For those who are asking if it'll get better on its own...... no, it won't.  There is pretty much no blood supply to the cartilage so tears don't heal.  But my experience is that building up the muscles that support the knee delays the onset of pain and reduces it.  The more I run the better it is, because of the increase in muscle strength.  The doc has also said that my knee isn't going to deteriorate if I don't get it fixed and I'm not going to do any more damage if I keep running on it or if I go skiing, which is what I'm doing this week

   

Amanda, I think you should push for an MRI and get it sorted as soon as you can.  Unfortunately you'll be low priority on the NHS so it helps if you've got health insurance.


Posted: 24/02/2009 at 01:47

I had a miniscus repair recently. My consultant told me there is wear on the cartilage, that i only have 2mms instead of 6mms. His advice was to return to running gently after four weeks, but if it hurts I should stop running completely. Any advice?
Posted: 04/03/2009 at 19:52

Dawn ...I had an arthroscopy on my right knee last Thurs to trim a torn cartliage went in at 9am had the op about 11.30 'ish and was up and walking again by 2pm ...plenty of icing and not supposed to drive for 7 days but we'll see about that! ...the compression socks aren't a good look its got to be said and you have to keep it on for a week! ...went in today to have the dressings and steri-strips off and had my first physio this evening

As for the physio rehab ...if last year (on my left knee) was anything to go by I hope to get on the bikes and cross trainers in a couple of weeks, running on the treadmills in about 6 weeks and running outside a couple of weeks after that ...starting off with as much of the run on grass as possible.
Posted: 04/03/2009 at 21:08

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