This is a common presentation to a physiotherapy clinic. I hope that the information below will clarify some of the confusing points.
What is the Mensicus - “The Cartilage?”
The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint - the medial and the lateral menisci. They assist in shock absorption. The knee also has articular cartilage that lines the surface of the joint and should not be confused with the menisci.
What are the types of tears: Degenerative and Traumatic
Degenerative tears are as a result of overuse and may or may not be attributable to a specific evident. They most commonly present between the ages of 40 - 60 years Until fairly recently, an arthroscopy with meniscal debridement was often performed for these types of injuries to smooth out the tears. However, recent evidence shows that very many people have resolution of symptoms with physiotherapy and exercises. If however, symptoms persist an arthroscopy may still be needed. It should be noted that an arthroscopy is not always a quick fix and the improvement of thigh muscle and buttock muscle (quadriceps, hamstrings and gluteal muscles) control through exercise should be done prior to surgery, to either avoid surgery altogether or ensure a good recovery.
Traumatic tears are, as the name suggests, usually as a result of a specific injury. They are often described by the shape and position of the tear. They often result in locking and giving way.
These tears usually need a surgical repair and will require a period of joint protection and rehabilitation to ensure a good outcome.
What are the symptoms and how is the problem identified?
Pain is usually the overriding symptoms and may range from acute severe pain to a dull ache. With the more significant tears you may also experience true locking or giving way. True locking is when the knee becomes completely stuck and cannot be moved. This usually require urgent attention as the knee is not functional. Giving way usually occurs whilst weight bearing and rotating or changing direction. Again this does require attention as further giving way can extend the tear.
A physiotherapist can identify the presence of a tear through a thorough subjective history taking and a physical examination where they will use specific tests to identify a tear. If there is concern about the extent of a tear or a need for surgery the physiotherapist may refer you for an MRI. An X Ray would not identify a meniscal tear.
What would physiotherapy involve for a meniscal tear?
Following an assessment your treatment will be planned to treat the various problems that may exist but could include:
Joint mobilisation for restoration of full range of movement .
Soft tissue massage for reduction of swelling and movement improvement.
Acupuncture, Ultrasound and Interferential for reduction of inflammation and pain control.
Exercises for strength, balance and range of movement.
If you feel you would like to discuss your knee problems or have an assessment, please do be in touch with Victoria at ThamesPhysio Ltd.