Knee Pain: Meniscus Injury

Many people wonder about the importance of the meniscus in the knee because they may have heard that parts of it may be removed after a surgery. The answer is – the meniscus is very important! There are two parts of the meniscus, the medial or inside portion and the lateral or outside portion. The medial portion is shaped like a “C” while the lateral portion is more circular shaped. Both are made out of fibro-cartilage, which is tough and flexible. Overall, the meniscus helps with shock absorption, provides stability, and lubricates the knee joint, which helps spread out the force from each step. Without the meniscus, walking, running, and jumping would be painful.

The meniscus is most commonly injured by quickly and repetitively changing directions in sports, but also can be torn by any one quick rotational force. Rotation or twisting movements place the most stress on the meniscus and can eventually cause tears. What are the symptoms of a meniscus tear? The most common symptoms are swelling, popping, limitation of knee range of motion, joint locking, pain along the joint line on the side of injury, and knee instability when walking.

A physical therapist can perform some orthopedic tests on the knee to determine if the meniscus is injured, but an MRI is needed to confirm the extent of the injury. The reason some people believe that the meniscus is not necessary is because years ago surgeons would remove the meniscus, which is called a total meniscectomy. However, this procedure is very rare and outdated. Another rare but newer procedure is a meniscus repair where the doctor will suture the torn parts together. The patient is non-weight–bearing for several weeks, however to have this prescribed the tear must exist in just the right way.

The two more common treatments for a torn meniscus are physical therapy alone or a partial meniscectomy or debridement followed by physical therapy. The outer one-third of the meniscus has a good blood supply but the inner two-thirds are avascular, or without blood supply. Good blood supply is important for the tissue to heal. If the doctor determines that the tear is very small or that the tear has good blood supply, physical therapy is the treatment of choice. Early on, physical therapy will focus on decreasing pain and increasing range of motion by using hands on manual therapy and/or ultrasound, and eventually the goal will be to increase strength to help you return to full function. If a surgical debridement (partial meniscectomy) is required, an arthroscopic surgery can be performed to remove small pieces of the damaged tissue. After the surgery, physical therapy should be prescribed and maybe similar to what was mentioned earlier: manual therapy, ultrasound, and a progressive exercise program to help you regain your full strength and range motion while decreasing pain. The meniscus is a very important part of your knee function, so seeking help from a knowledgeable physical therapist will greatly improve your quality of life.