Meniscal Injury

• Support the articulation of the femur against the flat tibial plateau 
  
• Absorb force
  
• Nourish the knee joint with synovial fluid

Medial tears (the meniscus located on the inside of the knee) are more common than lateral (the meniscus located on the outside of the knee) due to the attachment of the medial meniscus to the medial collateral ligament. 

Injuries are often a result of trauma (acute) or degeneration (chronic)

Acute: This is when excessive force is applied to a normal meniscus, typically through a twisting injury on a semi fixed limb such as a ‘cutting’ / change of direction movement or landing from a jump. A meniscal injury may be associated with other injuries to the knee such as medial collateral ligament or anterior cruciate ligament injuries. or a normal force on a degenerative meniscus. 

Chronic: These type of injuries are usually more prevalent in the older population and occur as a result of minimal trauma or stress on the knee.

In a traumatic injury the patient will be able to identify an event (such as a tackle, change in direction etc) when the knee injury occurred and there may be some minimal joint swelling as a result. Subsequently there may be reports of pain on the inside / outside of the knee, audible clicking when the knee is bent or straightened or the knee may lock.

Symptoms may be the same in a degenerative meniscal tear and day to day activities that require knee flexion whilst in standing, such as squatting or stairs are poorly tolerated. 

There are a number of special tests that we can use to help diagnosis a meniscal injury and while the sensitivity and specificity of such tests are varied, a thorough understanding of the mechanism of injury and a cluster of these tests being positive, we can be confident in our diagnosis.

McMurrays / Thessalys / Apleys test – rotation of the shin bone on the thigh bone.

Joint line palpation

Range of movement – there may be pain at the very end of knee flexion / extension

Functional testing – Tasks bending the knee in standing such as squatting / stepping down or landing from a jump may provoke symptoms

A vast majority of meniscal injuries heal on their own within 3-6 months and very little require surgery. Those that do may have a bucket handle tear where the torn meniscus sits between the femur and the tibia and prevents the joint from moving through its full range of movement. Physiotherapy can help by:

• Provide advice about the early management of the injury
  
• Aids to help offload the knee
  
• Gentle range of movement exercises
  
• Manual therapy
  
• Movement analysis of the lower limb kinetic chain 
  
• Graded strength programme
  
• Balance and proprioceptive exercises
  
• Return to sport assessment and advice