Meniscus Tear
Summary
A meniscus tear is a condition in which the crescent-shaped cartilage, known as the meniscus, between the knee joints, is damaged due to various factors. The main causes include traumatic injuries from strenuous activities and degenerative changes related to age. Meniscus tears can lead to symptoms like pain, tenderness, limitation of motion, locking, instability, and quadriceps atrophy.
Diagnosis involves various methods, with MRI being the most accurate, providing detailed images of knee joint soft tissues. X-ray examinations can help rule out other knee issues but cannot directly visualize the meniscus. Arthroscopic examination is a surgical procedure in which a tiny camera is inserted into the knee joint to directly observe and, if necessary, repair or remove the torn meniscus.
Treatment depends on the extent and location of the meniscus tear. Conservative approaches, such as extracorporeal shock wave therapy and DNA injection therapy, may be sufficient for mild cases. However, for significant tears, arthroscopic surgery is considered. Recovery involves crutch walking and physical therapy, with full functionality returning, although prolonged symptoms may occur, especially in adults.
To prevent meniscus tears, it is essential to reduce unnecessary stress on the knees by avoiding activities that excessively bend the knee joint and ligaments, such as squatting, sitting cross-legged, and kneeling.
Table of Contents:
- Definition
- Causes
- Symptoms
- Medical Testings
- Treatments
- Prevention
- Meniscus tear and Chiropractic
1. Definition
The meniscus is a crescent-shaped cartilage located between the knee joints, which serves to cushion impacts and facilitate the free movement of the joint. The condition in which this cartilage gets damaged due to external impacts or degenerative changes is referred to as “meniscus tear.”
A meniscus tear caused by impact
The meniscus, commonly referred to as the “knee cartilage,” is located between the knee bones. It plays a crucial role in weight distribution, dispersing external forces, protecting the joint cartilage, ensuring joint stability, and facilitating lubrication within the knee joint. Such tears in the meniscus occur when the knee is slightly bent and twisted, often due to excessive physical activity. While they are commonly associated with injuries resulting from strenuous exercise, as individuals age, degenerative changes can also lead to tears. In the latter case, there is often no history of significant trauma. Meniscus tears can be diagnosed through various clinical examinations and diagnostic tools, including simple X-rays and magnetic resonance imaging (MRI).
2. Causes
The primary reasons can be attributed to two factors: injuries from strenuous physical activity and degenerative changes due to age. Tears caused by degenerative changes can occur without any significant trauma. Initially, there may be no specific symptoms, and it’s only as the condition progresses that pain and joint discomfort become noticeable. In individuals aged 50 and above, even a simple stumble can be a trigger. A meniscus tear can be accurately confirmed only through magnetic resonance imaging (MRI).
3. Symptoms
Pain and Tenderness: Pain is experienced by almost all patients and may manifest in various forms. During the acute phase, many complain of severe pain, often due to increased intra-articular bleeding and effusion. Tenderness corresponds to the damaged area.
Limitation of Motion: Immediately following the injury, ambulation or participation in physical activities may be discontinued or restricted due to pain and swelling. Limitation of motion often accompanies abnormal sounds, with flexion restriction being a characteristic feature, especially in meniscus injuries.
Locking: Locking is a symptom where a sudden blockage in movement occurs at a specific flexion angle during knee joint motion. It is caused by interposition of a displaced meniscal fragment between the articular surfaces. Therefore, this symptom is commonly observed in injuries with large meniscal fragments, and its onset and resolution are both momentary.
Instability: Instability commonly arises from posterior horn meniscus injuries. Patients often feel pronounced instability in the knee joint, which can result in a sudden loss of strength during activities such as walking on uneven surfaces, descending stairs, or jumping.
Quadriceps Atrophy: With the passage of time following the injury, quadriceps atrophy invariably occurs. In particular, inner quadriceps atrophy is notably pronounced.
4. Medical Testings
McMurray Test: This test is performed with the patient lying straight or sitting, and the knee joint is flexed to 90 degrees. Then, while holding the ankle or foot, the joint is rotated inward and outward to evaluate pain and any sounds originating from the joint.
Apley Test: In this examination, the patient lies face down with the knees flexed at 90 degrees, and two different tests are performed.
X-ray Examination: X-ray examination can determine whether there are other knee issues, even though it cannot visualize soft tissues like cartilage. In cases of discoid lateral meniscus, the joint space at the point where the outer femur and tibia meet may appear wider in X-ray due to the thick nature of this type of meniscus.
MRI (Magnetic Resonance Imaging): This test exceeds an accuracy rate of 90% and is one of the diagnostic methods for confirming cartilage tears. Additionally, it can identify other associated injuries.
Arthroscopic Examination: Following the anesthesia of the torn cartilage, direct observation is conducted through arthroscopy, and at the same time, repair or removal of the torn cartilage can be performed. Rather than being a test, it is more akin to a surgical procedure.
5. Treatment
Meniscus tears are challenging to naturally heal, except for very limited cases where blood circulation is efficient. Therefore, depending on the extent, shape, and location of the cartilage tear, either excision or suturing may be performed, and in cases of extensive tears, cartilage transplantation is conducted.
Surgical Treatment:
Arthroscopy, the most commonly performed surgical method, involves inserting a small camera called an arthroscope into the knee joint. The camera transmits images to a large screen, allowing the surgeon to make incisions on the opposite side for the insertion of arthroscopic surgical tools.
Arthroscopic Surgery
Meniscus tears can be a challenging condition, and natural healing is often difficult to achieve. However, if the symptoms are mild, conservative treatments such as extracorporeal shock wave therapy and DNA injection therapy may be sufficient for recovery. Nevertheless, through precise MRI examinations, the healing capacity of the torn meniscus is assessed, along with the location and extent of the tear, concomitant ligament damage in the knee joint, the presence of arthritis, and other related factors. If the cartilage damage is extensive, or if symptoms such as pain and limitations in daily activities occur, consideration is given to arthroscopic surgery.
1) Arthroscopic Partial Meniscectomy or Ablation: In most cases, the most effective treatment involves removing the torn part of the discoid lateral meniscus.
2) Arthroscopic Repair: In rare cases where the torn section can be repaired, sutures are used to repair the discoid lateral meniscus.
Rehabilitation: After surgery, short-term crutch walking may be necessary to avoid weight-bearing on the operated knee. In cases where crutches are not feasible, a wheelchair may be used. Physical therapy and rehabilitation exercises typically begin when swelling and inflammation subside. Physical therapy or rehabilitation exercises are often performed at home.
Recovery: In most cases where surgery is performed for discoid lateral meniscus, a return to normal daily life is possible after surgery. However, in cases where the protective lateral meniscus is resected, there may be an ongoing risk of pain and the potential for later development of degenerative arthritis. Recovery tends to be faster in individuals under the age of 20 but may take longer (6-12 months) in adults, with the possibility of recurrent joint effusion. However, most individuals experience improvement. After surgery for discoid lateral meniscus, it is advisable to avoid high-impact activities on the knee, such as soccer, tennis, and basketball, as there is an increased risk of degenerative joint arthritis over time.
6. Prevention
To prevent meniscus tears, it is crucial to reduce unnecessary pressure on the knees in everyday life. Avoiding activities that excessively bend the knee joint and ligaments, such as squatting, sitting cross-legged, and kneeling, is advisable.
7. Meniscus tear and Chiropractic
While chiropractic care is not a primary treatment for meniscus tears, it can play a supportive role in managing pain, improving joint mobility, and enhancing overall musculoskeletal health during the recovery process. If you suspect a meniscus tear, it’s crucial to consult with a healthcare provider, such as an orthopedic specialist, to determine the most appropriate treatment plan. Chiropractic care may be considered as part of a holistic approach to addressing knee injuries.