Meniscal Injury

What is it?

A meniscal injury refers to damage to one of the two C shaped cartilages which separate the bones in the knee joint. These cartilages act as shock absorbers within the knee to assist in cushioning forces.

How does it happen?

The menisci in the knee are most commonly injured when the knee is twisted. This often occurs when changing directions quickly whilst the foot is fixed on the ground. It may also occur if a fellow competitor hits your knee causing it to twist or buckle.

How does it feel?

The first sensation felt when a meniscus is injured is pain within the knee joint. This may be associated with a sensation of something tearing. Depending on the severity of the injury, the knee may swell and you may have difficulty walking due to the pain. Swelling may be immediate or occur over a period of hours. The knee may also feel weak and unstable, and may produce clicking noises, lock or give way.

What should you do?

To limit the severity of this injury it is advised you stop your activity immediately and start initial treatment. The most important time in the treatment of any injury is the first 24-48 hours. Swelling is a necessary step in the healing process; however too much swelling can delay healing and cause further tissue damage. To control the amount of swelling and limit the degree of damage to the knee, the RICE regime should be commenced (rest, ice, compression, elevation). This will help to reduce blood flow to the injured area, thereby reducing the extent of swelling and tissue damage.

REST involves ceasing your activity or sport, and limiting the amount of weight you put through your leg. Crutches may be required if you are having difficulty walking.

ICE should be applied o the injured site for 15-20 mins every 1-2 hours. Ideally it should be applied using crushed ice wrapped in a moist cloth or towel.

COMPRESSION involves the application of a firm elastic bandage around your knee. It should be firm but not tight enough to cause pain.

ELEVATION involves lying with your knee resting comfortably on a chair or pillows so that it is above the level of your heart. You should continue the RICE regime until you consult a sports physiotherapist, preferably within two days of the initial injury.

What shouldn’t you do?

Following injury to a meniscus, you shouldn’t undertake activities which increase blood flow to the injured area. These include hot showers, heat rubs, the consumption of alcohol and excessive activity. These may increase the bleeding and swelling within the knee and potentially prolong your recovery.

Could there be any long-term effects?

Because the menisci in the knee have poor blood supply, when they are injured they are unable to heal by themselves. As such, they can result in ongoing problems, depending on the severity of the injury. These problems include persistent knee swelling, clicking, locking and giving way. To limit these ongoing problems surgery is often performed to remove the damaged portion of the meniscus. Recovery from surgery normally takes a number of weeks. In some situations, this may be prolonged if, at the time of the injury, other structures within the knee were also injured.

Management

The assistance of a sports physiotherapist is important in the treatment of a meniscal injury. Initially they can assist in determining which issues have been damaged and the extent of this damage. From this, they will be able to determine the most appropriate treatment. This may involve surgery, activity modification and strengthening and stretching exercises.

Brukner & Khan (2012) Clinical Sports Medicine.