Meniscus Injuries
Last week we talked about testing for serious ligament injuries in the knee. This week, we are going to talk about meniscus injuries.
So what is the meniscus?
The meniscus is a piece of cartilage inside the knee joint that helps provide extra stability and shock absorption. Each knee has 2 menisci: a medial meniscus and a lateral meniscus.
The lateral meniscus sits on the outside portion of the tibial plateau and is shaped more like a “C.” The medial meniscus sits on the inside portion of the knee and is shaped more like a backward “C.”
The tibial plateau is the flat top portion of the tibia that comes into contact with the femur.
The most commonly injured portion of the meniscus is the posterior horn of the medial meniscus. This is partly due to how the knee locking mechanism works and because a large percentage of force travels through the medial side of the knee during daily activity.
Fortunately, most meniscus injuries do not require surgery.
Even when a tear is present, conservative treatment with physical therapy is often recommended before considering surgical intervention. Years ago, surgeries such as meniscus repairs and meniscectomies were performed much more frequently. However, research has shown that many people achieve outcomes similar to surgery through physical therapy alone.
That said, there are situations where surgery may be appropriate.
One of the biggest red flags is persistent catching or locking of the knee that limits motion. This can occur with a bucket handle tear, where a portion of the meniscus flips into the joint and physically blocks movement. These injuries are often more painful and can significantly limit knee motion.
So how do we test for a meniscus injury?
We usually use a cluster of tests in the clinic.
Pain directly along the inside or outside joint line of the knee can be associated with a meniscus injury.
For this test, we bend the knee up as far as possible and rotate the shin inward to test the medial meniscus or outward to test the lateral meniscus. We then straighten the knee while monitoring for pain, clicking, or catching sensations.
In this test, the patient stands on one leg with the knee bent about 15 to 20 degrees and rotates their body side to side. Pain, clicking, or locking during this movement can indicate meniscus involvement.
Pain at the very end of knee bending or straightening can also suggest meniscus pathology.
If several of these tests reproduce symptoms, it gives us a much better idea that the meniscus may be involved.
If you would like to see these tests performed, click on the name of each test, and it will take you to a demonstration video.
Obviously, we do not want anyone dealing with a meniscus injury, but fortunately, most people improve very well with physical therapy. Personally, we have had a very good track record helping people recover from meniscus injuries and return to the activities they enjoy.
