Most meniscal injuries (meniscal lesions) occur during sports, from an accident, or from uncontrolled movement that twists the knee too much. The meniscus often tears, which leads to instability of the complicated knee apparatus and the lesion of the meniscus has to be operated on. But there are also degenerative changes in the menisci when the cartilage mass disappears.
What are meniscus injuries?
Damage to the cartilage disk in the knee joint represents meniscus injuries (meniscus lesions). In the knee joint area of all mammals there are two larger menisci.
The human knee carries a lot of weight and is used more than any other part of the body in a lifetime. The knee joint is a complicated structure made up of bones, muscles, tendons, vessels and cartilage. See AbbreviationFinder for abbreviations related to Meniscus Injuries.
Two of the knee’s supporting, large cartilage bands are the menisci, which run around the bony kneecap. They contribute significantly to the support of the whole structure and enable people to walk and bend and stretch movements. If the cartilage of the meniscus tears as a result of an incorrect movement, excessive rotation or a hard impact, the stability of the entire knee joint is impaired.
Many athletes and especially football players suffer from one or more meniscus tears in the course of their sporting life. The degenerative changes in a meniscus manifest themselves as arthrosis.
Injuries to the meniscus can therefore primarily be caused by the effects of force (e.g. in an accident) or cartilage wear, or when both factors come together. In addition, congenital malformations of the meniscus can trigger a meniscus injury. Meniscal injuries are classified according to the location of the lesion (posterior, medial, or anterior) and the type of damage.
Menisci are a wedge-shaped and crescent-shaped disc of cartilage. Each knee joint has an external and an internal meniscus, which are located between the shin bone (tibia) and the thigh bone (femur). The meniscus allows these two bones, which have differently shaped surfaces, to work together smoothly.
The two knee joint menisci absorb approximately 30% of the weight loads and ensure an even distribution over the joint. Meniscal injuries endanger the stabilizing, shock-absorbing, braking and load-distributing effect of the menisci.
As already indicated, meniscus injuries are often triggered by abrupt movements. These include a sudden turn or a violent stop, as is particularly common in some sports (e.g. football, tennis or alpine skiing).
The combination of high pressure and rotary motion often causes both ligament and meniscus tears. Movements performed regularly over long periods of time (e.g. long-distance running) put a strain on the cartilage and can lead to meniscus injuries.
Since the menisci only regenerate to a limited extent, they lose some of their ability to perform with increasing age. Over the years, they begin to become brittle and form cracks, so that even moderate stress on a meniscus can lead to a tear.
There is also the possibility that misaligned legs can cause meniscus injuries (meniscus lesions). With “ bow legs ” injuries to the inner meniscus are more likely, while with “ knock knees ” the outer meniscus is more at risk.
Symptoms, Ailments & Signs
Meniscus injuries (especially the meniscus tear) are noticeable through a typical pain characteristic, which in most cases occurs as a function of certain movements. The pain conditions are different depending on whether the inner or outer meniscus is affected.
The external meniscus is particularly painful when the knee is internally rotated or when the patient squats, ie the knee joint is strongly flexed. The knee also hurts when the inner meniscus is injured in a bent position, but it also often hurts when the patient sits up from a squat. In the case of meniscus injuries on the inside of the knee, the external rotation of the knee is also associated with pain.
Both meniscus injuries are felt with the movements mentioned with a stabbing, light pain. There is also pressure pain. if patient or doctor at the cleft of the knee joint, where upper and lower leg meet. With a little practice, this gap can also be felt by a layperson.
In the case of injuries to the outer meniscus, the pressure pain can be felt in the lateral knee joint space, and damage to the inner meniscus in the medial knee joint space. Difficulty walking in conjunction with stabbing knee pain also indicate meniscus injuries. This is particularly the case if there has been a fall or a confrontation during sport. A palpable effusion can indicate inflammation.
Diagnosis & History
The patient usually notices immediately that the meniscus has been torn or torn. Affected patients report that the tear of the meniscus could be heard with a bang.
Doctors can often diagnose a meniscus tear with a physical exam. The kneecap has slipped or is at least very easy to move and no longer has a hold. The diagnosis is confirmed by arthroscopy, in which a probe with a small miniature camera is inserted into the knee area.
Now the doctor can see the tear or multiple tears in the cartilage of the meniscus. If an arthroscopy device is not immediately available, an ultrasound examination can also be used for the initial diagnosis. More detailed examinations must follow as soon as possible in the hospital or in an orthopedic practice.
A diagnosis of meniscus injuries is based not only on the acute symptoms, but also on the patient’s information about continuous stress and accidents in the past. With a few simple steps and tests, the doctor can usually diagnose both meniscus damage and possible other knee joint injuries.
If an effusion has formed in the knee joint, fluid can be removed by puncturing the joint and analyzed to support the diagnosis. An X-ray provides information about possible bone injuries and cartilage wear. If there are still doubts, as already mentioned, an arthroscopy (knee joint reflection) or a magnetic resonance imaging ( MRT ) usually leads to a clear diagnosis.
If meniscus damage is not treated in time, joint effusions can expand and further cartilage damage can occur, which can cause osteoarthritis. Cracks that have occurred can expand and even lead to a tearing of the meniscus.
Meniscus lesions have a good chance of healing if the damaged meniscus is in an area of the cartilage that is sufficiently supplied with blood.
For some people, a meniscus tear is almost painless, while others complain of pain in the knee area. Normal walking is no longer possible after a meniscus tear and the patient has to undergo surgery.
The meniscus tear isn’t usually treated as an emergency, but surgery isn’t waited longer than absolutely necessary either, as the cartilage could suffer further damage from stress. The knee is supported by a bandage until the operation, but the use of plastering of the knee, which was previously used, is now controversial both before and after an operation.
Depending on the severity of the meniscus injury, the injury is treated either surgically or, in milder cases, locally. If an operation is finally carried out due to a serious injury, this, like all other operations, is associated with certain risks. A possible complication – especially with the open surgical method – is postoperative bleeding.
Another risk are infections caused by certain germs in the wound. In connection with a meniscus injury, an infection in the knee joint represents a very unfavorable disorder, since the inflammation can cause severe damage to the knee joint cartilage. However, an infection after a meniscus operation occurs only rarely, since the surgical procedure always takes place under sterile conditions.
In some cases, even after meniscus surgery, the pain may persist or reappear after a period of time. If the meniscus is replaced, there is a risk that the implant will also tear. Another complication after a meniscus replacement is an effusion in the knee. This would make a puncture of the knee a necessity. These after-effects can appear, but in reality they are very rare. After a meniscus operation, one should generally always bear in mind the risk that the meniscus could tear again later.
When should you go to the doctor?
If the affected person suffers sudden complaints of the musculoskeletal system, there is a health impairment that must be examined and treated. If mobility is restricted, medical care is required. A doctor should be consulted if there is pain in a resting position, if you experience pain when touching or applying pressure to the knee, or if you are moving. A meniscus injury is characterized by pain when the affected person gets up from a squatting position or is in a bent posture. A loss of the usual physical performance and disturbances in the usual movement sequences are signs of an existing disorder. A doctor should be consulted if there is no improvement in symptoms.
If swelling occurs on the knee, discoloration of the skin occurs or the knee becomes warm, a doctor should be consulted. If the symptoms start immediately after a sudden movement, an accident or during sporting activities, it is advisable to consult a doctor. If an effusion can be felt on the knee joint or if the optical shape of the knee has changed, a doctor is needed. If inward rotation of the knee causes discomfort, a doctor should be consulted. In the case of a meniscus injury, the cooling of the knee joint is perceived as pleasant and pain-relieving. It should be carried out before the examination.
Treatment & Therapy
The actual operation of the meniscus lesion is performed either under local or general anesthesia. The knee is tied off and a small incision is made near the site to be operated on. Large surgical incisions are no longer necessary with today’s invasive technology.
The surgeon uses arthroscopic surgical equipment to remove the cartilage, reassemble the torn parts of the meniscus and sew them up. In some patients, the meniscus is torn into two, three, or even more pieces. The wound is then stitched up and the leg bandaged.
A patient who has had an operation on the meniscus therefore needs a lot of patience in order to make the knee functional again. Physiotherapy for the operated knee usually begins a few days after the operation. If the movement of the knee is not trained, it threatens to stiffen. It is therefore essential for the patient to keep to the appointments with the physiotherapist or orthopedist.
Physiotherapy is painful and the treatment can last for months or, in the case of older people, for years. In the first weeks and months after the operation, the doctor will again perform arthroscopies in order to be able to observe the healing process. He will also use a puncture to remove wound fluid that can accumulate in the knee again and again.
There is no guarantee that the meniscus will not tear again. In support of the actual operation and also in the case of arthrosis, cartilage formation can be attempted in the follow-up treatment by means of injections of hyaluronic acid.
The aim of treatment for meniscus injuries is, on the one hand, to achieve freedom from pain or at least to alleviate pain and, on the other hand, to restore the functionality of the joint. Conservative, non-surgical therapy is an option, but surgery may also be an option. If there are only minor injuries to the meniscus, treatment is conservative with medication and exercise therapy.
However, an operation is often necessary, but in this case efforts are made to preserve the cartilage as much as possible. Before the start of conservative therapy, the patient is informed about the natural course of the disease. The doctor also gives advice on everyday behavior that is easy on the knee joints. In the future, no sports should be practiced that require too many abrupt changes in movement. The patient should also avoid squatting too deeply.
Specially designed physiotherapy strengthens the thigh muscles in particular. Electrotherapy can also be used as a supplement. Crutches relieve the convalescent knee joints to a large extent. If there is also inflammation, cooling has a pain-relieving effect. Cortisone-free medication is preferably administered against painful inflammation.
As noted above, operations are now performed by means of a knee joint reflection under general or partial anesthesia. Depending on the extent of the damage, operations are carried out on an outpatient or inpatient basis, whereby usually only a one-week stay in the hospital is necessary. An open operation rather than an arthroscopic one is usually only necessary if there is damage to the ligaments and bones in addition to the meniscus injuries (meniscus lesions).
Outlook & Forecast
A prognosis depends primarily on the extent of the damage. Age and general health are also important for the chances of recovery. The worst way is not treating it. This usually makes the meniscus injury even worse. Other areas of the knee, such as the ligaments, are also damaged in this way.
A meniscus injury is considered a male disease. About twice as many male patients as women show up in the doctor’s office. Athletes and employees in physically demanding jobs are considered to be at risk. Minor damage can usually be treated successfully with conservative methods. After a good two weeks of rest, a gradual load can be resumed. Severe damage must be treated surgically. The chances of success are considered good here. Complications only play a minor role. Gradual loading is possible again after about eight weeks.
Statistically, there is an increased risk of re-injury after a single illness. Before engaging in physical activity again, consult your doctor. Depending on the outcome of the therapy, patients may have to accept limitations. Certain types of sport may no longer be practiced, and professional reorientation may be indicated.
Avoiding deep squats as much as possible helps to prevent meniscus injuries. Sports that put a lot of strain on the knee joints (e.g. skiing, handball, football and tennis) should be avoided. In any case, a sufficient warm-up phase should take place before the sport and the wearing of protectors should not be dispensed with. Alternative sports such as swimming or cycling as well as gymnastics ensure long-term mobility of the knee joints and are therefore good prophylaxis against meniscus lesions.
In most cases, meniscus injuries are associated with severe pain, which has a very negative effect on the patient’s quality of life and also significantly reduces it. The affected person should slowly pick up the usual rhythm so that there are no further complaints. Sporting activities should be avoided until the treating doctor sees no more concerns. Sometimes those affected are dependent on the help and support of friends or relatives in everyday life in order to master it. Adequate rest and a positive attitude will promote a speedy recovery.
You can do that yourself
In the case of a meniscus injury, it is necessary to seek the assistance of a doctor. Despite all efforts, the injury cannot heal completely without symptoms on its own without medical care. In addition, there are a number of options that the person concerned can use to improve their well-being and alleviate the symptoms more quickly.
The protection of the knee is particularly important. The joint should be loaded carefully and only according to individual possibilities. If the knee is subjected to too much strain, the complaints increase. Physiotherapy exercises help with a healthy and optimal movement. These can be carried out daily and independently. In order to cope with everyday life, it is advisable to restructure some processes and enlist the help of relatives or friends. Wearing healthy footwear is also beneficial. High heels should be avoided. Comfortable, closed and breathable shoes in the right size help to prevent improper strain or malposition.
Sport should be stopped until the healing process is complete. Afterwards, sports that put a lot of strain on the knee should be avoided or reduced. Sports that are easy on the joints are more helpful. They include swimming or walking.