A Personal Approach
What is it?
The meniscus are two crescent-shaped fibrocartilaginous structures present in the knee that sit on top of the tibia (shin). They go through developmental changes during childhood, reaching a mature adult appearance by approximately 10 years of age. The Meniscus act as shock absorber and stabilizer within the knee when we are walking, running and bending keeping the movement smooth. Menisci are generally referred to as ‘the cartilage,’ in between your thigh bone (femur) and your shin bone (tibia). There is an inner (medial) and outer (lateral) meniscus, that moves inside the knee when we bend or straighten the knee. It is not uncommon to injure the meniscus playing sport and we can also injure this in normal daily life during tasks such as kneeling, bending or twisting.
Meniscus Tear, How does it occur?
In the younger population, a meniscus tear normally occurs from twisting your knee when the foot is planted on the ground such as squatting and twisting or changing direction quickly, and of course a trauma like a football tackle. This is common in sports such as football, rugby, netball, and tennis. Meniscal tears in children are significantly lower compared to adults; however, it has been increasing as children are participating more in high-level training and competition. As we age through adulthood, our meniscus degenerates and becomes less smooth and thinner, thus tears can occur when we bend or twist awkwardly from what seems more minor traumas or injuries.
When you injure a meniscus you might feel a ‘pop’ sensation as well as pain. Many people can still walk but it might feel unstable, catching, locking, or clicking that was not present before. Swelling may occur several hours later and you may feel that the knee becomes very stiff. Sometimes you may feel you can't bend or straighten your knee.
There are many different types of meniscus tears relating to the location, grading, and severity. Some will settle and not require surgery, however, some require surgery known as a meniscectomy or meniscal repair.
What to do if you think you have injured your Meniscus?
If you believe you have injured your meniscus no matter how small, you should still keep weight off your leg to protect from further trauma. Ice the knee to help swelling and pain and seek assistance from your physiotherapy or Doctor as soon as possible. If your knee is stuck and you are unable to straighten do not try and force this.
Treatment- Conservative Treatment
If you have a torn Meniscus the treatment options can be based on the severity of your tear and also your goals and outcomes for recovery. A torn meniscus may not heal on its own as there is a limited blood supply to the inner area that impacts healing. The middle and outer zones have blood supply thus may undergo some healing to the areas.
If the tear is not unstable or causing locking or catching it may be possible to undergo a rehabilitation process with your Physiotherapist. Stuart is highly skilled in this area and can easily guide you through your recovery process. A programme including exercises aimed at improving strength, stability and balance. This is very different to the Rehab of an ACL as they are different structures and are loaded differently. If they are not treated individually then we can cause undue loading prolonging your recovery.
Meniscus Surgery and Recovery
Meniscus surgery is undertaken by doing a Meniscus Repair, Partial Meniscectomy (removing a small piece) or a full Meniscectomy that is complete removal which now is very rare. Ideally, the best scenario is keeping the meniscus and sometimes the meniscus can be repaired using small stitches to hold the tear together. However many do not heal well due to reduced blood flow to the meniscus.
A Meniscectomy is when some of the damaged meniscus is removed. It consists of smoothing edges of the tear to prevent fraying and reduce the chance of further injury. This may be the medial or lateral meniscus and the percentage of removal depends on the type and size of the tear. This is very common and most make an excellent recovery.
Recovery from your operation can be very quick however, it is influenced by the procedure. Initially, you will have swelling and reduced movement and some pain. You will have crutches and be guided when they can be reduced depending on your procedure. If you have had a Meniscus repair it will require time healing thus crutches and a brace is required to protect the healing meniscus. You may be using your brace for 6 weeks and will take 4-6 months until returning to sport. If you had a meniscectomy then you may find you are back to normal activities and sport in 3-5 months.
As Stuart Mailer has extensive experience in Meniscus operation he can guide you safely back helping reduce your pain and progress you quickly and safely. This is done by a bespoke programme for your knee operation and your lifestyle and goals. We like to work along with your surgeon to help optimise your recovery