Understanding a Torn Cartilage
The menisci or “cartilage” of the knee remains a common source of knee pain for athletes of any age. The “C” shaped grisly structures assist in the congruent relationship between the femur, thigh bone, and the tibia or shin bone. The medial (inside) meniscus and lateral (outside) meniscus have a flat under surface that rests on the tibia while the concave topside of the menisci is perfectly shaped to houses the convex (rounded) distal end of the femur.
Both the medial and the lateral menisci have basically two functions:
- Shock Absorption – Decreasing the forces distributed to the knee joint surfaces.
- Joint Stability – By limiting motion and somewhat directing the relationship between the femur and the tibia, the menisci add stability to the knee joint.
The medial meniscus is more prone to injury compared to it lateral counterpart. The great amount of overall stability of the medial meniscus with it’s attachments with the medial collateral ligament and the knee joint capsule contribute to this problem. It is not uncommon to see injuries to the medial joint line indirectly injure the medial meniscus.
The “Unhappy Triad” injury is a three-structure injury involving the medial meniscus, medial collateral ligament (MCL), and the anterior cruciate ligament (ACL).
The manner in which the medial meniscus “heals” is worth noting. The peripheral zone or outer rim of the cartilage is the only part of the structure that has a blood supply. The central zone or inner part of both menisci lacks any significant blood supply. Because of this fact, only the injuries to the outer periphery of a meniscus will have any chance of healing.
Common mechanisms of medial meniscus tears include a direct blow to the outer part of the knee joint, forceful twisting of the knee and chronic pounding of the joint surface for a substantial length of time, as with older distance runners.
Degenerative conditions predispose the medial meniscus to injury.
Signs & Symptoms of a Torn Meniscus
- Knee joint line knee pain, which typically increases with twisting and bending movements.
- Knee swelling and joint line tenderness usually accompanied by a general inflammation throughout the knee.
- There may be joint locking, catching and/or clicking within the knee.
- Range of motion in bending and straightening the knee joint will be limited and painful.
- Stiffness around the joint, which hinders walking physically and psychologically.
- Difficulty bearing weight on the knee secondary to pain.
- A general sense of uncertainty with the knee when active, leading to the old label of a “trick knee”.
Professional Treatment for Meniscus Tears
The severity and type of tear sustained will guide the proper treatment approach for a torn cartilage injury.
- Seek a clinical exam so you know exactly what you are feeling and how to treat it without damaging other structures of the knee.
- “Ice is your friend” so spend some time together. Ice the entire knee, front, sides and back, for 10-15 minutes as often as possible.
- Rest the joint to minimize the swelling, which will decrease your symptoms while increasing your strength.
- Knee sleeves and stabilizing braces can help protect the joint from additional stress and improve the outcome.
- Utilize the latest physical therapy modalities and rehab devices to reduce swelling and decrease pain.
- Easy flexibility exercises while avoiding complete knee extension and knee flexion greater than 110 degrees is wise.
- Conservative strengthening of the quadriceps and hamstrings is important to start when the joint symptoms and swelling start to improve.
- Minimal weight-bearing cardio exercises such as biking, swimming and elliptical trainers should be included if both swelling and pain is under control.
Asking the Right Questions Like a Pro
Here’s what a smart pro athlete would ask his/her sports medicine specialists to ensure a fast and safe return to sports:
- Do I need to be worried about any long-term complications to this injury?
- Is my body alignment contributing to this injury?
- Do I need a rehabilitation program?
- Do I need further diagnostic tests like an X-Ray or MRI to properly evaluate my knee for any structural damage?
- How would you grade my knee’s articular cartilage in both the knee joint and behind my kneecap?
- Do you think that I will need a micro-fracture knee surgery now or in the future?
- What kind of exercises or home remedies do you recommend?
Elite Sports Medicine Tips from Mike Ryan
- Control Your Activities – Be smart now by limited what you’re doing, rest the knee joint & ICE/ICE/ICE now so you have a much better chance of not needing surgery and getting back on your feel FAST.
- Look Down – Check out your shoes. If they’re flimsy, have a big heel, lack great cushioning and/or have minimal lateral support, get them off your feet fast. You need a stable and supportive shoe if you have knee joint line pain.
- Eat Right – Healthy foods should be the order of the day. More fruits, less fatty foods.
- Listen to Your Knee – You need to know what makes your knee feel better and what makes it feel worse. It’s important for you to know the answers to these questions and I hope your doctor will be asking you the same questions.