Managing a Knee Torn Cartilage

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:

  1. Do I need to be worried about any long-term complications to this injury?
  2. Is my body alignment contributing to this injury?
  3. Do I need a rehabilitation program?
  4. Do I need further diagnostic tests like an X-Ray or MRI to properly evaluate my knee for any structural damage?
  5. How would you grade my knee’s articular cartilage in both the knee joint and behind my kneecap?
  6. Do you think that I will need a micro-fracture knee surgery now or in the future?
  7. 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.

 

 

Tackling a Lateral Meniscus Tear of the Knee


Understanding a Lateral Meniscus Tear

“I tore my cartilage” is the term most athletes use to describe the possible source of their knee joint line pain.  About 40% of the time, they’re correct.  Now ask them to identify culprit, aka “the cartilage”, in a police lineup and they’ll probably have the look of a cow staring at a fence.

The medial (inner) and lateral (outer) menisci are made up of very resilient cartilage.  Their design and cellular structure allows them to assist in the stability of the distal femur (thigh bone), distribute body weight forces across the joint surfaces and absorb compressive forces as we move.

Injuries to the menisci can significantly impair knee functions. Because of their relationship with other structures in the knee joint, the lateral meniscus is less prone to injury when compared with the medial meniscus. The lateral meniscus has less direct attachments to other structures in the knee. However, the long-term impact of a lateral meniscal injury is more concerning due to the high weight-bearing forces in the lateral compartment of the knee.  In other words, if you have a lateral meniscal injury, your likelihood of needing to have it addressed surgically increases and the presence of accelerated arthritic damage rises with time when compared to the medial meniscus.
The types of injuries to the lateral meniscus vary in location and severity, ranging from splitting into two segments to tearing around its more “C” shaped borders. Over time, meniscal micro trauma can result.

The lateral meniscus has minimal blood supply around its periphery.  With no direct blood supply to its central region, one can typically expect minimal healing with injuries involving this region of the lateral meniscus.

The two most common causes for meniscus tears are direct trauma and degenerative conditions. More often, the traumatic injuries involve twisting of the knee with the knee in a bent position.  This is commonly seen in contact sports. With this mechanism of injury, the foot is fixed to the ground resulting in a stretching of the meniscus. A direct blow to the inner part of the knee joint can also injure the lateral meniscus.

The degenerative damage is more commonly seen in the older population and is often associated with underlying arthritic changes. As the meniscus lose significant blood supply and weakens, it becomes more prone to injury. In this population, simpler twists and forces associated with daily activities may prove to be the cause of a meniscal injury.

Signs & Symptoms of Lateral Meniscus Tear

  • Excruciating pain and swelling immediately or up to 3 days after the activity in question.  Lateral joint line pain increases with rotation of the knee and weight-bearing.
  • Difficulty walking, bending or rotating the knee against resistance due to lateral knee pain.
  • The knee joint may become locked or “catch” if the loose piece of the meniscus is in a position of pain within the joint.  This flipping of the flap or unstable section of the cartilage will typically prevent full extension more often than it will limit full flexion.
  • Joint stiffness and tenderness around the outer edge and back ridge of the lateral joint line.
  • A general sense of insecurity with the knee with increased activity contributing to what older athletes tend to refer to as a “trick knee” due to its unpredictability.

Professional Treatment for Lateral Meniscus Tear

The best treatment is often a treatment of the symptoms and not the injury itself due to the limited healing capability of the meniscal tissue.

  • Ice the knee at least 4 times per day and immediately after all athletic activities.
  • Utilize the latest physical therapy modalities and rehabilitation equipments to control the pain, swelling and tenderness in the in and around the joint.
  • Strengthen the muscles directly influencing the knee joint. Strengthening exercise should be mostly pain-free. Muscles of the thigh, quads in front and the hamstrings in back, should be the main focus along with the hip rotators and the calves.
  • Soft tissue massage and stretching of the surrounding muscles and fascia needs to be included. This encourages the muscles to stay pliable which will accelerate the recovery time.
  • Surgery?  Let the doctor and YOU determine the answer to this question.  Closely monitor your symptoms and your activity level before you decide to “go under the knife”.  If unsure, gradually test your knee with functional activities along with the watchful eye a sports medicine specialist.
  • Eat right and drink right.
  • Be cautious of activities that twist the knee to avoid aggravating the injury.
  • Rest as needed.

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:

  1. Is this injury related to my athletic activities?
  2. What structures in my knee are damaged?
  3. Do I need further diagnostic test like an MRI?
  4. Do I need to have a knee scope and/or a micro fracture surgery?
  5. What kind of exercises do you recommend?
  6. Are there any long-term complications that we should discuss now?

Elite Sports Medicine Tips from Mike Ryan

  • Train With “Training” Specifications: Train smarter.  You can be aggressive and keep your knee pain-free by minimizing the twisting motions during your training.
  • Surgery is Just One Option on the Menu:  Many doctors may tell you otherwise but here is the truth: Just because you have a meniscal tear does not necessarily mean you need to have surgery.  The location of your injury, your pain level, the present knee limitations and your past medical history are the most important factors in determining whether you need to be walking around the surgical center trying to look cool in one of those drafty Johnnies!
  • Grocery Choices: You know when it’s junk or healthy. Help yourself to a healthy diet if you’re serious about getting back to competing like you did 10 years ago.
  • Ride Your Way Up: Don’t play “hero” on day #1 with your agility drills and running.  Bike riding is a great way to get your range of motion back and to start the leg strengthening process the smart way.  It’s time to change your mindset and getting on the bike and in the swimming pool is a great way to start.
  • Employ Proper Techniques: You accidentally did something wrong to incur the meniscal tear so now your focus should be to doing it right. Proper techniques and progression are the keys along with getting in with the right physical therapist.