Torn Meniscus

The most common knee injury is the torn meniscus. This can happen due to trauma caused by a forceful twisting or hyper-flexing of the knee joint, mostly if you put your whole weight on it. 

We have two menisci on both of our knees, which are C-shaped cartilages positioned on the top of the tibia, which are called the lateral and medial. If you have a torn meniscus, you will feel knee pain, stiffness, swelling, and a popping sensation. 

A conservative measure is physical therapy for the knee injury to strengthen the muscle, or you can use a home remedy such as ice. But if these measures are ineffective, you may require knee surgery.

The signs and symptoms of torn meniscus include:

• Pain that occurs whenever you flex or extend your knee
• A popping sensation with the injury
• Swelling of the injured knee
• Inability to stretch out the injured knee
• Stiffness or rigidity
• A tendency for the injured knee to get stuck or lock up, along with difficulty bending it

If you experience these symptoms, see your doctor for further diagnosis.

The causes of torn meniscus include:

• Sudden stops and turns
• Knee stress due to walking, running, bending, climbing, or kneeling
• Suddenly rotating or twisting the knee forcefully
• Lifting heavy objects or squatting deeply
• Participating in contact sports like basketball or football

If you suspect you have a torn meniscus, set up an appointment with your doctor to receive a diagnosis. Your doctor will give you a thorough physical exam, including putting your knee in different positions to see what the causes of your knee injury are. 

Your doctor may ask what activities you have been doing for the past several days that may have contributed to your knee injury. The doctor may recommend an X-ray, though it will not show the torn meniscus; it will, however, rule out other knee injuries, such as broken bones. 

Another test that may be recommended is an ultrasound so the physician can see inside your knee. If you have a loose flap of cartilage in between the knee’s moving parts, it will be seen in the ultrasound. You can also use an MRI (Magnetic Resonance Imaging), which uses a strong magnetic field and radio waves to produce cross sectional images of internal structures and allow a more detailed evaluation of the knee cartilage. Both soft and hard tissues in your knee can be seen in an MRI. 

Your doctor may also use an arthroscopy to examine the inside of your knee. An arthroscope instrument is inserted near the knee and transmits an enlarged image of the inside into a monitor, as it contains a small camera and a light. Surgical instruments may also be inserted through this instrument.

Treatments for torn meniscus depend on the location and size of the injury. The doctor may advise you to take a complete rest and not to engage in rough activities that will use the full force of your knee or sports that may cause you to forcefully twist your knee. Your doctor may also recommend the use of crutches or walking canes to remove pressure from your knee and allow it to heal completely. 

You may put ice on the affected knee to reduce swelling and pain. You can use frozen foods, an ice pack, or a towel with ice cubes in it, and place it on your knee for about fifteen minutes every four to six hours over two consecutive days, and then as often as needed. There are also over-the-counter medicines or pain relievers that can reduce the knee pain. 

You can do physical therapy to strengthen the muscle and support the knee joint, thus helping to stabilize your legs. You can use arch supports and other shoe inserts to decrease stress on certain areas of the knee, and they may distribute force more evenly around the knee.

One can use non-steroidal anti-inflammatory drugs, also called NSAIDs, which help reduce pain and swelling. There are some common over-the-counter medications available, such as ibuprofen, aspirin, and naproxen. However, one should check with the doctor before taking these medicines. Teenagers and small children should avoid consuming these medications, especially aspirin, which is known to increase the chance of Reye’s syndrome. This syndrome is a complication of the central nervous system and is usually seen in teenagers or children who take aspirin.

If the knee is really bad, surgery is an option. The meniscus may be surgically removed if it cannot be repaired or if it is still painful. An instrument called an arthroscope is inserted, and, after the surgery, you will have to do some exercises to stabilize and strengthen the knee. Young adults and children may be able to repair a torn meniscus without needing surgery.

To prevent torn meniscus, exercise regularly to strength the leg muscles. This will help stabilize the knee joint and thus prevent future injury.

You can also use protective gear or a knee brace while participating in some sports.

There are some simple exercises that can be performed to help maintain the strength of the muscle. These are done in the front of the thigh (the quadriceps), calf, hips, and back of the thigh (the hamstrings). All these areas are very important for the smooth functioning of the leg while the knee heals after an injury or surgery. Be sure to perform these exercises only after receiving advice from the doctor and only if there is minimal or no pain. These exercises can be done at home, however, if the pain worsens while performing these exercises, stop the activity immediately and consult a doctor. Below are some of the exercises one can perform:

• Hamstring curls: This exercise strengthens the back of the thigh muscles. One should perform the repetitions around eight to twelve times. Lie comfortably on your stomach with the knees straight. If you feel the kneecap is uncomfortable, roll up a washcloth and put it under the leg, slightly above the kneecap. Slowly lift the foot of the injured leg by bending the knee. The foot should be brought up towards the buttocks. If you feel pain with this motion, try to do it without bending the knee to avoid any painful motion. You can also add a cuff weight to the ankle, around 2kg. With the weight tied at the ankle, you need not lift the leg more than twelve inches to get this hamstring workout.

• Quad sets: The aim of this exercise is to build as well as maintain the strength in the muscles on top of the thigh. By doing this action, one is “setting” the quadriceps by holding them tight. Complete eight to twelve repetitions several times throughout the day. Sit on the floor by straightening the injured foot in front of you. Tighten the muscles on top of the thigh. This should be done by pressing the back of the knee flat on the floor. Hold this position for almost six seconds, after which you can relax or rest for ten seconds.

• Leg raise to the front: This exercise strengthens the muscles on the top of the thigh and around the hip area. One can do this for eight to twelve repetitions. Lie on your back with the uninjured knee bent. The foot should rest flat on the floor. The injured leg should be kept straight. While doing this exercise, the lower back should have a normal curve. This can be determined by slipping your hand flat in between the floor and the small of the back. The palm should be touching the floor and the back touching the back of the hand. The thigh muscles should be tightened with the injured leg being pressed and the back of the knee should be flat on the floor. Hold the knee straight. Keeping the thigh muscles tight, lift the injured leg as high as possible so that the heel is 30cm off the floor. Hold this position for five seconds and then slowly return to the normal position.

• Leg raise to the back: The benefit of this exercise is that it strengthens the muscles in the buttocks and the back of the thigh. You can perform eight to twelve repetitions. Lie flat on your stomach and raise the leg straight back towards the ceiling. The toes should be lifted about 15cm off the floor. Hold this position for five seconds and then slowly return to the normal position. If there is any strain, discontinue this exercise.

• Heel dig bridging: This exercise is known to work on the hamstrings as well as the muscles around the lower body and hips. You can do this exercise for eight to twelve repetitions. However, if it causes too much pain, it should be discontinued. First, lie on your back with both knees and ankles bent such that only the heels are digging into the floor. At this point, the knees should be bent at about ninety degrees. The belly muscles should be tightened by pulling in the belly button towards the spine. Slowly push the heels into the floor while squeezing the buttocks. Next, lift the hips off the floor until the hips, knees, and shoulders are all in a straight line. This position should be held for six seconds while breathing normally. Slowly lower the hips back onto the floor and relax for ten seconds.

Prognosis

If the meniscus tear appears in the red zone, a young person, or as a small tear, the prognosis is good. In such instances, surgery is often considered a last option, because the tear usually heals all by itself. Also, if surgery happens, the recovery time is quite short. If the tear is in the white zone, the case becomes a bit complicated, as healing in this area is quite slower. Also, if the person is older or a senior, the healing process is at a bare minimum. The idea of meniscus removal from the white zone is also not a good one, since this can lead to the load completely falling on the other portion of the meniscus. This in turn would lead to an increase in the chances of osteoarthritis in the knee at a later stage.

According to research, alternative and homeopathic remedies for torn meniscus include:

• Arnica
• Rhus tox, to ensure healing momentum
• Apis, for significant swelling
• Ruta graveolens, a classic ligament
• Bryonia, for severe pain
• Ledum, for dark bruising

You can cope with torn meniscus by avoiding activities or rough sports, such as soccer or football, that aggravate your knee injury. Always use an ice pack and buy some pain relievers to ease the pain in your knee.

There are several risks and complications associated with torn meniscus.

Athletes such as soccer, football, or basketball players are most at risk to have torn meniscus, because they use their legs and knees to their full force, with aggressive pivoting and twisting. 

Chances also increase as you reach the age of sixty-five because of the wear and tear of the knees over the years.

A torn meniscus may lead to an inability to completely move your knee, or you may develop osteoarthritis.