Sporting Injuries and Meniscal Tears – What is a Meniscal Tear
A meniscal tear is a part of the knee that helps to make the knee joint more congruent. The two bones that make up the main part of the knee joint is the Femur (thigh bone) and the Tibia (leg bone). Both of these bones are responsible for maintaining the movement of bending and straightening the knee. The Patella (knee cap) and Fibula (Smaller leg bone) also contribute as they attach to important tendons and ligaments, without which, the knee would not function well.
The main bending and straightening happens at the Femur and Tibia. But these two bones do not match well with each other. The meniscus is 2 “C” shaped pieces of cartilage, that make the Femur and Tibia congruent. They are important for shock absorbing purchases and for making the knee bend in a particular way.
The image to the right shows the meniscus. It is made up of the two C shapes. The centre part of this image is where the ligaments are held, and are not part of the meniscus.
The Meniscus only has a blood supply around the very edge, and therefore, when it is torn, the tear usually cannot be repaired, unless the tear occurs near the blood supply area. In young teenagers, this blood supply extends much further into the meniscus then it does once you are over 20 years old.
The main ways of injuring a meniscus is when you twist hard on your knee, in an awkward way. This will cause the knee to sheer the meniscus, causing a tear. In some cases, the tear is within the main part of the meniscus, causing it to shift inside the knee joint space, and lock the knee. When the knee is locked, this is an indication that surgery is required, even if it unlocks, as the knee is then prone to locking all the time.
Most of the time, the meniscus is damaged during sports that require twisting and pivoting quickly. This includes Football, Netball, Tennis, Squash and Basketball. When your foot is stationary on the ground and your body moves quickly on this, the only damage occurs at the point of weakness, which is the relatively soft meniscus.
When torn, the meniscus causes pain. Often this is experienced as clicking, locking or catching. A doctor will press on your knee, and will bend and straighten your knee whilst rotating your leg, to try to catch the torn meniscus. You will feel that your knee is not that stable, when your meniscus is torn.
If it bothers you when playing sport, an arthroscopy (keyhole) surgery is required. This is where two or three small holes are made to place a camera inside the knee. This a very minimally invasive way of viewing the entire knee, and has very low complication rates. This enables a surgeon to view the entire knee joint from the inside, and deal with any damage to the cartilage.
In most people, the tear cannot be repaired, and the torn and unstable portion of the tear is removed. This can decrease further tearing, and will usually alleviate all the pain associated with the tear. Once the wounds have healed, a patient can usually return to their full sporting activities within a few weeks. Intensive physiotherapy after is usually not required. The rate of infection is low, and most likely sits around the 1 in 500 bracket, depending on other factors that a patient may have (smoking, diabetes).
In older individuals, an MRI may show a meniscus tear. If this did not occur due to some kind of trauma, it is very likely a degenerative tear. These are different to the traumatic, acute tears as described above. These degenerative tears can also cause pain, but are usually the result of advancing arthritis. For people over the age of 50, who have not experienced any trauma, who have a meniscal tear, the results of surgery are not as good as for those who are younger, who obtain their tear through sport. The reason is because there is likely an element of underlying osteoarthritis in the knee. If this is the case, a knee arthroscopy may not alleviate all of the pain.
If you suspect you have a meniscal tear, an MRI is a good first investigation, as it will show 95 out of 100 tears. If you have had an injury resulting in a meniscal tear, that doesn’t improve within 2-3 weeks, then an arthroscopy is usually required.
Dr Liew performs his knee arthroscopy as a day surgical procedure. You are generally walking without any sticks of crutches immediately after surgery, and you will have to refrain from high level sport for 2 weeks. You will need someone to pick you up after your procedure due to the general anaesthetic.
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