Meniscal injury

What is a meniscal injury?​

The meniscus is a C-shaped piece of specialised cartilage. You have two in each knee, and they act as a shock-absorbing spacer. The are positioned opposite to eachother and together form a ring on top of the shin bone to stop the thigh bone from crashing down on it. They have a hazardous job and, as such, are prone to splits and tears. 

 

Sometimes the splits and tears are painful, and sometimes they aren't. When they are painful, they can be accompanied by swelling and stiffness.  The meniscus is toughest between the ages 16-40. During this time, it takes a high-force trauma like a big twist, a blow to the knee or a nasty collision to injure it.  Like all cushions, the meniscus softens over its lifecycle; as a consequence, you can develop small splits and tears that are not accompanied by obvious, high-force trauma. These are often referred to as degenerative tears - a terribly scary name for an incredibly normal process.

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Myths around meniscal injuries.

Many misconceptions surround meniscal injuries.

 

Myth #1 The first one is the suggestion that the meniscus tear has to heal together or be repaired/removed in order for your knee to get better.  

 

Research shows that if you are over the age of 40 and active, you are highly likely to have a meniscus tear, whether you have pain or not.  This is important because it means painful meniscal tears can get better.  It is important here to separate getting better with tissue healing - and this is where most of the confusion comes from.  Your body is amazing at adapting, and your meniscus is very good at its job. It's so good, in fact that even with a tear it can still perform the large majority of shock absorption. The initial pain and swelling you can sometimes get from a meniscus tear is more to do with your body sounding a very clever alarm to warn you that something new and threatening has happened.  Getting better often involves your body turning down the alarm as your meniscus happily goes back to doing it's job. 

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Myth #2 is that you need surgery once your meniscus is painful.  

 

For several decades it was the norm to remove part of or all of the meniscus once it was injured.  This led to some early improvement, followed by early-onset osteoarthritis.  Some very clever people decided to question the efficacy of these surgeries so did a rather large research project comparing surgery to non-surgery management and they found that at 6 months and 12 months there was no difference.  The important thing here is that you can reduce the risk of early onset arthritis and be confident that not having the surgery leads to equal outcomes. Some meniscal tears require surgery and there is no escaping that, but these are under very specific circumstances. If you have consistent locking of the knee, then it's likely that your meniscus is moving around in your knee and that will not get better with time.  Equally if you get to 12 months and you have not improved like the research has suggested then it DOES remain an option to consider surgery.  The final option is reserved for very specific surgeries which we will talk about below -- meniscal repairs.