Meniscal Injuries

Another knee article? What is left to talk about in the knee? The meniscus is a piece of cartilage and has a number of important responsibilities.

First, it is a shock absorber. It is not hard like bone, but softer like the discs in our back. When we walk, run and jump, the bones transfer force up the limb and the meniscus help decrease the impact when the force is transferred from bone to bone.

Second, it helps with stabilization. The knee joint is a stable joint by design with the ligaments and muscles, but not because of the bone structure. It is not a deep socket like the hip but much flatter joint surface like our fingers. The meniscus is thicker on the outside of the knee than the inside, so it helps deepen the rather shallow knee joint.

Third, it reduces arthritis to the articular cartilage, the smooth lining of the ends of the knee bones. Without the meniscus there is more bone to bone contact which leads to quicker breakdown of the smooth lining. For this reason, orthopedic surgeons always attempt to repair a meniscus if able, rather that taking it out. The articular cartilage actually does not have pain receptors in it, so the reason why articular damage hurts is because of the bone structure under the articular cartilage that does have pain receptors.

The meniscus can get damaged two ways. First, is trauma. Meniscal damage is very common when ACL tears occur. The ACL injury occurs generally with twisting and twisting with compression also shears the meniscus potentially causing a tear. The second way is with degeneration and general wear and tear. As we age, our body tissues get dehydrated. I am not talking about whether you drink enough water --although everyone should stay hydrated and yes, that level does affect cartilagenous tissues in our body--but just like foam around handles and rubber seals around car doors shrink and breakdown, so do these types of cartilage. This lack of hydration leads to increased potential for meniscus breakdown.

There are a number of signs of meniscal issues. First, joint line pain is generally present. The pain though can be deeper though. Second, catching or locking. If the tear causes a big flap, the flap can get folded over and block the knee bones from moving in a certain direction. Either of these symptoms warrant a discussion with your primary care physician and or orthopedist.

Meniscal tears can heal, but where the tear is located is a very important part of this determination. If the tear is in a place that can heal, a surgeon can repair it with staples or stitches. If is located on the more inside of the knee, where circulation is poor, it will not heal and more than likely, the surgeon will remove the torn portion. Although a repair of a meniscus will require a number of weeks with crutches while removal of the menicus will have no weight bearing restrictions, the weight bearing limitations of the repair are worth the benefits in the long run.

There are non-surgical options that may be considered prior to undergoing the knife, and yes, physical therapy is one of them. Physical therapy focuses on improving the circulation to the knee joint with low resistance cyclical motion, improving the strength around the knee and assuring good alignment with the hip and foot.

To avoid mensical damage, avoid deep knee squats and lifts is the main prevention point. While activity will increase wear and tear, not performing physical activity to "save" your meniscus is not a good alternative! If you knee is limiting your physical activity, please consult your primary care, orthopedist or physical therapist, so you can get back to your favorite sport, recreational activity or simply back to getting around the house. Do not let knee pain hinder you getting benefits for your heart and other joints.