Meniscus injuries are among the most common injuries to the knee joint. The menisci are sickle-shaped and lie between the thigh bone (femur) and the shin bone (tibia) on the tibia plateau. The menisci serve as a buffer and compensate for incongruities between the tibia and the femur.
They have a direct connection to the knee capsule and two adjacent muscles. Therefore, in case of meniscus problems, the musculature should always be considered. One of the typical injury mechanisms is the rotation of the knee joint when the lower leg is fixed.
This usually causes the inner meniscus to tear together with the anterior cruciate ligament and the inner ligament. In addition to a tear of the meniscus, a meniscus blockage can also be present. This is usually caused by stretching too quickly after long periods of sitting. This causes a spasm of an adjacent muscle (M. Semimembranosus) and the knee can no longer be stretched.
Symptoms
Immediately after a trauma, pain cannot usually be precisely attributed. The entire knee is painful and swells up. If the tear has existed for a longer time, the pain can be localized more precisely.
In the case of an external meniscus lesion, the pain appears on the outside of the knee joint gap and moves from front to back due to the movement of the menisci during flexion. In most cases, a maximum bending movement of the knee joint is no longer possible, so that a compensatory counteraction is taken immediately. The load capacity of the entire leg also decreases, and the usual sports and movements are only possible with pain or not at all.
Specific tests can diagnose a meniscus injury. Tests such as Springing Bloc, McMurray, Steinmann, Cri du menisque and Apley are classic examinations. From the above examples, almost all tests must be positive to confirm a meniscus lesion. The final MRI examination finally gives the correct statement.
Treatment
Whether surgical treatment is necessary is decided by the doctor according to the extent of the injury. In doing so, the tear should be refixed as far as possible and a complete removal of the meniscus should be avoided. During the first 6 weeks after the operation, partial weight bearing is necessary.
The movement limits are also prescribed by the doctor. In physiotherapy, the knee joint is moved within the appropriate limits from the beginning. In addition, the swelling is treated with decongestant grips or manual lymph drainage.
In cases of pain due to the tendon attachment or the musculature, ice, special massage techniques (so-called friction) and soft tissue techniques can be used. The patient can carry out elevation and cooling alone as often as possible. In addition, walking with crutches should be worked on, as it is particularly important to maintain partial weight bearing.
Only in this way can further damage to the tissue be prevented. Strengthening exercises for the front and rear leg muscles can be performed by isometric tension. The back of the knee is kept depressed to activate the front thigh muscle.
The tension in the flexion of the knee without movement addresses the so-called ischiocrural muscles. If the patient is allowed to put weight on the knee and to bend and stretch at most, the missing movement should be improved by manual therapeutic techniques. In doing so, the therapist orients himself to the sliding mechanism of the knee joint.
The shin bone slides backwards when bent and forwards when stretched. This movement is supported by the therapist. Strengthening exercises can be increased, whereby particular attention should be paid to the leg axis. Coordination and balance training is particularly important for the stability of the knee joint and should be incorporated gently into the therapy.
