A meniscus tear is a painful knee joint condition that is mostly caused by sports that put a lot of stress on the knees. These include soccer and skiing. In the course of a meniscus tear, there is lasting damage to the cartilage disc in the knee joint (meniscus). Furthermore, a meniscus tear can also cause general wear and tear of the joint in old age.
What is a meniscus tear?
Schematic diagram showing the anatomy and structure of the meniscus. Click to enlarge. The human knee joint has two menisci that serve to cushion pressure and transmit force between the two bones of the leg. When one or both menisci tear, it is referred to in medical terms as a meniscus tear. It is characterized by pain in the knee, which is more or less severe depending on the tear; in addition, the knee can no longer be extended. The diagnosis must be made clinically, using methods such as magnetic resonance imaging and arthroscopy.
Causes
In most cases, a meniscus tear is related to wear and tear of the menisci. Tears of the inner meniscus are much more common than those of the outer meniscus. The menisci are a layer of cartilage between the two bones of the knee joint. In the course of life, wear and tear also occurs on them – this is a component of osteoarthritis and is called meniscopathy. For example, older people may develop meniscus tears as a result of too much stress on the material being used. This can be especially the case during sports if no protective devices, such as spring-loaded shoes, are worn. In the case of diseases such as osteoarthritis, however, even minor stresses in everyday life can be dangerous. Cracks are also possible at a younger age. This is especially true if the knee joint has to withstand exceptionally high loads. Various sports involve a high risk – in the event of injuries or accidents, even people with healthy joints can injure the menisci.
Symptoms, complaints and signs
A meniscus tear is usually a very painful affair, so that affected people are significantly disrupted in their own movement. Typical signs of a meniscus tear are severe pain in the knee. The entire joint can no longer be moved properly with an existing meniscus tear, so that even the smallest movements cause severe pain. In the case of an acute or sudden meniscus tear, the stabbing pain occurs immediately after the respective load. Severe and clearly visible swelling] is also possible, occurring immediately at the knee joint. In case of degenerative changes, the pain gets worse and worse over a longer period of time until the meniscus is torn. In the case of a tear of the muscle, the pain is by no means as bad. Pain only occurs when pressure is exerted. The course of movement is only very rarely restricted with a tear of the meniscus. Only explicit movements and positions of the joint cause pain, so that a tear is often not recognized as such. Anyone who completely forgoes medical and medicinal support must expect a considerable worsening of the symptoms that occur. Also permanent damage is possible if not in time to go to the doctor.
Disease progression
In general, there are no major complications and serious complaints with a meniscus tear. Only the known dangers and risks associated with meniscus surgery may occur. Only rarely do nerve injuries or cartilage and ligament damage occur in the course. Timely detection of joint stiffness requires an early visit to the doctor. However, osteoarthritis can still occur.
Complications
Due to the meniscus tear, the affected person primarily suffers from relatively severe pain. The pain itself is burning and stabbing and can also spread to the surrounding regions of the body and cause pain or swelling there as well. The affected regions are also swollen and there is swelling and pain in the joints themselves. It is not uncommon for the joints to also become inflamed, resulting in restricted movement. As a rule, the meniscus tear significantly reduces the quality of life and there are various restrictions in the patient’s everyday life.Complications occur in most cases if the affected person continues to put strain on his body after the meniscus tear. This can lead to irreversible consequential damage. However, even after successful treatment, the body’s full load-bearing capacity is not restored. However, the patient’s life expectancy is not reduced by this condition. There are also no further complications during the treatment of the tear. With the help of surgical interventions, the discomfort can be relatively well limited. In some cases, the insertion of implants is necessary.
When should you go to the doctor?
A meniscus tear is a serious injury that, as a rule, should always be treated by an appropriate physician. Usually, such an injury occurs due to an unusual or heavy load. Affected individuals immediately complain of a sharp and long-lasting pain that does not subside even at rest. As a result, normal movement is no longer possible, making a visit to the doctor essential. Those who decide to seek medical treatment can expect a complete and quick recovery. However, if a visit to the doctor is delayed, then significant complications are to be expected. In many cases, surgery may even be required to ensure a full recovery. Otherwise, this injury may not heal properly and may even result in permanent secondary damage. In addition, an untreated meniscus tear can even lead to inflammation or the formation of an abscess. Pus fluid develops, which in particularly bad cases can even lead to blood poisoning. Therefore: A meniscus tear should always be treated medically and with medication. Only then can healing without complications be made possible.
Treatment and therapy
The treatment of a meniscus tear consists first of all of performing a knee endoscopy to define the exact nature of the tear. During this procedure, the knee joint is flushed, and then a lens is inserted through which the meniscal tear can be examined. This is important in order to subsequently select the correct surgical procedure, as MRI images, for example, do not provide an accurate indication of what the condition is. Three options are then available. The simplest solution is meniscus suturing. In this procedure, the meniscus is repositioned with suture material or special meniscus arrows, and the material then dissolves on its own. This method makes it most likely that full athletic activity can be resumed. The second option is treated as a partial resection. In this case, part of the meniscus is removed. The advantage of this is that the healing process is faster. However, heavy loads are critical for the joint afterwards. In severe cases, a donor meniscus or an implant is transplanted. Athletes can also train with it again, but run a higher risk of arthrosis.
Outlook and prognosis
Provided certain guidelines are followed, meniscal tears have a favorable prognosis. Normally, freedom from symptoms is achieved within a few months. Nevertheless, usual sports activities or physical stress may not be resumed for several years. Without medical treatment, severe pain and considerable impairment of locomotion occur. Gait insecurities and a decrease in physical performance occur. Lifelong disorders occur if treatment is not initiated. In addition to medical care, a subsequent physiotherapeutic treatment supports a good prognosis. Here, the patient learns how to gradually bring his body back to its previous performance capacity. Movement sequences are trained and specific exercises are learned to strengthen the knee joint. For optimal further development, the patient should also incorporate the training into everyday life outside of the sessions that take place. This will lead to an improvement in the general state of health and shorten the healing process. In spite of everything, it should be taken into account that the risk of secondary diseases is increased if the patient continues to exercise heavily. Many of those affected subsequently suffer from arthrosis in the course of their lives.This circumstance must also be taken into account when making the prognosis that osteoarthritis is a chronic disease that leads to significant loss of range of motion.
Prevention
In order to prevent a meniscus tear at an early stage, it is important in the first place to protect the knee joint from osteoarthritis. In this way, wear and tear does not become an issue until late in life, if at all, and the menisci remain resilient for a long time. For example, good shoes are important for sports or activities that put a lot of stress on the joint. Dangerous sports with an extreme risk of injury (e.g. soccer) to the knee are best not practiced at all – if they are, proper protection is important. If higher wear and tear is known, heavier, risky loads should be avoided altogether if possible.
Aftercare
The healing process for meniscus tears is lengthy and sometimes complex, so aftercare focuses on dealing with the injury in a positive way. The physical limitation can be very distressing to those affected, so it is important to accept the situation and adopt a positive attitude. This sometimes stimulates the recovery process and maintains quality of life despite the aggravating circumstances. The meniscus tear reduces the quality of life considerably and there can be many restrictions in everyday life that have to be taken into account by those affected. Further discomfort usually occurs when the body continues to be heavily loaded despite the meniscus tear, so physical activities should be taken up only very cautiously and in consultation with the attending physician.
What you can do yourself
In everyday life, movements should be controlled and well reflected throughout life. Correct movement patterns can hold back wear and tear on the joints for as long as possible. If cartilage and joints are already damaged, there is a chance that even one movement that is not performed optimally can lead to a meniscus tear. Wearing healthy footwear is recommended in all age groups so as not to trigger incorrect stresses or overstresses. To minimize unnecessary wear and tear on the bones as a whole, care should be taken to keep your own weight in the normal range. Excess weight immensely increases the likelihood of joint damage and thus also the functional activity of the menisci. Since the meniscus tear does not heal independently without medical intervention, the affected person should seek the cooperation of a medical professional as soon as possible in case of complaints. Early diagnosis reduces the size of the tear and has implications for continued health. During the healing process, the patient’s cooperation is helpful. The medical advice should be followed in order not to cause permanent discomfort. In the first days after the procedure, rest should be maintained and the affected knee should be almost completely relieved. Subsequently, the healing process is accompanied by physiotherapeutic exercises, which the affected person can perform on his or her own responsibility in everyday life. Sporting activities should not take place until the healing process has been completed in order to avoid relapse.
