Symptoms of meniscus rupture

Introduction & Causes

In the knee joint there are two cartilage discs (one inside and one outside), called menisci, which serve to absorb loads that the knee has to bear. If one or both of them tear, this is called a meniscus tear. The symptoms of a meniscus tear differ depending on whether the tear is caused by

  • Injury (a trauma) suddenly occurred or occurred in the context of
  • Degenerative changes (signs of wear and tear) of the knee has come about slowly and on the other hand, depending on the circumstances,
  • How severe the injury is.

In the case of an injury-related meniscus tear, which is found particularly frequently after sports injuries, especially among footballers or skiers, those affected complain of severe pain.

However, this pain does not originate from the meniscus itself, as it is not supplied with nerves that can transmit a pain signal. Since it is often a concomitant symptom of a torn meniscus, however, pain is felt in the end that emanates from the surrounding structures. Classical for such a clinical picture are pains in the area of the

  • Irritation or even
  • Inflammation of the joint capsule and/or a
  • Effusion in the joint occurs,
  • Hollow of the knee and at the
  • Lateral knees, which sometimes reach up to
  • Shinbone can radiate.

Which of the two menisci is injured can often be determined from the location of the pain in the knee joint.

Symptoms of damage to the inner meniscus are pain on the inside of the knee, pain on the outside indicates damage to the outer meniscus. The pain can also be triggered by pressing the joint gap with the finger, because that is where the menisci are located. To do this, press the furrow with the knee bent, which can be felt on the right and left side of the lower edge of the kneecap.

The pain can also be triggered by turning (=rotation) the leg in a bent position. To do this, the bent leg is rotated inwards or outwards while lying down. Symptoms of damage to the inner meniscus here are pain on the inside of the knee during external rotation.

Pain on the outside of the knee during counter-rotation inwards indicates a torn meniscus in the outer meniscus. Furthermore, symptomatically often a wandering of the pain and the sensitivity to pressure with increasing flexion of the knee can be observed. Pain in the knee joint in the usual yoga seat can also occur with an injury to the inner meniscus.

Through these and other tests, in which the pain is triggered by specific movements, a trained examiner can determine the location of the torn meniscus more precisely. However, this usually requires some practice and the exact diagnosis should be left to a specialist. In addition to the pain, a swelling in the knee joint is also impressive.

The torn meniscus represents an enormous stimulus for the mucosa of the joint capsule, which is why it produces more synovial fluid in the joint. The result is an excess of this fluid. This condition with excessive joint fluid in the joint is called joint effusion.

Since the joint capsule has only limited space, the entire capsule swells, which leads to visible symptoms in the form of a visible thickening and restriction of movement in the knee joint. Externally, the knee appears thick and swollen. The pressure in the capsule irritates the nerve endings in the joint capsule and the affected person feels a tension pain in the entire knee joint area.

In case of larger effusions, the sign of the “dancing patella (kneecap)” can be observed. When the knee is extended, the kneecap can be pressed down as if into a fluid cushion. If the affected person has thicker knees or is uncertain, the healthy knee of the affected person is always suitable for comparison.

If the symptoms last longer, a doctor should always be consulted and, if necessary, treatment should be initiated in order to prevent negative long-term consequences such as knee joint arthrosis (= wear and tear of the knee joint). If the meniscus is torn off on the inside of the knee, the pain is typically localized there. The pain can be triggered by applying pressure to the inner joint space of the knee.

Often a slight pressure at this point is sufficient to cause severe pain in the knee. This is especially the case when, as is often the case with injuries to the inner meniscus, the inner ligament of the knee is also injured. In addition, rotary movements and bending of the knee are particularly painful.

Especially a turning movement of the foot outwards with simultaneous flexion of the knee joint leads to strong pain on the inside of the knee. Therefore this kind of pain triggering is also used as a test for diagnostics. Even if the stretched leg is pressed slightly outwards at knee level, pain can often be triggered.

Of course, even when standing, one notices that a strain on the knee is painful when slightly tilted inwards. However, any type of meniscus tear usually causes an effusion of the knee joint, which causes the entire knee joint to be painful after a short time, so that it is sometimes difficult to determine the side. With a torn meniscus on the outside of the knee, the outer joint space of the knee is very painful when pressure is applied.

This can cause pressure pain from above as well as from the side. A shift in weight, which leads to pressure on the outside of the knee, can also trigger pain. In most cases, as with the inner meniscus, a clear assignment of the pain to the sides is difficult without special tests.

The outer meniscus is particularly painful when the foot is turned inwards with the knee bent. This movement also represents the typical test for damage to the outer meniscus. Pain can often also be triggered by pressing the stretched leg outwards.

Since the outer meniscus is less often damaged by accidents, but often slowly, a joint effusion has often already occurred, so that the whole knee usually already hurts. A rupture of the outer meniscus can also lead to restrictions in movement. In addition, the cracking or snapping described above can occur.Some patients generally also experience a feeling of instability in the knee when meniscus tears occur.

The typical stabbing pain in a torn meniscus is very strong, which sometimes even leads to the point where normal walking is no longer possible due to the pain. Often the pain is also diffuse and cannot be limited to a certain point. The painful aspect of a torn meniscus is not the tear itself, since the meniscus does not have nerves that can cause and transmit pain.

The pain is caused by irritation of the surrounding tissue, either by torn pieces of the meniscus irritating the joint capsule, or by the meniscus itself, which is no longer firmly anchored in the knee joint due to the tear, being displaced by even small movements so that it exerts pressure on the joint capsule, which then results in the typical stabbing pain. At the same time, this model of pain development also explains why the pain is predominantly motion-dependent, since the pain-sensitive structures in the knee are only irritated when movement is involved. A cracking sound in the knee joint is an indication of a severe form of knee damage.

This is typical above all in the case of a severe meniscus tear with complete tearing of meniscus parts. However, if the noise occurs in direct connection with a fall on the knee, for example, bony damage can also be the cause. In the case of a torn meniscus, the sound can also be less cracking but more snapping.

It is caused by the fact that parts of the meniscus have separated from the rest and now float freely in the joint. This not only leads to the formation of noises, but also to an inflammatory reaction. It is possible that the free parts of the meniscus become trapped in the joint, or that the still solid parts behave untypically during movement.

Both can cause the noises. In most cases, in addition to cracking during certain movements, there is also a restriction of movement in a certain direction of movement, since the free meniscus parts block the joint function here. In the case of such a severe meniscus tear, treatment in the form of arthroscopy should definitely be performed to remove the meniscus parts and prevent further damage. (see: Surgery of the torn meniscus)