Meniscal tear

What is a meniscus tear?

It's a tear of one or two menisci in the knee joint.

What is a meniscus?

Menisci are tissues that act like cushions in our knee. We have two menisci in the knee: the medial and lateral menisci. They have several important roles such as :

• Absorbing shocks
• Transmitting forces
• Contribute to stability
• Contribute to knee proprioception (perception of the knee in space)

What are the causes of meniscus tears?

Meniscus tears can occur in two ways:

• Following a knee injury
• Often from a fall on the knee or a twist of the knee with the foot planted on the ground.
• Gradually, due to wear and tear of the menisci over the years.

What are the risk factors for degenerative meniscus tears?

The following factors increase the risk of suffering a degenerative meniscus tear:

• Body Mass Index (BMI) greater than 25
• Men are more at risk than women
• Have a job that requires squatting or kneeling for at least one hour a day

What are the symptoms of a meniscus tear?

The symptoms of an acute tear are:

• Pain inside the knee or diffuse in the knee
• The pain may be increased by:
• Putting weight on the leg
• Walking
• Bending the knee
• Doing a squat
• There may be swelling of the knee

The symptoms of a degenerative tear are:

• Progressive onset of pain AND pain only inside the knee
• Mild to severe pain during twisting motions, activities, or sports

"It's important to know that up to 76% of people with degenerative meniscal tears have no pain. So a degenerative meniscal tear doesn't automatically hurt!"

How is a meniscus tear diagnosed?

Diagnosis is made on the basis of symptom history and clinical examination. In some cases, magnetic resonance imaging (MRI) may be necessary. Care must be taken, however, as not everything seen on an MRI is relevant.

« Moreover, in the majority of meniscus tears, getting an MRI does not change the treatment plan, which remains physiotherapy first and foremost in most cases. »

When should you see a physiotherapist for a meniscus tear?

You should consult a physiotherapist if you have symptoms as described above, or if your doctor has already ruled out any other cause for your pain.

You do not need to see a doctor before consulting a physiotherapist. If your condition requires medical attention, your physiotherapist will be able to tell you.

What physiotherapy treatments are available for a meniscus tear?

Your physiotherapist will do an assessment to determine your limitations and will evaluate the following elements:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

Depending on the results of the assessment, your physiotherapist :

• Mobilize your knee to reduce pain and improve your movement
• Give specific exercises to re-educate control of your knee movements
• Give you exercises to restore mobility, reduce pain and regain muscle strength
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Provide advice on your posture and movements

Do I need surgery for my torn meniscus?

In most cases, the answer is no. Here are a few points to enlighten you:

• For traumatic tears, surgery offers a slight benefit in the short term (3 to 6 months). However, in the long term, physiotherapy achieves the same results as surgery.
• For degenerative tears, physiotherapy is as effective as surgery. Surgery can be considered for those who do not respond to physiotherapy.
• There is clear evidence that knee meniscus surgery increases the risk of developing osteoarthritis of the knee in later life. So it's important to consider all the facts before rushing into surgery.

What can I do at home for a meniscus tear?

Temporarily stop doing movements that cause too much pain, and then gradually start doing them again.

If it's a traumatic tear, follow the PEACE and LOVE principles. Read the blog post on PEACE and LOVE (coming soon) and then read here for tips that apply to meniscus tears.

PEACE & LOVE tips specific to meniscus tears:

(make sure you've read the blog post that explains the PEACE and LOVE steps in detail)

For C = Compression:

Use a compression bandage or taping to wrap your knee.

For L = Load:

• Start walking again and put weight on the leg gradually, without increasing the pain significantly. Wait until you're no longer limping before increasing the duration of your walks.

For V = Vascularisation:

Light to moderate cardio activity without pain accelerates healing. For a meniscus tear, you can:

• Do stationary cycling without pain
• Swim without pain

If you're a runner, refer to the blog post on running (link coming soon) for concrete running tips.

To learn more...

You can view the podcast PARLE-MOI DE SANTÉ by one of our physiotherapists, Alexis Gougeon.

Episode #1 talks about preventing and treating running injuries.

Watch the episode on YouTube

• Spotify
• Apple Podcasts

Sources

• Décarie S, Fallaha M, Frémont P, Martel‐Pelletier J, Pelletier JP, Feldman DE, Sylvestre MP, Vendittoli PA, Desmeules F. Diagnostic validity of combining history elements and physical examination tests for traumatic and degenerative symptomatic meniscal tears. PM&R. 2018 May;10(5):472-82.

• Diagnosis validity of combining history elements and physical examination tests for traumatic and degenerative meniscal tears PM&R Journal. 2018 May; 472-482

• Snoeker BA, Bakker EW, Kegel CA, Lucas C. Risk factors for meniscal tears: a systematic review including meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. 2013 Jun;43(6):352-67.

• Messner K, Gao J. The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment. Journal of Anatomy. 1998 Aug;193(2):161-78.

• Arthroscopic Partial Meniscectomy or Conservative Treatment for Nonobstructive Meniscal Tears: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2016 Sep;32(9):1855-1865

• Petersen W, Achtnich A, Lattermann C, Kopf S. The treatment of non-traumatic meniscus lesions: a systematic review comparing arthroscopic partial meniscectomy with non-surgical treatment. Deutsches Ärzteblatt International. 2015 Oct;112(42):705.

• Brignardello-Petersen R, Guyatt GH, Buchbinder R, Poolman RW, Schandelmaier S, Chang Y, Sadeghirad B, Evaniew N, Vandvik PO. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open. 2017 May 1;7(5).