Meniscal tear

What is a meniscal tear?

It is a tear of one or both menisci in the knee joint.

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What are the menisci?

We have two menisci in the knee: the inner and outer meniscus. The menisci are tissues that act as cushions in our knee. They have several important roles such as:

• Absorbing shocks
• Transmitting forces
• Contribute to stability
• Contribute to knee proprioception (awareness of the knee's position in space)

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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.

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What are the risk factors for degenerative meniscus tears?

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

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

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What are the symptoms of a meniscus tear?

The symptoms of an acute tear are:

• Pain inside the knee or diffuse pain throughout 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

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The symptoms of a degenerative tear are:

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

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« It is important to know that up to 76% of people who have degenerative meniscus tears have no pain. Therefore, a degenerative meniscus tear does not automatically cause pain! »

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How is a meniscus tear diagnosed?

Diagnosis is possible through a review of your symptoms and a clinical examination. In some cases, magnetic resonance imaging (MRI) may be necessary. However, it's important to be aware that 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. »

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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 that may be responsible for your pain.

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

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What physiotherapy treatments are available for a meniscus tear?

Your physiotherapist will perform 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

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Based on the assessment results, your physiotherapist will:

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

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Do I need surgery for my meniscus tear?

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

• 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.
• It is clearly demonstrated that meniscus surgery on the knee increases the risk of developing knee osteoarthritis later in life. Therefore, all factors should be considered before quickly opting for surgery.

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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.

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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 the advice here that applies to meniscus tears.

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PEACE & LOVE tips specific to meniscus tears:

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

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For C = Compression:

Use a compression bandage or taping to wrap your knee.

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For L = Load:

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

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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

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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If you are a runner, please refer to the blog article on running (link to come) for concrete tips for running.

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To learn more...

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

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Episode #1 discusses the prevention and treatment of running injuries.

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Find the episode on YouTube:

Click below to listen to episodes on podcast platforms:

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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).

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