HEALTH TALK: The knee – Torn meniscus

INTRODUCTION

The knee is a joint consisting of a number of structures, including bones, tendons and ligaments.  Two C-shaped pieces of cartilage known as the menisci (singular: meniscus) curve around the inside and outside of the knee to stabilize and cushion the joint (prevent bones from rubbing against each other).

Forcefully twisting or rotating your knee can lead to a torn meniscus. In older adults, degenerative changes of the knee may contribute to a torn meniscus.

Conservative treatment – such as rest, ice, and medication – is sometimes sufficient to relieve the pain of a torn meniscus. In other cases, however, surgical repair may be required.

SIGNS AND SYMPTOMS

The meniscus may tear in various directions. On occasion, a lengthwise tear flips into the knee joint instead of staying around the edge of the joint – an injury called a bucket- handle tear. Less often, the meniscus may split in two directions.

The first symptom of a torn meniscus may be a popping sensation in the knee. In 24 to 48 hours, swelling and pain may occur. In some cases, a flap of the torn cartilage “locks” the knee joint. You may have difficulty walking or bearing weight on your knee.

RISK FACTORS

Twisting the knee poses a risk of a torn meniscus. This risk is particularly high for athletes – especially those who participate in contact sports, such as rugby, or activities that involve pivoting, such as tennis. The risk also increases as you get older, due to years of wear and tear on the knee.

WHEN YOU SHOULD SEE THE DOCTOR

Contact your doctor if you have a suspicion you have a torn meniscus – you feel a popping sensation in your knee, your knee is painful or swollen, or you can’t move your knee like usual. In the mean time, apply ice to the affected knee. If you have pain, take an over- the- counter pain reliever.

DIAGNOSIS

Often, the doctor can diagnose a torn meniscus during a physical examination. He or she may bend your knee and ask you to move your foot in various directions. Your doctor may order an X-Ray of the knee, or Magnetic Resonance Imaging (MRI) when it’s available. This will not only confirm the diagnosis but study the extent of the tear as well.

In some cases, arthroscopy may be done. The instrument, an arthroscope, is inserted through a tiny incision near your knee. It contains a light and a small camera, which projects an enlarged image of the inside of your knee onto a monitor. If necessary, surgical instruments can be inserted through the arthroscope or through additional small incisions in your knee.

COMPLICATIONS OF A TORN MRNISCUS

These include:

•    Knee instability
•    The inability to move your knee normally
•    Persistent knee pain

TREATMENT

First, there is conservative treatment. Doctor may recommend:

•    Rest. Don’t do anything to aggravate your pain. You may want to use crutches to take the pressure off your knee and promote healing.

•    Ice. Ice can reduce knee swelling and pain. Use a cold pack, a bag of frozen vegetables or a towel filled with ice cubes for 15 to 20 minutes at a time. Do this every couple of hours the first day or two, and then as required.

•    Medication. Over-the-counter pain relievers can also help ease knee pain.

•    Knee exercises. Physical therapy can help you strengthen and stabilize the muscles around your knee and in your legs.

•    Orthotic devices. Arch supports or other shoe inserts can help to distribute force more evenly around your knee or reduce stress on certain areas of your knee.

If your knee remains painful, stiff, or locked, surgery may be recommended. For younger adults, it is sometimes possible to effect a repair. In other cases, the meniscus is trimmed. Again, surgery is often done through an arthroscope. Recovery from arthroscopy is much faster than traditional knee surgery. One can return home on the same day, although full recovery may take weeks or months, as is traditionally the case.

If the meniscus has degenerated, a knee joint replacement may be recommended.

PREVENTION

Regular exercise, good for so may other reasons, if it includes strength training, can help you strengthen and protect your knees. Start slowly and gradually increase your intensity. Use proper form and protective gear for your given sport.

Short and sweet today, I hope.

See you next week. Happy Independence celebrations.