Meniscus Tear

Home Physio specializes in diagnosing and carefully treating Meniscus Tear while making sure each patient is fully informed throughout the process. Serving the Central, West & North London , Home Physio is known for delivering outstanding results while helping you minimize your personal investment and creating a suitable treatment plan for your needs.

Home / Conditions / Meniscus Tear

What is cartilage

Cartilage is a very strong, smooth, elastic, fibrous structure found in joints and at the end of long bones. In the body it takes many forms and has multiple purposes throughout the body.
In the knee we have two types of cartilage; articular cartilage and the menisci cartilage.
The articular cartilage is located on the end of the bones; the femur (above the knee) and tibia (below the knee). Articular cartilage is involved in osteoarthritis.
The menisci are situated in between the bones, on top or below the articular cartilage, they are not connected to the articular cartilage.
For this article we are going to solely focus on menisci cartilage.

What is the function of meniscus?

The menisci are a fibrocartilaginous structure that provide the joint with increased stability, distributes body weight evenly through the knee and increases shock absorption.
There are two menisci. The one on the outside, also known as the lateral meniscus and the one on the inside, known as the medial meniscus (see image below). The medial meniscus is the most commonly injured of the two.
Each meniscus has an anterior and posterior horn and most tears occur at the posterior horn.
A torn meniscus is a common injury that can affect active and sedentary patients of all ages.

How do you tear the meniscus?

The meniscus is most commonly injured by a twisting or turning movement whilst your foot is planted on the floor. In a young sporty person this could be due to turning quickly when playing a game of football or a tackle during a rugby match.
The effect of this twisting movement puts torsion throughout the meniscus and causes the fibres to tear. This results in an acute tear of the meniscus. Some people report they hear their knee click and feel pain immediately.

There are many different types of tears (see image below). The different tears can present with their own specific symptoms. For example, a ‘bucket handle tear’ may cause ‘locking’ of the knee. ‘Locking’ is when the knee gets stuck in one position and you cannot move it. This is very painful and debilitating when it happens. Not everyone with this type of tear experiences this problem.

As we get older meniscal tears can occur with the same twisting mechanism but they can also occur due to seemingly innocuous movements such as misjudging a step or turning whilst walking. It is not unusual that there is no specific incident or trauma, before the knee becomes painful.

How do you know if you have a meniscal tear?

The symptoms can vary from person to person but the key signs and symptoms are:

Swelling – this normally takes 24 hours to develop after the onset of pain or injury
Tenderness on the inside (medial meniscus tear) or outside (lateral meniscus tear) of the knee
Pain with straightening the knee
Pain and an inability to bend the knee fully i.e. unable to pull your heel into your buttock
‘Locking’ and ‘clunking’ of the knee
Pain whilst squatting, twisting and kneeling

How is a meniscal tear diagnosed?

Meniscal tears are quite straightforward to diagnose. Clinical assessment has been shown to be around 80% accurate for diagnosis of meniscus tears. Your physiotherapist will carry out specific clinical tests to assess for tenderness on the joint line (where the meniscus is located), your range of movement, the amount of swelling in your joint and the stability of your knee. There is a specific meniscal test called the ‘McMurray’s test’ that your physiotherapist may additionally carry out to help establish your diagnosis.
If we are unsure of your diagnosis or we would like to understand more about the extent and type of the meniscal tear then we may refer you for an MRI scan. MRI scans are also very useful to assess for any other contributing factors such as an associated ligament tear. We can refer you directly without going to your GP.

At Complete Physio our highly experienced physiotherapists will comprehensively assess your knee joint using a series of clinical tests.
Some of our clinicians are also fully qualified musculoskeletal sonographers and will carry out a diagnostic ultrasound scan of your knee.

Ultrasound is unable to assess the deep portion of the meniscus, however, it is an effective tool to assess for any swelling and inflammation in the knee. Ultrasound can also visualise meniscal cysts and other structures in the knee such as the medial and lateral collateral ligaments and the surrounding tendons. Meniscal cysts are small fluid-filled pockets that arise from the meniscus. These can occur secondary to a tear.

There is no extra charge for an ultrasound scan.

Research has shown an increased risk of early onset of arthritis after damaging your meniscus and therefore an accurate diagnosis and appropriate treatment is paramount to a positive outcome (Kulkarni et al, 2014 ).

Physiotherapy

Most meniscal tears improve with time and physiotherapy. Physiotherapy will include load modification e.g. reducing your running and walking and reduction or avoidance of the movements and activities that make your pain or swelling worse.
This advice will also be accompanied with a comprehensive exercise programme. Exercises will focus on your quadriceps (the muscle on the front of your thigh) and hamstring (muscle on the back of your thigh) muscles. You may also receive exercises to target your calf, “core” and hip. These exercises may be a combination of home exercises and gym based exercises depending on your individual circumstances. The exercises will progressively improve the strength and stability around your knee.
Treatment may involve ‘hands-on’ treatment to the knee such as soft tissue technique, and joint mobilisation to the hip, knee and ankle to improve range of movement and pain. Some of our physiotherapists may use acupuncture as an adjunct as part of your treatment programme.

Here are a few simple tips you may like to try if you suspect you have a torn meniscus.

These tips will depend on how long you have had the injury and how much swelling there is. We would always advise you seek expert help if you have any concerns or your pain and swelling gets worse:

Try applying an ice compress e.g. small packet of frozen peas, wrapped in a towel, on your knee for 10 minutes. This will help to reduce inflammation and pain. DO monitor your skin as you can burn yourself with ice.
If you have significant swelling, we would advise you get a simple neoprene knee brace (image below right) or tubigrip. This will help reduce pain and swelling.
Do not keep your knee in the same position for prolonged periods of time. If you sit at a desk all day make sure you regularly get up and move around. This will stop the knee stiffening up.
Complete regular gentle knee stretches, within your available pain-free range. Make sure you are bending and straightening your knee. Keeping your knee still is generally not useful.
Gentle quadriceps contractions (see image left below) will help to maintain some muscle strength. In sitting, slowly straighten your knee by squeezing your thigh. Complete the movement within your available pain-free range.