Meniscus Tear: What is it, Symptoms, Diagnosis and Treatment

As with most knee injuries, it is common to experience severe pain or weakness with a meniscus tear.

As with most knee injuries, it is common to experience severe pain or weakness with a meniscus tear. Meniscus tear can manifest itself with various symptoms that limit daily activities and reduce the quality of life and is among the most common injuries.

What is Meniscus?

Meniscus is a tissue with a fibrocartilage structure that provides load transfer, contributes to knee stability, has the function of absorbing shock and impacts, and prevents bones from wearing out and wearing out by friction.

How Does Meniscus Injury Occur?

The knee must usually be bent severely for a meniscus tear to occur. In some of these cases, the broken piece of cartilage may compress the knee joint, preventing its movement and causing it to lock. Meniscus injuries can occur with direct or indirect contact. The best examples of meniscus tear due to direct contact are frequently seen in football players and volleyball players. Meniscus tears, which are frequently encountered due to sudden and sharp direction changes during running, may also be accompanied by anterior cruciate ligament (ACL) injuries.

Meniscus tears that are not related to direct contact or trauma and are generally seen in the elderly population can be called degenerative tears. The risk may be higher for older athletes, as the meniscus structure loses its strength with age and cannot fully fulfill its support function. The likelihood of meniscus injuries in people over the age of 65 is higher than in other age groups. If the meniscus structure deteriorates and degenerates with age, experiencing discomfort such as knee sprain increases the risk of meniscus tear. The degenerative meniscus tear pattern differs from the tear pattern caused by contact and trauma. This is important because it will also change the treatment approach.

Various symptoms may occur due to meniscus injury, such as pain, swelling, hearing a sound during the formation of the lesion, or locking, especially in some types of tears. Approaches to be applied in meniscus treatment generally follow a certain order. Approaches such as protection, rest, applying ice or cold, wrapping the area (compress), and elevating the damaged leg usually give good results. Symptomatic drug therapy approaches may also be preferred to relieve pain and reduce swelling. In most cases, the meniscus can heal on its own, but there are also types of tears that need to be repaired surgically. It is recommended to get support from a specialist doctor and an experienced health institution in the diagnosis, treatment and follow-up of meniscus tears.

What are the Risk Factors for Meniscus Tear?

Activities and sports that may cause aggressive, sharp bending or rotation in the knee joints are among the most important risk factors for meniscus tear. The risk of meniscus tears is higher, especially in individuals who engage in sports that involve contact, such as football and volleyball, and that place heavy load on the joints, such as jumping and twisting. The risk is also high in tennis and basketball athletes. This type of sports can cause damage or degeneration in older knee joints and tissues. However, obesity also weakens the joints, puts too much load on the knee, eliminates its flexibility and increases the risk of meniscus tears.

What are the Complications of Meniscus Tear?

Permanent knee pain is one of the most common complications that may occur due to meniscus tear. Individuals may face conditions such as a feeling of collapse in the knees, inability to perform movements that could be done in the past, and chronic knee pain due to a torn meniscus. The likelihood of developing osteoarthritis may also increase due to injuries to the knee bones and joints.

What are the Symptoms of Meniscus?

The most common and main symptom of meniscus tear is pain felt at the knee joint line. Locking, loss of function, feeling of being stuck and swelling in the uncomfortable knee are among the main symptoms. There are also reported cases of numbness or a feeling of ejaculation in the legs. The main reason for numbness in the leg is the displacement of the torn meniscus, the tissues can break down and damage the thigh muscles. Pain may not be very severe in the early stages of the injury and may not cause restriction in movements. However, as the inflammation progresses, the pain often becomes worse. Pain located in the upper part of the knee, where the meniscus is located, may be aggravated, especially when carrying weight, getting in and out of a car, or squatting. Going up and down stairs is also often painful, and overuse of the knee can lead to increased swelling. The first symptoms of meniscus can be summarized as follows.

• Loud noise and popping sensation in the knee during the formation of the lesion
• Swelling and edema
• Pain, especially when rotating the knee
• Difficulty straightening the knee after a fracture
• Locked feeling causing difficulty in movement
• Numbness in leg muscles
• feeling of ejaculation

If there is severe pain when the knees are bent, if there is swelling or redness in the knee and the knee cannot be moved, if there is an unexpected loss of function, it is important to consult a healthcare institution without delay and undergo a comprehensive examination.

How is Meniscus Diagnosed?

A detailed and careful physical examination is required to make a diagnosis in patients who complain of knee pain and swelling or who have a suspected meniscus tear. Testing the knee and leg in different positions, performing various maneuvers and checking the gait is a situation that the doctor will evaluate. The purpose of the meniscus tear examination procedure, known as the McMurray Test, is to compress the meniscus and evaluate the presence of pain. Hold the knee with one hand and the ankle of the same side with the other hand and bend the knee fully. The menisci on both sides are also tested by rotating them. Pain or hearing noise due to medial (inner) and lateral (outer) meniscus damage or tear means that the test is positive. Advanced diagnostic methods and imaging studies are needed to diagnose meniscus in patients with a positive McMurray test. Imaging tests requested in cases of suspected meniscus tear can be summarized as follows.

• X-Ray imaging (X-ray): It is not possible to diagnose meniscus tears with X-Ray because it is surrounded by cartilage structure. However, this method is generally preferred to ensure that the condition causing pain and swelling in the knee is not a bone fracture or a different disease.
• Magnetic Resonance Imaging (MRI): Magnetic resonance imaging is the method used to evaluate the knee joint and cartilage structure in detail. MRI is a diagnostic tool that provides detailed imaging of both soft tissues and hard tissues. It is safe to use in children and pregnant women as it does not contain X-rays or radiation and provides imaging using a magnetic field. The most detailed and reliable approach to the diagnosis of meniscus tear is MRI.

What are the Treatment Approaches to Meniscus Tear?

Some factors are important in the treatment of meniscus tears. These factors include the size and pattern of the tear, its location, the patient’s lifestyle and age, and their expectations and needs from treatment. One of the most important factors that change the treatment approach is the size of the meniscus tear and whether it includes the part rich in blood vessels, called the red zone. Spontaneous healing is not expected in injuries to the outer part (white area), which is an area poor in blood vessels, and intervention is required. For small tears and red area damage, healing may occur spontaneously over time. The methods used in the treatment of meniscus tears can be listed as follows.

• Knee rest and relaxation
• Applying ice to reduce severe pain and swelling, applying ice for 15-20 minutes every 3 to 4 hours can provide relief from pain.
• Prevent swelling and apply compression with an elastic bandage or knee brace
• Physiotherapy applications

Conservative treatments may not be sufficient for every case. If the tear is very large and causes symptoms such as locking and numbness in the knee, surgery may be required. Surgery to repair a meniscus tear is not very complicated and is generally safe.

Untreated meniscus tears can progress, worsen symptoms, and cause irreversible complications. The risk of developing arthritis in the knee increases due to an untreated meniscus tear. For early diagnosis and appropriate treatment of meniscus tear, it is important to consult a healthcare institution without delay in the presence of unexpected symptoms and to create a treatment and follow-up plan with an expert and experienced doctor.