The Menisci of the Knee. Treatment and Rehabilitation

Damaged menisci are a very common complaint, especially in young and middle aged males.

They often result from twisting movements when the weight is on the knee. This compression with the knee in a bent position combined with a rotary force will tear the menisci like pressing down and twisting with your hand on wet tissue paper. This is especially so if they are worn or unhealthy in any way.

The medial meniscus is more commonly injured than its lateral counterpart. This is partly to do with the fact that it is less mobile than the lateral meniscus and therefore cannot absorb stresses so well before tearing occurs.

The onset of symptoms will normally be sudden with the classic combination of signs and symptoms being any of the following:

*swelling (moderate rather than severe)

*pain - general discomfort with sharper pain if the knee is moved towards the fully bent or more often fully straight position.

*loss of movement - patterns of movement loss vary but it is common for their to be loss of full extension (straight)

*loss of muscle power - may be apparent if the injury is an old one.

There are however a great variety of presentations with a meniscal pathology. Instead of a tear presenting as above there may be the development of a meniscal cyst which is painful but does not give the same strong mechanical symptoms as a tear.

The menisci of the knee have an extremely poor blood supply. This is the reason they tend not to heal once damaged. The degree of damage can vary greatly. There can be anything from just a 'flake' knocked off the surface to a major 'bucket handle' tear of the whole structure. A'bucket handle' tear is a name given to a certain type of tear in a mensicus.

Treatment and Surgery

Knee surgery to repair and/or remove damaged menisci is very common and has been for the last thirty years or so. It used to be a case of removing all or most ot the injured structure during surgery. Nowadays however it is deemed better to trim the damaged part away to save as much of the original tissue as possible.

All such surgery is done using the 'keyhole' or arthroscopic method. Most operations are over in minutes and the patient is able to walk unaided a few hours later. Over the next few weeks a sensible rehabilitation programme will see an excellent result.

One of the main problems people suffer with following menisectomies, as they are called, is the presence of swelling described medically as a persistent low level effusion. The existence of this troublesome swelling results, very often, from impatient and hurried atempts to speed up progress.

Pain after this type of surgery is not a major problem and tends not to be a limiting factor until the onset of a throbbing and heavy ache caused usually by excessive standing or weight bearing. Once evidenced it is not easy to resolve as it involves a duration of non weight bearing on the knee. Patients are reluctant to follow such a regime, with the restrictions it involves, and the effusion tends to persist for many weeks, albeit at a low level.

In contrast the compliant patient who spends a good degree of time in the first ten to fourteen days avoiding excessive walking and weight bearing tends to have what is known as a 'dry knee', allowing strong and progressive rehabilitation to recovery over the next few weeks.

Read more about menisci and their rehabilitation