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Meniscal tear

Among the many problems that hinder the knee’s functionality and mobility, the meniscus injury is undoubtedly one of the most common. It can have a dual origin: traumatic or degenerative. Traumatic injuries are caused by buckling or twisting of significant intensity to the knee (for example, sports injuries or accidents), while degenerative injuries are related to joint wear, with causes related to repetitive posture required by strenuous physical work, or congenital malformations.

Age group

Meniscal tears can happen to anyone who performs strenuous jobs or to athletes.

Anatomy of the meniscus

Inside each knee are two circular fibrocartilage rings called the menisci; they are interposed between the femur (thigh bone) and the tibia (shinbone). The medial is C-shaped and the lateral is O-shaped. They are hard and rubbery and act as shock absorbers for the knee joint. They guarantee stability by absorbing shocks, distributing loads on the articular cartilage, giving correct motor movements, and at the same time, maintaining the unity of the articular surface. The meniscus can be injured or broken during physical activity due to trauma or hard twisting or more frequently, with advanced age due to tissue degeneration.

Symptoms

The most obvious symptom in a meniscal tear is when pain is felt in the medial or lateral area of the knee, often associated with swelling of the joint. If the lesion has occurred following a trauma, the swelling is almost immediate, with a sensation of an internal rupture accompanied by a dull popping sound (or the classic ‘crack’ sound) and great sensitivity to touch. On the contrary, a degenerative tear causes pain to increase over time. If there is a meniscus tear, it is common to have impaired mobility such as difficulty in flexion-extension and/or pain when squatting, loss of strength in the quadriceps and a decreased knee stability.

When should you call a doctor?

You should call a doctor when one or more of these symptoms persist for several days: if the knee becomes “stuck” or if you are unable to bend it after being stretched, an appointment should be made immediately.

Diagnostic tools

During evaluation, tests such as the Appley test, the McMurray test and the palpation of the joint line are made to verify the integrity of the menisci. In addition, there may be a need for an X-ray of the knee in anteroposterior view under load and lateral view for the study of the bone. It is also recommended to perform an MRI to study the cartilage, ligament, and meniscal parts.

What to do in the meantime

Rest, ice, compression, and anti-inflammatory medication are recommended, combined with the use of crutches to protect the knee from loads. If you are immobilized, anticoagulant therapy is suggested to prevent complications such as deep vein thrombosis (DVT).

How to prevent meniscal lesions

For optimal prevention of meniscus injury, it is necessary to perform exercises to strengthen the legs’ quadriceps muscles regularly. This helps to stabilize the knee joint while protecting it from harm. During sporting activity, it is advisable to wear protection including knee braces and perform the exercises correctly. It is essential to warm up and stretch before training. It is also necessary to wear gym shoes suitable for your activity and well-fitted.

Conservative therapies

Conservative therapies are recommended for degenerative lesions of the meniscus that do not cause mechanical symptoms, such as joint block, as well as for people older than 55 years old. If there are no meniscus tears, anti-inflammatories, painkillers, cryotherapy or topical drugs can be used to treat discomfort. This is combined with physiotherapy sessions to improve the knee’s joint mobility and strengthen the quadriceps. Physiotherapy, drug therapy, and infiltrative therapies, with cortisone or hyaluronic acid, are useful for relieving pain.

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