Meniscal Tear

The meniscus is a cartilage cushion between the shinbone (tibia) and thigh bone (femur). It protects and stabilizes the knee joint. Unfortunately, the meniscus can tear with forceful twisting or rotation of the knee and is a very common sports injury.

What is a meniscal (cartilage) tear?

The meniscus is a piece of cartilage in the middle of your knee. Cartilage is tough, smooth, rubbery tissue that lines and cushions the surface of the joints. You have a meniscus on the inner side of your knee (the medial meniscus) and a meniscus on the outer side of the knee (the lateral meniscus). Each meniscus attaches to the top of the shinbone (tibia), makes contact with the
thighbone (femur), and acts as a shock absorber during weight-bearing activities. If a meniscus tears, it can cause knee pain and can limit motion.

How does it occur?

A meniscal tear can occur when the knee is forcefully twisted or sometimes with minimal or no trauma, such as when you are squatting.

Symptoms

Symptoms may include the following:

• You have pain in your knee joint.
• You have immediate swelling with fluid in the joint, called an effusion.
• You can’t fully bend or straighten your leg.
• Your knee locks or gets stuck in one place.
• You hear a snap or pop at the time of the injury.

A chronic (old) meniscal tear may give you pain on and off during activities, with or without swelling. Your knee may sometimes lock, and you may have stiffness in the knee.

Diagnosis

Your health care provider will review your symptoms and how the injury occurred. He or she will ask about your medical history and examine your knee. Your provider will move your knee in several
ways that may cause pain along the injured meniscal surface. You may have x-rays to see if the bones in your knee are injured, but a meniscal tear will not show on an x-ray. An MRI scan (magnetic resonance imaging) can help diagnose a meniscal tear.

Treatment

Initial treatment for a meniscus tear includes the following easy to remember acronym, LUSKIN:

Standing Calf Stretch
Facing a wall, put your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 18 inches behind your uninjured leg. Keep your injured leg straight and your heel on the floor and keep your toes pointed towards the wall. Next, do a slight lunge by bending the knee of the forward leg. Lean into the wall until you feel a stretch in your calf muscle. Hold this position for 30 to 60 seconds and repeat three times.

Hamstring Stretch
Lie on your back and bring the affected leg towards your chest. Grab the back of your thigh and try to extend your leg. Hold this position for 30 to 60 seconds, feeling a stretch in the back of your thigh. Repeat three times. You may also try this with a towel around your foot if it is more comfortable.

Quadriceps Stretch
Stand sideways to a wall, about an arm’s length away from the wall, with your injured leg towards the outside. Facing straight ahead, keep the hand nearest the wall against the wall for support. With your other hand, grasp the ankle of your injured leg and pull your heel up toward your buttocks. Do not arch or twist your back. Hold this position for 30 seconds. Repeat three times. This may also be done while lying on the opposite side and grasping the ankle of the affected leg. Do not arch or twist your back. Hold this position for 30 seconds and repeat three times.

Quadriceps Sets
Sit on the floor with your injured leg straight in front of you. Press the back of your knee down while tightening the muscles on the top of your thigh. Hold this position for five seconds. Complete three sets of 10.

Straight Leg Raise
Sit on the floor with the injured leg straight and the other leg bent, foot flat on the floor. Pull the toes of your injured leg toward you as far as you can, while pressing the back of your knee down and tightening the muscles on the top of your thigh. Raise your leg six to eight inches off the floor and hold for five seconds. Slowly lower it back to the floor. Complete three sets of 10.

Abduction
Lie on your uninjured side, leaning on the elbow of your uninjured side and using the arm of the injured side in front of you to stabilize your body. Slowly lift the injured leg up, hold for five seconds, then lower slowly. Be sure to keep your hips steady and don’t roll forwards or backwards. Complete three sets of 10.

Adduction
Lie on your injured side with your top leg bent and flat foot placed in front of the injured leg, which is kept straight. Raise your injured leg as far as you can comfortably and hold it there for five seconds. Keep your hips still while lifting your leg. Hold this position for five seconds, then slowly lower your leg. Complete three sets of 10.

Extension
Lie on your stomach. Raise your injured leg as far as you can comfortably and hold it there for five seconds. Keep your hips still while lifting your leg. Hold this position for five seconds, then slowly lower your leg. Complete three sets of 10.

Clamshells
Lie on your side with your knees slightly bent, keeping your legs and ankles together. Open and close your knees like a clam by lifting your top knee up until it is parallel with your hip. Keep your feet together throughout the exercise, move slowly and controlled as if someone is pushing against your knee while you are pressing it up. Complete three sets of 10.

How long will the effects last?

If you have a small tear that has not been repaired or removed, you may still be able to function well and be active. However, your knee may sometimes swell, lock, be stiff, or hurt during activities
If you have surgery, you will need to spend time rehabilitating your knee. Everyone recovers at a different rate, depending on the severity of the injury and their general health. Many people return to their previous level of activity within a month or so after surgery.

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If
you return too soon, you may worsen your injury, which could lead to longer healing times.
Everyone recovers at a different rate. Returning to your sport or activity will be determined by how
soon your knee recovers, not by how many days or weeks it has been since pain began. In
general, the longer you have symptoms before you start treatment, the longer it will take to get
better.
You may safely return to your sport or activity when, starting from the top of the list and
progressing to the end, each of the following is true:

• You have full range of motion in the injured knee, compared to the uninjured knee
• You have full strength of the injured knee and hip compared to the uninjured knee and hip
  and are able to complete the above exercises without pain
• You can jog straight ahead without pain or limping
• You can sprint straight ahead without pain or limping
• You can jump on both legs without pain, and you can jump on the injured leg without pain
  Return to your sport at about 50% effort, and increase by about 10% each week. If you begin with
  pain, you may need to rest for a few days before returning to activities.

Prevention

Unfortunately, most injuries to knee cartilage occur during accidents that are not preventable. However, you may be able to avoid these injuries by:

• having strong thigh and hamstring muscles
• gently stretching your legs before and after exercise
• wearing shoes that fit properly when you exercise and that are right for the activity

When skiing, be sure that your ski bindings are set correctly by a trained professional so that
your skis will release when you fall.