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One of the most commonly
injured parts of the knee, the meniscus is a wedge-like
rubbery cushion where the major bones of your leg connect.
Meniscal cartilage curves like the letter "C"
at the inside and outside of each knee. A strong stabilizing
tissue, the meniscus helps the knee joint carry weight,
glide and turn in many directions. It also keeps your
femur (thighbone) and tibia (shinbone) from grinding
against each other.
Football players and others
in contact sports may tear the meniscus by twisting
the knee, pivoting, cutting or decelerating. In athletes,
meniscal tears often happen in combination with other
injuries such as a torn ACL (anterior cruciate ligament).
Older people can injure the meniscus without any trauma
as the cartilage weakens and wears thin over time, setting
the stage for a degenerative tear.
Signs and symptoms
You might experience a
"popping" sensation when you tear the meniscus.
Most people can still walk on the injured knee and many
athletes keep playing. When symptoms of inflammation
set in, your knee feels painful and tight. For several
days you have :
- Stiffness and swelling.
- Tenderness in the joint line.
- Collection of fluid ("water on the knee").
- Without treatment, a fragment of the meniscus
may loosen and drift into the joint, causing it
to slip, pop or lockyour knee gets stuck,
often at a 45-degree angle, until you manually move
or otherwise manipulate it. If you think you have
a meniscal tear, see your doctor right away for
diagnosis and individualized treatment.
Diagnosis
Tell your doctor exactly
what happened and when. He or she may conduct physical
testing to evaluate the extent of your meniscal tear.
You may need X-Rays to rule out osteoarthritis or other
possible causes of your knee pain. Sometimes your doctor
may use a magnetic resonance imaging scan (MRI) to get
a better look at the soft tissues of your knee joint.
Your doctor may also use a miniature telescope (arthroscope)
to see into your knee joint, especially if your knee
locks.
Menisci tear in a
number of different ways :
- Young athletes often get longitudinal
or "bucket handle" tears if the femur
and tibia trap the meniscus when the knee turns.
- Less commonly, young athletes get
a combination of tears called radial or "parrot
beak" in which the meniscus splits in two directions
due to repetitive stress activities such as running.
- In older people, cartilage degeneration
that starts at the inner edge causes a horizontal
tear as it works its way back.
Conservative treatment
Initial treatment of a
meniscal tear follows the basic RICE formula :
rest, ice, compression
and elevation, combined with nonsteroidal anti-inflammatory
medications for pain. If your knee is stable and does
not lock, this conservative treatment may be all you
need. Blood vessels feed the outer edges of the meniscus,
giving that part the potential to heal on its own. Small
tears on the outer edges often heal themselves with
rest.
Surgical repair
If your meniscal tear does
not heal on its own and your knee becomes painful, stiff
or locked, you may need surgical repair. Depending upon
the type of tear, whether you also have an injured ACL,
your age and other factors, your doctor may use an arthroscope
to trim off damaged pieces of cartilage. In selected
cases your doctor can actually repair the torn meniscus
rather than taking it out.
A cast or brace immobilizes
your knee after surgery. You must complete a course
of rehabilitation exercises before gradually resuming
your activity.
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