The menisci, the medial (inner) and the lateral (outer), are two wedge-shaped fibrocartilaginous structures of the knee joint that have the paramount functions of supporting the load transmission between structures, providing shock absorption, and enhancing knee stability by improving the congruency of the joint itself. An interesting feature of the menisci is that the outer parts are more vascularized than the inner, characteristics that become relevant in the management of these injuries. The most common injury mechanisms consist of a twisting motion performed on a semi-flexed knee, often reported during high intensities multi-directional sports (e.g.: soccer, basketball, skiing, etc.). Due to the high-energy twisting mechanisms, patients that injure their knees in this way, tend to report associated ligament injuries, such as Anterior Cruciate ligament and Medial Collateral ligament. Even if less common, meniscal injuries can also occur in forced knee flexion actions, when the patient quickly bends the knees under loaded conditions through a wide range of motions (e.g.: squatting, landing from a fall, lifting heavy weights, etc.). Despite not being the main injury mechanism, low-energy impact injuries are also possible and often reported in older adults, where degenerative changes (e.g.: osteoarthritis) or repetitive stresses (“wear and tear”) might have already contributed to decreasing the meniscal structural tolerance. Meniscal injuries tend to be classified by their injury direction/pattern (horizontal, longitudinal, radial, bucket-handle, flap and complex tears) and each of them presents different specifics and implications for their management. Symptoms of a meniscal tear can significantly vary between subjects depending on the injury mechanisms, associated injuries and type/location of the tear. Common symptomatology includes swelling, pain, clicking, catching and potentially locking with associated inability to flex or extend the knee.
Management
The management of meniscal injuries strongly depends on the specifics of the injury itself, the patient’s condition and the practised sport. Minor tears, especially if located within the periphery of the meniscus (strongly vascularised area with higher potential for healing) tend to be treated conservatively while in more complex tears, surgical treatment is the most recommended strategy. Different procedures (such as meniscal repair, meniscectomy, meniscal transplant, etc.) could be implemented during surgery and are always discussed in detail with the patients and the medical-surgical team. The most updated evidence suggests trying to save as much meniscus as possible during the procedure due to its vital functions in preserving knee joint health. Regardless of the implemented management strategy, our strong advice is to seek medical attention from a specialised rehabilitation facility that can take care of your recovery from the beginning to the end. In Isokinetic, our rehabilitation team works in close contact to support your recovery process and maximise your outcomes. After being visited by one of our specialised doctors, you will be prescribed a rehabilitation plan tailored to you and your condition. Your recovery process will take place in different rehabilitation environments such as the pool, the gym, the movement analysis and retraining room and our field. In the pool and gym, you will minimise your symptoms, progressively restore knee mobility, and then increase your strength. Your recovery will then continue in our movement analysis room where you will optimise your movement quality to finally progress to our on-field rehabilitation service that will allow you to return to your sport and activities.