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Meniscus tear: definition, treatment, symptoms

by Josephine Andrews
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meniscus tear (meniscus damage) is an injury to the menisci. These are two articular cartilages that act as “shock absorbers” in the knee joint. Damage to the meniscus results in tears in the ring-shaped cartilage caused by improper strain during sport or age-related wear and tear. Depending on the extent of the damage caused by the meniscus tear, there are various treatment options. However, not all meniscus damage requires treatment. Read everything you need to know about meniscus tears here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

S83 M23

quick overview

  • Treatment: First aid measures (cooling, elevating), painkillers, rest, physiotherapy , possibly surgery
  • Symptoms: pain when the knee joint moves and when pressure is applied, accumulation of fluid in the joint, in severe cases it is not possible to straighten the leg
  • Causes and risk factors: falls, usually when the knee is rotated, the effects of violence, wear and tear, overload
  • Diagnosis: Various movement tests, validation is by means of magnetic resonance imaging or joint reflection
  • Course and prognosis: The course depends heavily on the type and location of the meniscus tear, but it is fundamentally important to protect the leg and seek medical help.
  • Prevention: Age-related wear and tear can only be prevented to a limited extent. Those affected should avoid activities and sports that put a strain on the joints.

What is a meniscus tear?

The menisci (gr. mēnískos = moon-shaped body) are two ring-shaped cartilages that lie on the side of the knee between the bones of the upper and lower leg. They act as shock absorbers, which means they increase the contact surface and reduce friction between the bones. The menisci thus enable gliding, painless movement in the knee joint – at least as long as there are no tears in the tissue. Then doctors speak of the so-called meniscus tear.

In the knee joint, a distinction is made between the inner and the outer meniscus. The medial meniscus (medial meniscus) is crescent-shaped and relatively immobile because it is firmly attached to the medial ligament (lig. collaterale mediale). It is therefore not well able to evade the forces acting on it and therefore tears more easily.

In contrast, the outer meniscus (lateral meniscus) is more or less round in shape and less attached to the surrounding tissue. It therefore has a greater range of motion when exposed to force, and a meniscus tear is less likely to occur with it.

Typically, a meniscus injury occurs primarily in fall injuries where the knee twists. Such traumatic meniscus damage often occurs during sports such as skiing or soccer. A meniscus tear also occurs with age-related wear or chronic overloading of the knee joint, for example in some professional groups with predominantly squatting work, such as tilers.

A meniscus tear sometimes runs through the tissue in all directions and affects all parts of the meniscus. In addition to the shape of the tear, the location of the tear in the meniscus is decisive for the choice of therapy. A suture is often possible in the well-perfused outer zone, while the doctor often has to remove the injured portion of the meniscus in the inner zone with poor blood circulation.

Acute complaints or pain in the knee do not occur with every meniscus damage. Depending on the size and extent of the tear, various symptoms appear, which handicap those affected to varying degrees. The treatment of the meniscus tear depends on this: In cases with no or minor limitations, a meniscus tear can be treated conservatively (without surgery). In severe cases, surgical therapy or an artificial meniscus may be necessary.

Different types of meniscus tears

The meniscus tears in different ways. That is why doctors differentiate between different forms of meniscus damage:

  • Longitudinal tear: The tear is parallel to the fibers of the meniscal cartilage.
  • Bucket handle tear: Special form of longitudinal tear in which the meniscus is literally split. This meniscus tear extends from the front portion (anterior horn) to the back portion of the meniscus (posterior horn) and is often very painful.
  • Radial tear (transverse tear): The tear is transverse to the fibers of the meniscus cartilage.
  • Flap tear (tongue tear): The tear begins in the inner zone of the meniscus and extends from there to the outer zone. Often due to previous degenerative damage.
  • Horizontal meniscus tear: The tear is to a certain extent in the middle of the meniscus and splits it like a fish’s mouth into an upper and lower “lip”.
  • Complex tear: Combination of different meniscus tear shapes with more than one main tear direction.

How is a meniscus tear treated/operated on?

The therapy for a meniscus tear depends on the size of the tear and the existing pain. Basically, it is best to self-treat (“first aid”) immediately after an accident and there is a suspicion of a torn meniscus. In this way it is possible to keep the extent of the damage and the pain small. If the symptoms persist, it is advisable to have them clarified and treated by a doctor. If left untreated, a meniscus tear can result in consequential damage.

Not only the shape of the tear is decisive for the therapy, but above all whether this tear is localized in the inner or outer zone of the meniscus. While the outer zone towards the skin is well supplied with blood, the inner zone towards the middle of the knee is hardly supplied with blood. In the case of a meniscus damage in the outer zone, it is therefore often possible to sew it up. Due to the good blood circulation, there is a high probability that the tear will heal again.

In the case of a meniscus injury in the inner zone, on the other hand, the chance of healing the damage is reduced. In this case, it may be necessary to surgically remove the injured portion of the meniscus.

First Aid: What to do if you tear a meniscus

If a meniscus tear occurs during sport or on an excursion, the affected person should cool the knee immediately, for example with ice packs or compresses with cold water. The ice should not lie directly on the skin, but be wrapped in a soft cloth. It is advisable to elevate the leg and move it as little as possible. These measures reduce the swelling of the knee.

If the pain persists, those affected should definitely consult a doctor after the first treatment. In addition to a meniscus tear, injuries to the cruciate ligaments, collateral ligaments, kneecap or other structures may also be responsible for the pain.

Conservative treatment of a meniscus tear

Surgery is not necessary for every meniscus damage. Small tears in the outer zone of the meniscus, which is well supplied with blood, can often be treated without surgery. A so-called conservative (non-surgical) therapy is also an option if there is already evidence of regression (degeneration) of the bone in the knee or significant joint wear and tear (arthrosis). Conservative therapy consists of:

  • pain medication
  • Injecting anti-inflammatory substances (such as cortisone) into the joint space
  • cooling
  • gentleness
  • Physiotherapeutic exercises with muscle building

Whether the therapy is successful depends on the extent of the damage, any previous damage to the knee and the individual stress requirements in everyday life. In uncertain cases, the doctor may first try conservative therapy and, if unsuccessful, switch to surgical treatment.

How is a meniscus tear operated on?

Opinions in the professional world differ widely on the benefits of meniscus surgery. It is clear that the treatment method for a meniscus tear depends on various influencing factors and that there is no general recommendation for meniscus damage treatment.

In particular, if parts of the meniscus have come loose at the tear and are in the joint space, there is usually no way around meniscus surgery. The aim of such an operation is to preserve as much meniscal tissue as possible and to restore mobility as much as possible.

Open surgery and arthroscopy for a meniscus tear

There are two types of meniscus surgery available: arthroscopic and open meniscus surgery. While doctors used to operate mostly openly, today arthroscopic meniscus surgery is the method of choice. The procedures are performed under local anesthesia or sometimes general anesthesia.

Arthroscopy (joint reflection) is a so-called minimally invasive method. This means that the doctor does not make a single large incision during the meniscus surgery, but instead makes two to three smaller incisions. Through the first incision, he guides a rod-shaped camera into the knee, which transmits images from inside the knee joint live to a monitor. Through the other incisions, the surgeon inserts the surgical instruments used to remove torn parts or to create a meniscus suture.

The advantage of an arthroscopy is that the small injuries to the skin heal faster and no large scars remain after the meniscus operation. The open method can be used, for example, if not only a meniscus tear is to be treated, but there is also damage to the ligaments in the knee joint or the joint capsule.

Surgical techniques for meniscus tears

Regardless of whether the operation is arthroscopic or open, the following surgical techniques are available for meniscus surgery:

  • Meniscal repair (meniscal suture): The surgeon sews the torn tissue back to the healthy parts of the meniscus and knee joint capsule. This operation is only possible if the tear does not extend through the entire meniscus and the torn part is still attached to the capsule. Only in this case is the blood supply to the sewn-on part of the meniscus guaranteed. In the initial period after the operation, those affected are usually given a splint and are only allowed to put partial weight on the leg, as the tear has to heal first. A normal everyday load is possible after about six weeks, light sporting activities such as cycling or swimming, which do not put any strain on the knee joint, after about six months. After six to twelve weeks, light professional activities are possible again.
  • Partial meniscus removal (partial meniscus resection): In this procedure, the surgeon removes the piece that has been torn off (partial meniscus resection) or the entire meniscus (meniscus resection). A meniscus resection is possible on an outpatient basis, since those affected can walk carefully again on the same day with the help of forearm crutches. Targeted physiotherapy exercises begin in the first few weeks after the operation. With mostly sedentary activities, it is possible to return to work after about two weeks.
  • Meniscus replacement (installation of an artificial meniscus): In meniscus replacement, the doctor completely removes the damaged meniscus and inserts an artificial replacement model in its place. Since there are not yet enough study data available to finally assess the quality of this procedure, meniscus replacement is not yet one of the standard procedures in meniscus tear therapy.

What are the symptoms of a meniscus tear?

Depending on the cause of the injury, the symptoms of meniscus damage vary in intensity. In the case of an acute meniscus tear, pain in the knee usually occurs very suddenly. With degenerative changes in the knee, they develop over time and get progressively worse.

Depending on which meniscus is injured, the pain can be more localized to the side (lateral) of the knee or inward (medial).

Meniscus tear symptoms when the outer (lateral) meniscus is damaged:

  • Pain when rotating the knee inwards (internal rotation)
  • Pressure pain at the lateral knee joint gap (this can be felt with the fingers)
  • Pain when squatting down
  • Possibly pain when straightening the leg
  • Stabbing pain that cannot be precisely located (diffuse pain)

Meniscus tear symptoms when the inner (medial) meniscus is damaged:

  • Pain when rotating the knee outward (external rotation)
  • Pressure pain at the medial knee joint gap (this can be felt with the fingers)
  • Pain when getting up from a squatting position
  • knee flexion pain

Effusion from meniscus tear

The injury to the menisci and the torn, loose pieces of fiber in the joint can lead to inflammation, which in turn can lead to a build-up of fluid in the knee joint space. Doctors speak of a knee joint effusion. In some cases, the accumulating liquid can even be felt from the outside. The knee may be swollen. Because the effusion presses on the surrounding tissue, it sometimes causes pain.

Serious meniscus tear symptoms

It is particularly complicated when fiber parts of the menisci are torn off and move freely in the joint. If such pieces of fiber completely block the joint, they make it impossible to straighten the leg (locked stretch). The classic symptoms of such a severe meniscus tear are a snapping or clicking in the knee joint, which can be heard and felt when moving. If such a meniscus tear is left untreated, the joint may wear out permanently and irreparably. Osteoarthritis of the knee occurs.

Meniscus tear symptoms with a chronic course

In the case of degenerative changes in the knee, the symptoms of a meniscus tear do not necessarily appear acutely, but rather develop over a long period of time. Those affected often notice increasing instability in the knee joint and move more cautiously. Since the meniscus can no longer fully fulfill its functions (shock absorber, distribution of the applied pressure and joint stabilization), a chronic state of irritation develops. This hurts or sometimes leads to a knee joint effusion.

Sometimes the pain is stronger and sometimes weaker. There is a risk that those affected will not perceive these as meniscus tear symptoms and, as a result, will not rest or consult a doctor. The longer a meniscus tear goes untreated, the more the damage spreads.

In the case of changes caused by wear and tear, the pain occurs primarily under stress, and in some cases it persists shortly afterwards. If the knee swells after light physical activity or standing for a long time, this is a sign that the knee joint is already overtaxed by this relatively moderate load. As the condition progresses, those affected find it increasingly difficult to fully straighten their leg or bend it sharply.

Those affected who notice such symptoms repeatedly should consult a doctor. With timely treatment, it is often possible to preserve the meniscus. This is often not the case with advanced meniscus damage, so that meniscus removal is necessary.

Causes and risk factors

A meniscus tear has various causes. About half of all cases of a meniscus injury are due to a regression (degeneration) of the cartilage tissue. The other half is caused by acute injuries, often when the meniscus is already damaged.

degeneration

Meniscus degeneration is understood by physicians as an increasing structural weakness of the fibrous cartilage that makes up the meniscus. Due to wear and tear, the cartilage tissue is less resistant to the effects of force and is therefore more susceptible to a meniscus tear. Such cartilage wear is quite normal after a certain age.

However, certain occupations that put greater strain on the knees have a higher risk of a meniscus tear. These include, for example, athletes, construction workers, gardeners or tilers.

injury

The menisci are able to absorb strong vertical loads (e.g. when jumping from a low height). However, if the force acts on the fibrocartilage tissue at an angle from the side, it overstretches and may tear.

Typical triggers for a meniscus tear are falls with a twisting movement in the knee, for example when skiing or playing football. In such accidents, the meniscus is held in place by body weight while the foot twists at the same time. Especially with a previously damaged meniscus, there is a risk of a meniscus tear. Meniscus damage also occasionally occurs in everyday life, for example when squatting down.

In addition, direct trauma to the entire knee leads to a meniscus tear in some cases. Doctors then speak of a primary traumatic meniscus tear. For example, in the event of a fall from a great height, it is possible for knees, adjacent bones and menisci to be damaged together.

In very rare cases, a meniscus tear occurs due to genetic changes in shape. An example of this is the so-called disc meniscus, in which one or both menisci do not have the usual ring-shaped structure, but are a flat disc. This is under increased stress with every movement and thus wears out faster.

investigations and diagnosis

The right people to contact if you suspect a meniscus tear are your general practitioner or an orthopedic specialist . Not every meniscus tear necessarily causes symptoms that severely affect those affected. In many cases, smaller cracks go unnoticed and grow back on their own.

The visit to the doctor usually begins with the patient describing their current symptoms and any previous illnesses (anamnesis). The doctor asks, for example,

  • whether there is pain and where exactly and with which movements it occurs,
  • how long the complaints have existed
  • whether there was an event, for example during sports, in which the knee was subjected to exceptionally high loads,
  • whether the knee is exposed to heavy loads for professional reasons and
  • whether an operation on the knee has already been performed.

Physical examination

After the anamnesis, the physical examination follows If a meniscus tear is suspected, there are several tests available (meniscus tests) to determine which meniscus is injured.

In the Steinmann, Apley-Grinding, Böhler, McMurray and Payr tests, the doctor moves the lower leg and thigh. In doing so, he loads the inner or outer meniscus. The position that hurts allows conclusions to be drawn about the location of the damage. The inner meniscus is affected much more frequently by damage than the outer one. If meniscus pain occurs, the doctor secures the suspected diagnosis “meniscus tear” by carrying out further examinations.

During the physical examination, the doctor also checks whether a joint effusion has formed, whether palpation of the knee joint gap is painful and whether there are problems in straightening the leg (extension restriction). This is typical of the so-called “basket handle tear”, in which the torn end of the meniscus gets caught in the knee joint.

Further examinations: MRI and arthroscopy

Meniscus tear: MRI

Magnetic resonance imaging (MRI) is the most important examination when a meniscus tear is suspected. It shows the soft tissue of the knee (ligaments, menisci, muscles, etc.) in a high-resolution sectional image. A healthy meniscus shows up in the MRI as a consistently black structure. Lighter spots can be seen in the cartilage wear and a clear light stripe in the case of a tear.

With an MRI, it is possible to better assess the extent of the damage and the location of the exact meniscus injury. This is important because the therapy depends on the location and course of the tear. According to the MRI findings, doctors differentiate between three degrees of severity in meniscus tears:

  • Grade 1 (punctiform MRI signal inside the meniscus without contact to the surface): degenerative damage inside the meniscus
  • Grade 2 (line-shaped MRI signal in the interior of the meniscus without contact with the surface): degenerative damage or tear in the interior of the meniscus
  • Grade 3 (signal with contact with the surface of the meniscus): complete rupture of the meniscus

Meniscus tear: arthroscopy

During arthroscopy (joint endoscopy), the doctor inserts a tiny camera into the knee joint to take a closer look at the structures of the knee. To do this, he makes a small incision under local anesthesia, through which he pushes a rod-shaped instrument into the knee. A light source and a camera are attached to this rod, which transmit the images from the knee joint live to a monitor. Another incision allows a small hook to be inserted, which the doctor uses to test the condition and functionality of the menisci and ligaments in the knee.

The advantage of arthroscopy over MRI is that damage to the meniscus can be treated immediately in the same procedure during arthroscopy. In addition, it is possible, especially in the case of a basket handle tear, to immediately remove detached meniscus parts from the joint space.

Additional investigations:

X-ray examination

An X-ray examination primarily reveals changes in the bones. It makes sense for people who are suspected of having joint wear and tear (arthrosis) in the knee or damage to the bones. The X-ray examination is usually used after a fall or an injury with subsequent pain.

ultrasound examination

During an ultrasound examination (sonography), the doctor determines whether the ligaments that keep the knee stable around the menisci are also damaged. A knee joint effusion can also be seen on ultrasound . The ultrasound examination is not a standard examination and is only done if the symptoms make further damage outside the menisci likely.

Course of the disease and prognosis

In any case, it makes sense to have a meniscus tear professionally treated. Those affected who notice signs of knee problems should at least have the cause and possible further development clarified by a specialist. An untreated meniscus tear may grow larger over time and may also damage other structures in the knee (ligaments, articular cartilage).

A general prognosis is not possible due to the diversity of the disease. Minor damage usually heals on its own with conservative therapy and rest. However, especially in athletes and certain professional groups, the strain on the knees is so great that meniscus damage is possible again at any time after a meniscus tear has healed.

After a meniscus tear, those affected should initially only put weight on their knee gently. With certain physiotherapeutic exercises, the muscles around the knee can be strengthened and the menisci slowly get used to the strain again.

How long does a meniscus tear take to heal?

It is not possible to make a general prognosis as to how long a meniscus tear will last. How long those affected with a meniscus tear are ill depends on the size of the tear and the extent of the damage. After a meniscus tear operation, it takes about six weeks before those affected are allowed to put weight on their knees again.

However, depending on the surgical technique, doing sports is only advisable after a rest period of two to three months at the earliest. If a conservative treatment of the meniscus tear is possible without surgery, it will take a few weeks to months to heal. The downtime during which those affected with a torn meniscus should not go to work is just as varied. Depending on the severity of the injury and the type of therapy, it ranges from around two weeks to three to four months for more stressful activities.

Prevent

Damage to the meniscus can only be prevented to a limited extent, as it is often due to normal, age-related wear and tear. For people who have already had a meniscus tear, it is advisable to avoid activities that put strain on their knees at work and in their free time. The same applies to static loads where the position of the knee does not change over a longer period of time. It is also advisable to have risk factors such as leg misalignments treated orthopedically and to strive for a normal body weight.

Affected people who want to play sports again should always seek personal advice from a doctor. In severe cases, it is advisable to generally avoid strenuous sports such as soccer or skiing in order to avoid a meniscus tear or further meniscus damage.

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