Lateral Meniscus Tear
What is a Lateral Meniscus Tear?
A meniscus tear is a laceration of the meniscus of the knee most commonly caused by abrupt twisting or turning of the knee joint, often with the foot planted and the knee bent. Meniscus tear can also occur when lifting something heavy or from extreme bending of the knee. When this happens to the lateral meniscus, it is known as a lateral meniscus tear. Injuries to the lateral meniscus are less common than medial meniscus injuries because it doesn’t attach to the lateral collateral ligament like the medial meniscus attaches to the medial collateral ligament.
A meniscus tear is a common knee injury. Meniscus tears can occur in all age groups. Most traumatic tears occur in active people from age 10-45 involved in sports. Degenerative tears are most common in people from age 40 upward, which are thought to occur as part of the aging process when the collagen fibers within the meniscus start to break down.
The knee is made up of three bones: your thighbone (femur), leg bone (tibia), and kneecap (patella). The two wedge-shaped pieces of cartilage that act as shock absorbers between your femur and tibia are called menisci. They are tough and rubbery to help cushion the joint and in combination with the ligaments, they keep the knee stable.
The menisci are thick rubber-like pads of cartilage. They are C-shaped discs that cushions your knee. Each knee joint contains an inner and outer meniscus (medial and lateral meniscus) that sits on top of the tibia bone. Each meniscus acts as a shock absorber cushioning the impact of the femur on the tibia during weight-bearing activity and also to help distribute load in the knee. Normally the surface of the meniscus is very smooth allowing easy movement of the femur on the tibia when you bend or straighten your knee. Occasionally due to excessive weight bearing or twisting forces, the meniscus can be torn or damaged so that the surface is no longer smooth.
The meniscus has blood supply only at its outer attachments. Tears at the outer edge of the meniscus (red zone) tend to heal well because there is good blood supply. Minor tears may heal on their own with a brace and a period of rest. About 4/5 of a meniscus has no blood supply and therefore cannot heal a tear. These types of tears have to be repaired operatively.
The meniscus tears in different ways. Meniscal injuries can be classified on their appearance, location, shape, extent and origin. Common tears include:
- Longitudinal: tear along the longitudinal axis and parallel to the outer margin of the meniscus
- Radial tear: tear transverse to the circumferential fibers of the meniscus. If they reach the periphery it transects the entire meniscus. They are more common in the lateral meniscus and are often associated with ACL tears. Radial tears, which occur in the avascular inner one-third of the meniscus, have little potential for healing.
- Bucket Handle tear: complete longitudinal tear where a portion of the meniscus becomes detached from the tibia and the end result is a dislocated central part of the meniscus looking like a bucket handle. They are 3 times more common in the medial meniscus than the lateral meniscus.
- Transverse tear: tear in the horizontal axis of the meniscus.
- Cleavage tear: complete transverse tear that separates the meniscus into superior and inferior fragments. They are common in older people and have little or no healing capacity.
- Parrot’s beak tear
A combined, incomplete radial and longitudinal tear (oblique tears); with a displaceable component that resembles a parrot’s beak. Usually occur at the junction of the posterior and middle thirds of the meniscus.
- Root tear
Tear in the anterior or posterior meniscal roots where the meniscus attaches to the tibial plateau.
- Degenerative tear
They are complex tears; they occur in multiple planes and are combinations of the above tears. Can occur as a result of degenerative arthritis, therefore common in older people.
How Do Meniscus Tears Happen
Sudden or traumatic meniscus tears often happen during sports. Players may squat and twist the knee, causing a tear. Direct contact, like a tackle, is sometimes involved. Traumatic meniscus tears are more frequent in the medial meniscus, with o without associated anterior cruciate ligament injury.
Older people are more likely to have degenerative meniscal tears. Cartilage weakens and wears thin over time. Aged, worn tissue is more prone to tears. Just an awkward twist when getting up from a chair may be enough to cause a tear.
Signs and Symptoms of Meniscal Tear
- Well localized pain in the knee, especially during twisting or squatting
- Stiffness and swelling
- Catching or locking of your knee
- The sensation of your knee “giving way”
- Possible loss of range of motion
- In some cases, difficulty walking, sitting-to-standing, running and with prolonged bending of the knee
A meniscus tear that catches, locks the knee, or produces swelling on a frequent or chronic basis should be repaired operatively before it damages the articular cartilage in the knee.
Our Physiotherapy Approach for Meniscus Tear
Step 1 – Thorough History & Assessment
The key to an effective treatment plan is to have the correct diagnosis. We start every management plan with a thorough history of your condition followed by a physical exam to ensure the correct diagnosis is made. We also rule out any medical condition for which further evaluation may be required. Then we determine if a referral to your doctor, orthopedic specialist or the need to get further testing is needed, such as an x-ray prior to treatment. Next, we discuss our findings and treatment options and together decide on a treatment plan. Once this is agreed upon, treatment typically starts on the first visit.
Step 2 – Pain Management and Decrease Swelling
Managing pain and swelling is usually the primary goal for patients with a meniscal tear. To help with this, we will choose the most appropriate from a variety of modalities. These modalities may include electrotherapy (interferential current, TENS), cold therapy, and manual techniques to help improve your pain.
Step 3 – Restoring Range of Motion and Strength
Increasing range of motion and strength is an important part of the rehabilitation process and crucial in reducing the risk of future injuries. Manual therapy techniques (passive range of motion, joint mobilization, muscle energy technique, and facilitation techniques) in addition to an exercise routine (including stretching and range of motion exercises) will help you to restore ankle flexibility and range of motion. Also, an individualized strengthening exercise program, targeting specific muscles will help to increase your strength, balance and overall function. Depending on your activity level, more advance exercises will be prescribed to gradually return to sports such as hockey, tennis, basketball, football, etc.
Step 4 – Restoring Function And Providing Walking Aids
Some patients with a meniscal tear will experience difficulty with certain activities, such as walking, sitting-to-standing, climbing stairs and running. Restoring function is the ultimate goal of the physiotherapy treatment. As part of your rehabilitation process, a functional exercise program is designed to help you improve your function and facilitate your daily activities.
In some cases, knee braces are recommended to improve pain and increase function. Our Physiotherapist will assess you particular case and make the appropriate recommendations.
Step 5 – Education and Self-Management
We believe that good communication and education is crucial in achieving positive outcomes. We educate our patients on their conditions, what to expect, and give you the proper tools to help with your recovery from home.
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“My first meeting with Dr. Nick helped to put the pain in context. Finally, an explanation and some real answers.”
– Jeff Smith, Sackville, NS