Meniscal injuries

The menisci have a central role in the movement of the knee joint, and not only because of their position as C-shaped discs on top of the shin bone.

Anchored at the front and back horns and connected to the joint capsule, they can absorb the compressive forces acting on the knee and spread them evenly across the joint as tensile forces.

Beyond that they even out the different curvatures of the joint surfaces of the femoral condyles and the top of the shin bone – and so make a decisive contribution to the stability of the knee joint.

What happens when a meniscus tears?

Definition

Because of the high mechanical load, injuries of the medial and lateral meniscus are comparatively common. They can occur spontaneously – usually as degenerative tears – or in the course of other injuries, for instance a cruciate ligament rupture, above all during sport. The type of tear can vary (longitudinal, bucket-handle or radial, for example) and influences the treatment.

Causes

Meniscal tears affect competitive athletes and less active people alike. A degenerative tear often arises without an acute injury. Instead, repeated loading gradually weakens the tissue, which finally ends in a complete tear. During sport, rotational movements with the knee slightly bent and the foot fixed are typical triggers – for instance when a football move is stopped with the studs caught in the turf. Meniscal tears therefore occur particularly often in ball sports or in alpine skiing. In combination with other injuries, excessive peaks of pressure can arise that tear the meniscal tissue. We particularly frequently see tears in the posterior horn of the lateral meniscus with cruciate ligament injuries.

Symptoms

At the moment of injury patients frequently report a sudden, stabbing pain or a feeling of something catching. Depending on the type of tear, sporting activity may still be possible at first, before swelling or fluid in the joint appears over the following hours. Pain at rest is also common. Degenerative tears, by contrast, often occur when getting up from a squat – after gardening, for example – and cause pain like a knife.

Diagnostics

The symptoms described are often typical, so that specific clinical tests already give us a good first impression of the state of the meniscus. Magnetic resonance imaging (MRI) supplements the assessment, particularly where there is a concrete suspicion. It allows further injuries to be identified or ruled out and the type of meniscal tear to be assessed precisely.

Symptoms

At the moment of injury patients frequently report a sudden, stabbing pain or a feeling of something catching.

Stabbing pain

Meniscal tears frequently show themselves as stabbing pain when the knee joint moves

Locking

Folded-over parts of the meniscus can restrict movement

Effusion

Irritation of the joint lining by the tear leads to more fluid forming

The knee joint in detail

The medial and lateral meniscus are highlighted in the model

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Treatment options for meniscal tears

Meniscal tears occur in different forms – a factor that is decisive for the choice of treatment. Both non-surgical and surgical approaches aim to restore pain-free movement and load-bearing in the knee joint. As the loss of meniscal tissue increases the risk of later osteoarthritis, we try to preserve as much tissue as possible during an operation – whether by sparing smoothing, by resection or by a meniscal repair. The choice of the right procedure depends on the individual form of the tear.