Knee pain is one of the most common orthopedic complaints in the U.S. Some studies indicate 19% of the population has knee pain. While there are many causes of knee pain, this week’s blog will focus on the meniscus. You will learn what torn meniscus symptoms feel like, how to treat a torn meniscus, and the recovery time for meniscus tears treated with physical therapy and with surgery.
So what is a meniscus? There are two in each knee, one on the inside (medial) and one on the outside (lateral). A meniscus is cartilage pad that provides cushion and stability to your knee, protecting the ends of your thigh and shin bones. Meniscus attach to the bone with small ligaments.
The diagram above is a cross section of the knee from the viewpoint looking down at the top of the shin bone (tibia). As you can see, the lateral meniscus on the outside of your knee is C shaped and thicker on the outer rim. The medial meniscus on the inside of your knee is also thicker on the outer rim and has a more oblong shape.
The following diagram shows typical locations of medial meniscus tears. Tears can occur due to an injury related to sports, recreation or trauma but can also occur as part of aging. Either way, meniscus tears may cause significant symptoms. Meniscus tears are diagnosed with MRI and a clinical exam.
- Swelling or tightness in the knee especially when you bend it
- Pain with squats, stairs, bending and twisting while standing and with walking
- Pain upon full bending and a twisting of the knee
- The knee may lock, catch or get stuck when you move it
Recent evidence is moving away from knee surgery as the first line of defense for meniscus tears. New research is promoting physical therapy as the best treatment for most meniscus tears, at least initially. Healing can take up to 8 weeks and symptoms will reduce within the first few weeks of physical therapy.
How to Treat Meniscus Tears in Physical Therapy:
Management of the swelling is the first step in any physical therapy program. Aggressive icing (4-6 times daily), compression and elevation along with rest are prescribed in the days following a meniscus tear and are utilized until swelling subsides. High dose fish oil (2-4 g daily) is also recommended as a way to control inflammation.
We then work on restoring normal motion and strength to the muscles around the knee with meniscus tear. In the photo to the left, the patient is working on full hyperextension of the knee. The full hyperextension is also called full straightening. Hyperextension is essential for normal function of the knee and takes a load off of your healing meniscus. Your physical therapist will also provide hands on stretches to the knee to ensure the shin bone and thigh bone are moving correctly. Once full hyperextension and motion is restored at the knee, your physical therapist will work on muscle building. Quadriceps, calf and hamstring exercises are commonly prescribed to help you heal from a torn meniscus. Typically exercises start in a non-weight bearing position and progress to standing.
Functional retraining is another key part of the physical therapy program to help you heal from a meniscus tear. Your physical therapist will make sure you stand, walk and can do functional activities like stairs, jog, and cutting/twisting motions safely before you complete PT.
Recovery time for meniscus tears can take up to 12 weeks to completely heal. With the right physical therapy, you can notice improvements in how you feel in 2-4 weeks.
How to Treat Meniscus Tears with Surgery:
If you have a very large or unstable meniscus tear or you have failed to improve with physical therapy, surgery may be a good option. Knee menisectomy is the most common orthopedic surgery performed in the United States annually. For menisectomy, the surgeon shaves off the torn meniscus (https://www.youtube.com/watch?v=kB98kPLOcBM). Following the procedure, physical therapy as described above is highly recommended. Your recovery time to return to full sports and activity post-surgery may be 6-8 weeks depending upon how your physical therapy goes. At times, surgeons choose to do a meniscus repair where the meniscus is re-attached to the bone. Recovery time is extended with a meniscus repair as compared to menisectomy. Your surgeon can guide you on which procedure is best for you.
I hope this blog helps you understand the symptoms of meniscus tear, what a meniscus is and how to treat meniscus tears. If you think you have a meniscus tear based upon your symptoms, see a physical therapist. Our recent How to Find a Good PT blog can guide you in that process.
Best of Luck!