A knee meniscal tear is a very common knee injury, especially with athletes and individuals who play team sports that involve a lot of pivoting and switching angles when running. Meniscus tears are also a common injury in the population who perform a lot of squatting for their jobs, such as plumbers, electricians or miners. Physical Therapy is the most helpful and cost-effective intervention in treating knee meniscus tears. Your physical therapist will help you manage the pain, weakness and swelling that ensues after a meniscal tear and, if surgery or injections are required, can help you recover your strength and range of motion after the procedure is performed.
What is a Meniscal Tear?
The meniscus is a C-shaped cartilage that cushions and absorbs impact in the knee. The knee has 2 menisci - one on the medial (inner) side of the knee and one on the lateral (outer) side of the knee. They both serve as a pedestal for the femur to sit on and cushions weight bearing loads that are placed on the tibial shaft.
A meniscal tear happens when the lower leg is twisted or turned quickly as the knee joint is bent. The tear typically happens when the foot is planted on the ground and the patient twists or changes direction of movement of the leg, like in a pivoting motion. Most meniscal injuries happen in athletes who play running or pivoting sports, but meniscal tears can happen to anyone at any age as well. A common leg injury, like a torn cartilage, is synonymous with a torn meniscus.
Signs and Symptoms of a Meniscal Tear
The pain and symptoms you might feel would be:
- Sharp, intense pain in the knee joint
- Feel or hear a "pop" in the knee; this might also feel like a tearing sensation
- Experience pain with walking and a “catching” sensation that does not make the movement of bending/straightening smooth
- Pain or difficulty with straightening the knee
- Swelling in the knee joint occurs within 24 hours of meniscus injury
How is a Meniscus Tear diagnosed?
Your physical therapist will conduct a thorough evaluation that comprises of tests that indicate a possible meniscus tear. Your therapist will review your sports or activity lifestyle and will request you to playback details of how the injury happened. Your range of motion of your knee will be measured and you and your physical therapist will better hone in on the specific movements that aggravate your knee pain during the evaluation. Your PT will then try to perform special tests to ascertain the degree of damage on the meniscus tear. This involves applying pressure to the meniscus and may cause pain. If it does, then it is a strong likelihood that you have a meniscal tear.
If your PT suspects a large tear, or if your pain levels are high enough to indicate further consultation with a surgeon, your physical therapist will refer you out to get more imaging via an MRI, and will recommend local trusted orthopedic surgeons to look further into your knee.
Can Meniscus cartilage grow back on its own?
Unfortunately the answer to this very common question is no, meniscus cartilage in most cases cannot grow back. The C-ring of the cartilage is mostly nonvascularized tissue that has no blood flow to it. Without blood flow, regeneration of tissue without external stimulation is not possible. There are parts of knee cartilage that has some vascularization to it, but the damage to the cartilage will have to be large and extensive to reach these regions of the knee.
Regarding regeneration of knee cartilage, there has been some experimental studies looking into PRP (platelet rich plasma) therapy and Stem cell therapy in helping cartilage cells heal. These studies are as yet limited in scope, but holds some very promising results for patients suffering from knee cartilage wear. If you would like to consult a PRP of stem cell therapist, we highly recommend a Reflex Clinic of Portland, who specialize in these types of noninvasive procedures.
As yet, PRP and stem cell therapy is not covered by health insurance, but we hope that as research mounts in support of it, we will see this tide change.
What Can Physical Therapy Do For My Knee?
A majority of knee meniscal tears can be conservatively managed with physical therapy. It used to be that arthroscopic surgeries were the go-to treatment of knee meniscal tears, with the surgeon arthroscopically debriding torn cartilage and cleaning up the joint of loose tissue. However, recent has shown that outcomes after these surgeries are not as helpful as physical therapy. The most cost-effective path is to try physical therapy for short course of treatment to see if you pain and swelling can be helped conservatively. Your physical therapist will also work together with you to improve strength and tolerance of daily activities like stairs, so you can restore full strength and mobility in the knee.
Your physical therapist will use ice and compression therapy to control for pain and swelling. Though we want to keep it to a minimum, there will be times when you will have increased swelling and it is important to note when your knee does this, as it is a hint that you may been too active on the injured knee. You should let your physical therapist know when this occurs - but don’t be frightened, this is a normal reaction to increased activity.
Your physical therapist may also use a type of electric stimulation called NMES (neuromuscular electrical stimulation) to help with increasing the targeted muscle strength. In addition to this, your physical therapist will design an exercise regime meant to progress you through so you can return to daily functions of the knee such as stooping, squatting and lunging. The endgame of this exercise regime is to return to full daily function and return to sports, with full movement and full strength. You will also be prescribed a home exercise program to bridge progress between visits to PT - this is very crucial to your recovery as strength and stability of the knee is vital preventing any further tearing of the meniscus and allows for improvement in walking and running biomechanics.
As you recover in your treatment, your physical therapist will conduct further exams and tests along the way to let you know when is a good time to return to sport. Returning too soon can cause further knee damage, so we want to make sure you are strong and stable enough to return to all activities at full force.
If Your Knee Needs Surgery
Patients who do not respond well with physical therapy, and those who are suspected to have bigger and more intense tearing in their meniscus may need surgery. Meniscectomies involve removing torn cartilage and loose tissues in the knee joint that may be aggravating movement and causing pain. This is considered a simple procedure, of which will also require physical therapy treatment after the procedure is done. The same PT goals apply after surgery- to return to full range of motion, full strength and full capacity for functional movement and sports. Most patients are able to make a full recovery within 2 months of the injury.
After Meniscectomy Surgery
Your physical therapy rehabilitations will very similar to the rehab for nonsurgical meniscus tears, with the exception that your pain and swelling will come from the trauma of surgery. Since most meniscectomies are done arthroscopically, there will not be as extensive pain involved. Your physician may prescribe the use of crutches or a cane so you avoid overloading the knee after surgery, but these assistive devices can be weaned off quickly as the pain in the knee diminishes. Ice and compression will be used to control for pain and swelling, of which you can extend to home use as your physical therapist will use PT sessions for range and strength gaining.
After Meniscus Repair
There will be occasions when a surgeon decides to repair the meniscus rather than removing pieces of it. Research studies show that when a surgeon opts for this route, a repair may have more long-term benefits than a removal because this will preserve as much cartilage as possible and therefore may reduce progression of arthritis later in life.
Rehabilitation after a meniscus repair may take longer than physical therapy for meniscectomies because of the need for protecting the repaired and healing tissue. The rehab period may also depend on the extent of cartilage damage, and the rehab protocols of the surgeon performing the repair.
Physical Therapy will follow the same plan of care: ice and compression to reduce swelling, and progressive exercises to allow the patient to work up to sports participation again. A knee brace may be prescribed by the surgeon to help with knee tracking and offloading the knee joint. The brace may a “stop” to it, in that you will be able to fully extend the knee but the stop will prevent bending of the knee part a certain point to prevent stress on the repaired cartilage. **
Returning to Activity
Your physical therapist’s goal is to return you to as much full capacity as possible. Daily activities of living, such as squatting, lifting objects like children or groceries, squatting, kneeling and stair climbing are all activities that they will strengthen you for and practice with you to ensure good biomechanics.
It is important to communicate with your physical therapist the particular impacts and motions that your typically do if you have a demanding job or lifestyle. If you are an athlete, this may mean that your rehab stint may be longer as the loads you put on your knee will no doubt be more demanding than stair climbing. Your return to sport will depend heavily on the extent of your injury, the amount of time you have been off your activity, and the type of sport you do. Your therapist will take into consideration these factors and goals while he/she is progressing your plan of care and will work with your physician closely to determine when it will be safe and appropriate for you to return to full sports activity.
Can a meniscal tear be prevented?
Research on whether knee braces help prevent meniscal injuries is poor. Rather, internal bracing by way of strengthening and conditioning is the most helpful in stabilizing the knee during pivotal motions. Physical activity, and physical conditioning helps with strengthening the surrounding muscles of the knee, so this will give you most bang for your buck in reducing meniscal tear events and prepares your body for demands from sport and strenuous activity.
Since meniscal tears typically happen when the body is pivoting with the foot planted on the ground, avoiding these activities or these instances will help in preventing meniscal tears from happening. When your foot is planted on the ground and when you are squatting, be sure not to twist or bend suddenly or excessively. In some sports, this is impossible to avoid - so make sure you strengthen your knee and do your conditioning.
If you are not sure what kind of a preventative program you should follow, contact your physical therapist at Stride Strong Physical Therapy and we set you off on the right foot.
