Meniscus Tear: What It Is, Symptoms, Diagnosis, and Treatment

As with most knee injuries, it is common to experience severe pain or weakness in the case of a meniscus tear.

A meniscus tear can manifest with various symptoms that restrict daily activities and decrease quality of life, making it one of the most frequently seen injuries.

What is the Meniscus?

The meniscus is a fibrous cartilage tissue that contributes to knee stability by facilitating load transfer and has the function of absorbing shocks and impacts, thereby preventing the wear and friction of bones.

How Does a Meniscus Injury Occur?

A meniscus tear usually occurs when the knee is forcefully bent. In some cases, the broken cartilage fragment can compress the knee joint, preventing movement and causing it to lock. Meniscus injuries can arise from direct or indirect contact. Common examples of meniscus tears due to direct contact are often seen in football and volleyball players. Meniscus tears that frequently occur during running due to sudden and sharp changes in direction can also be accompanied by anterior cruciate ligament (ACL) injuries.

Meniscus tears that are not associated with direct contact or trauma, typically seen in the older population, can be referred to as degenerative tears. As the structure of the meniscus loses its strength with age and fails to perform its supportive function fully, the risk may be higher for older athletes. The likelihood of experiencing a meniscus injury is greater in individuals over 65 compared to other age groups. Deterioration and degeneration of the meniscus structure with age can increase the risk of experiencing conditions like knee sprains, which in turn heightens the risk of meniscus tears. The pattern of degenerative meniscus tears differs from that of tears caused by contact and trauma, making it significant as it may alter the treatment approach.

Symptoms of a meniscus injury can include pain, swelling, hearing a sound during the formation of a lesion, or locking, particularly in certain types of tears. Approaches to treating the meniscus typically follow a specific order. Methods such as protection, rest, applying ice or cold, compressing the area, and elevating the injured leg generally yield good results. Symptomatic medication to relieve pain and reduce swelling may also be preferred. In most cases, the meniscus can heal on its own, but there are types of tears that require surgical repair. It is recommended to seek support from a specialist and an experienced healthcare institution for the diagnosis, treatment, and follow-up of meniscus tears.

What Are the Risk Factors for Meniscus Tears?

Activities and sports that can cause aggressive, sharp bending or twisting of the knee joints are among the most important risk factors for meniscus tears. Individuals engaged in contact sports like football and volleyball, which involve jumping and placing heavy loads on the joints through bending, have a higher risk of meniscus tears. The risk is also elevated for tennis and basketball players. These types of sports can cause damage or degeneration in the knee joints and surrounding tissues in older individuals. Additionally, obesity can weaken the joints, leading to excessive load on the knee and reducing its flexibility, thus increasing the risk of meniscus tears.

What Are the Complications of Meniscus Tears?

One of the main complications that can arise from a meniscus tear is persistent knee pain. Individuals may experience feelings of instability in the knee, inability to perform movements they previously could, and chronic knee pain due to a torn meniscus. There is also an increased likelihood of developing osteoarthritis due to injuries in the knee bones and joints.

What Are the Symptoms of a Meniscus Tear?

The most common and primary symptom of a meniscus tear is pain felt along the knee joint line. Other main symptoms include locking of the affected knee, loss of function, a sensation of catching, and swelling. There are also reported cases of numbness or a feeling of instability in the leg. The primary cause of the numbness in the leg is the displacement of the torn meniscus, which can damage the surrounding tissues and thigh muscles. Initially, the pain from the injury may not be very severe and may not cause restrictions in movement. However, as inflammation progresses, the pain typically intensifies. Pain located in the upper part of the knee where the meniscus is situated can worsen when bearing weight, getting in and out of a car, or squatting. Climbing up and down stairs is also often painful, and excessive use of the knee can lead to increased swelling. The initial symptoms of a meniscus tear can be summarized as follows:

• A sound coming from the knee and a feeling of popping during the formation of the lesion
• Swelling and edema
• Pain, especially during knee rotation
• Difficulty in straightening the knee after it has been bent
• A feeling of locking that causes difficulty in movement
• Numbness in the leg muscles
• A feeling of instability

If there is severe pain when the knees are bent, swelling or redness occurs in the knee, and the knee cannot be moved, it is crucial to seek medical attention promptly and undergo a thorough examination if there is an unexpected loss of function.

How is a Meniscus Tear Diagnosed?

In patients who present with complaints of knee pain and swelling or suspected meniscus tear, a detailed and careful physical examination is necessary for diagnosis. Testing the knee and leg in different positions, performing various maneuvers, and assessing walking are part of the doctor's evaluation. The examination procedure known as the McMurray Test aims to compress the meniscus and assess the presence of pain. One hand holds the affected knee, while the other hand holds the same side ankle, and the knee is fully bent. Both sides of the meniscus are tested by rotation. The presence of pain or sound associated with medial (inner) or lateral (outer) meniscus damage or tear indicates a positive test. Patients with a positive McMurray test will require advanced diagnostic methods and imaging studies to confirm a meniscus diagnosis. The imaging tests that may be requested in cases of suspected meniscus tear can be summarized as follows:

• X-Ray Imaging: Due to the cartilage structure surrounding it, meniscus tears cannot be diagnosed with X-ray. However, this method is often preferred to rule out whether the cause of knee pain and swelling is a bone fracture or another condition.
• Magnetic Resonance Imaging (MRI): The method used to evaluate the knee joint and cartilage structure in detail is magnetic resonance imaging. MRI is a diagnostic tool that allows detailed imaging of both soft and hard tissues. Since it does not involve X-rays or radiation and utilizes a magnetic field for imaging, it is safe for use in children and pregnant women. MRI is the most detailed and reliable approach for diagnosing meniscus tears.

What Are the Treatment Approaches for a Meniscus Tear?

Several factors are important in the treatment of meniscus tears. These factors primarily include the size and pattern of the tear, its location, the patient's lifestyle and age, as well as their expectations and needs regarding treatment. One of the most significant factors that alters the treatment approach is whether the meniscus tear involves the large area with blood vessels, known as the red zone. Tears in the outer part, which is the avascular (white) zone, are not expected to heal spontaneously and require intervention. In contrast, small tears and damage to the red zone may heal on their own over time. The methods used in the treatment of meniscus tears can be listed as follows:

• Resting and immobilizing the knee
• Applying ice for 15-20 minutes every 3 to 4 hours to reduce severe pain and swelling
• Using an elastic bandage or knee brace to prevent swelling and apply compression
• Physiotherapy treatments

Conservative (protective) treatments may not be sufficient for every case. If the tear is very large and causes symptoms like locking and numbness in the knee, surgery may be necessary. Surgical procedures for meniscus repair are not very complicated and are generally safe.

Untreated meniscus tears can progress, worsen symptoms, and lead to irreversible complications. The risk of developing arthritis (joint inflammation) in the knee increases due to an untreated meniscus tear. For early diagnosis and appropriate treatment of a meniscus tear, it is important to seek medical attention without delay in the presence of unexpected symptoms and to create a treatment and follow-up plan with a qualified and experienced physician.