Medial Meniscus Tear

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About

Imagine it's your first time alpine skiing. You come down the hill too fast, hit a bump, catch one ski in the snow and have your leg twisted outward. If you're unlucky, the ski patrol might wind up taking you the rest of the way down. Compression combined with rotation of the knee joint, whether it's during a skiing accident, a basketball pivot or something as ordinary as slipping on ice, is one of the most common causes of a meniscal tear, which is a tear in the fibrocartilage that makes up the two menisci in each of your knees.

People who have this injury often feel a dull and constant pain in and around the knee when resting, but a sharp pain when walking or bending the affected leg. If the injury is severe, they may also experience debilitating pain that leaves them unable to walk. There may be some swelling as well, but this may take a few hours after injury before becoming apparent.

If you've got all those symptoms but don't remember experiencing any awkward leg twisting, you could still have a meniscal tear. In fact, healthcare practitioners distinguish between traumatic tears, like those that happen in skiing accidents, and degenerative tears, which most commonly develop as people age.

To understand the difference between the two causes, think of the two menisci (the lateral, or outer meniscus, and the medial, or inner meniscus) working together to form a shock absorber. Traumatic events can overload this shock absorber, causing partial or complete rips. Degenerative changes, on the other hand, simply wear it out.

The latter occurs when the tissue that makes up the menisci dries out, becoming less elastic and less effective at absorbing forces and providing stability. This drying out is a natural aging process that researchers don't yet fully understand. It can make people susceptible to tears, even when they're just performing relatively routine, non-stressful activities such as dancing or squatting.

While anyone at any age can suffer a traumatic meniscal tear, young adults appear to be more susceptible because of their more active lifestyles. Degenerative tears, on the other hand, are most common in people in their late 50s or early 60s. Regardless of whether you're suffering from a degenerative or traumatic tear, however, studies suggest that conservative care is often more effective than surgery for this type of condition.

Surgery may be necessary for severe tears, however. It involves removing part of the meniscus and suturing or scaffolding a graft, possibly a collagen implant, in the knee to promote the growth of new tissue. This surgery is a last resort, and while it generally has good results, non-invasive care should be your first choice as it involves a lesser risk of side effects.

If you suspect a meniscal tear, see your healthcare practitioner as soon as possible regardless of the amount of pain you feel. Tears to the menisci commonly occur with additional injury to surrounding structures, so your healthcare practitioner should perform a thorough examination. Also, because there is poor blood supply to the inner edges of the menisci, tears in this region are infamous for healing poorly. The sooner you seek care, the better.

Anatomy

As mentioned in the About section, the menisci work like a shock absorber. When you walk, they absorb about one-third of the impact your femur (thighbone) puts onto the tibia (shinbone) below, by transferring the weight down. Composed of fibrocartilage, a durable elastic tissue, the menisci sit on either side of the knee in the joint line, where your thighbone meets your shinbone. The one on the outside is the lateral meniscus and the one on the inside is the medial meniscus. The lateral meniscus is oval-shaped, while the medial meniscus is C-shaped, and each wraps one of the two ends of the thighbone like a horseshoe on a pole.

Like rubber bands, the menisci are bendable and flexible -- to a point. When they move outside their range of motion, they can snap. This commonly occurs when someone comes down hard on their foot while their leg is rotated and bent.

Most commonly, these injuries occur to the medial meniscus. In fact, medial meniscus injuries are 20 times more common than lateral meniscus injuries. There are two reasons for this. First, in most cases of knee injury the knee rotates outward, not inward. Second, the lateral meniscus is stronger than the medial meniscus.

Meniscal tears occur along a spectrum, from partial to complete. In severe cases, a torn piece of the meniscus can move into the center of the knee, preventing the thighbone and shinbone from moving properly and producing a locking effect that stops patients from straightening their leg. In either case, however, there can be damage to other structures of the knee, so it's important to have your chiropractor perform a thorough examination.

Chiropractic Care

It's important that after injuring your knee you see your chiropractor immediately. Any delay in diagnosing a problem will hinder healing and possibly lead to future instability and damage. Conservative chiropractic care is often essential for the rehabilitation of a meniscal tear, and is usually a better choice than surgery in mild cases.

To care for your meniscal tear, your chiropractor may use adjustments to your knee, back or sacrum, which will restore function to misaligned or malfunctioning joints. Adjustments to the knee help to improve the joint's function and mobility, which can diminish after a meniscal tear. Adjustments to the back or sacrum, also known as spinal manipulative therapy, are also helpful. If you have a knee problem, it can affect your gait and disrupt your walking posture, which places strain on muscles that connect in your low back. Over time, this can make the joints in your back stiff or hypomobile. Adjustments will free them up and enable your spine and nervous system to function properly.

Your chiropractor may also want to use physiotherapeutic devices like ultrasound and interferential current (IFC) to help your knee heal. Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve irritation, break down scar tissue and speed healing.

IFC works in a similar way, but sends electrical waves through the body instead of sound waves. These painless, mild electrical waves penetrate the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the impulses at the knee, your chiropractor can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain. IFC also helps decrease inflammation and speed up the healing process.

Once the injury has begun to heal, your chiropractor will probably recommend a number of exercises that will help you regain function, including stretching, strengthening, proprioceptive and aerobic activities. By stretching muscles around the knee, you can increase the joint's flexibility and help guide the knee back through its proper range of motion. Strengthening the muscles in this area can help promote the muscle balance necessary for the knee to work properly. Proprioceptive and aerobic activities are also important. By performing proprioceptive exercises, you can retrain your brain to communicate effectively with your knee, ensuring balance and coordination. By performing aerobic exercise, you can help improve blood flow to damaged tissue, facilitating healing.

If your injury doesn't respond to conservative care, your chiropractor may refer you to a medical specialist for surgery. The most common surgery for a meniscal tear is a partial menisectomy, which involves a surgeon making a small incision in the knee and using a thin camera as a guide while removing meniscal tissue.

Unfortunately, there's a correlation between tissue removal and degenerative knee changes. So if you require surgery, you should still have post-operative chiropractic care to help the healing and rehabilitation process.

Medial Meniscus Tear

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