The mensicus are our shock absorbers in the knee. They help to create a secure and stable platform for the femur (leg bone) to connect withe the tibia in the lower leg. Without them, our knee wouldn’t be secure and be able to deal with the myriad of forces and shocks that we subject our legs to. A simple jog wouldn’t be able to happen if it weren’t for these important fibrocartilagenous pads in our knees.
So it’s vital that when we are taking care of our knees, we do everything we can to try and avoid injury to the meniscus. Sadly this is not easy as discs in our body age and deteriorate from the minute we start jumping and running and being human! Meniscus tears are a major issue for most of us who are involved in sport and primarily in squatting. That pretty much covers the entire population!
Tears can be degenerative or as a result of trauma, especially when you are involved in twisting actions with the foot planted. It’s very much like the Monte Carlo biscuit analogy that I have used in articles on disc bulges and protusions. Where the meniscus differs from the intevertebral discs of the spine is that the meniscus are a lot more hard wearing. Vertebral discs are 90% water whereas meniscus are more dense with 22% of collagen/72% water. Made up primarily of hardy fibro-cartilage the meniscus work to reduce friction in the knee and provide stability for the articulation of the leg bones in extension and flexion.
A tear in the menisci is usually caused from a twisting motion in a flexed knee position. This compression of pressure combined with a twisting action can tear fibres in the pads that result in ‘flaps’ of fibrous tissue. The most common tear usually occurs in the medial meniscus often when we rotate medially (inwards) on a fixed foot (such as turning sharply on a soccer pitch). The excessive rotation and force when the femur rotates against the tibia can create minor tears that will exhibit pain on the same side of the joint as the effected meniscus. These broken fibres can catch in the knee and create a ‘locked knee’ sensation where extending the knee becomes painful. It can be that a partial tear doesn’t create pain or prevent movement but a ‘click’ or ‘popping’ knee can be a result. This usually indicates that the broken fibres are not being caught in the knee action and that the tear is minor.
In the case of more severe tears, key hole surgery is usually the most advantageous rehabilitation, whereby the torn ‘flap’ is removed and/or the meniscus is smoothed out to prevent any rogue fibres from creating issues with normal knee operation. Recovery is relatively quick and can be 3-8 weeks. The severity of the tear and its location determine whether surgery is an option. Intrasubstance, horizontal and radial tears occur within the meniscus and are considered incomplete tears that usually don’t require surgery or are a degenerative nature. Flap tears, Complex and Bucket Handle tears are more complex lesions that usually require surgery as the fibres are inhibiting knee movement and function. The location of the tear also determines whether surgery is an option. Posterior tears are much more common than anterior and these peripheral tears are easier to be repaired surgically. Central tears inside the bulk of the meniscus are very difficult to repair and the lack of blood supply in this area makes repair very difficult. Indeed there are ‘zones’ for location of a tear that denotes whether the injury can be operated. The ‘RED RED ZONE denotes the outer third, ‘RED WHITE ZONE’ the area more intrinsic with a relative blood supply and the ‘WHITE WHITE ZONE’ the avascular inner third. Replacement surgery may be the best option in these cases.
As we age, mensical tears become more likely and the surgical option of repair becomes less appropriate. Surgery usually requires removing (resecting) the torn section or it can even be stitched together (in some cases). Younger patients respond much more to surgical intervention and can recover with good movement after meniscal tears. With surgical techniques (minisectomy - removal of damaged section) often leading to long term osteoarthritis, management of the injury is the best option for those in 40+ bracket. . In this case, sadly - sports such as football or basketball can be considered dangerous and this can spell the death toll for participation in these actions.
The best option for recovering from a mensical tear is strengthening the muscles surrounding the knee. As the mensicus are primarily shock absorbers, our other natural shock absorbers are our muscles. Creating strong quadraceps, in particular Vastus Medialis Obliquous (VMO) and hamstrings will help to stabilise the knee and increase the ability of the knee to deal with stresses of shock absorption. LIkewise creating stronger lower leg muscles will also contribute to stable knee function as well as assisting with absorption. You can create a functioning knee joint with these muscles in play. If you are willing to do the work.
So bearing in mind the types of activities you are involved in and how well you have progressed with keeping your leg muscles strong and balanced, meniscal tears can be avoided. However as we age and our cartilage deteriorates, these tears become much more prevalent and the real risk of suffering from them can be a reality. So do your best to keep your balance and alignment in your legs well trained, your stability sound and your technique in sports well planted. Sometimes it is all about how well we land and not how well we jump that makes the difference. And then sometimes - age just catches up.
