Meniscal/cartilage – should I be concerned?

First thing first, what is this meniscus that we all keep hearing about? A meniscus is a C shaped ring of cartilage in the knee, situated between the femur and tibia bones. There are both lateral and medial menisci in the knee. The main functions of this cartilage are shock absorbance, to distribute stress across the knee during weight-bearing, to act as a secondary joint stabiliser, to provide articular cartilage nutrition and lubrication, to facilitate joint gliding, to prevent hyperextension and to protect the joint margins.

The meniscus is divided into 3 zones: the red-red, red-white and white-white zones. The zones are divided by vascularisation and thus healing potential. The red-red zone is the peripheral zone – it is very well vascularised and has good healing potential. The red-white zone is the middle third with less vascularisation but can sometimes heal.The white-white zone has no blood supply and therefore, cannot heal itself. 

Common signs and symptoms of a meniscal injury:

  • Injury mechanism involving twisting on a bent knee if traumatic
  • Painful ROM
  • Joint line tenderness
  • Positive provocative maneuvers e.g. appleys, mcmurrys 
  • Catching/clicking/locking/giving way

The management of a meniscus tear will depend on the zone/age/pattern of the tear, whether it is stable/unstable, the patient’s characteristics e.g. age, compliance, co-morbs etc., and personal goals and daily routine – i.e. does the meniscus need to be surgically repaired in order for them to return to work/sport/daily activities to their regular standard. A degenerative tear or a non-degenerative tear which is asymptomatic or stable is usually treated non-surgically. In the other cases, such as non-degenerative tears or tears which are symptomatic (feeling of locking/giving way etc.), the tears are usually treated surgically. 

Therefore, the main point is that the management of a meniscal/cartilage tear in the knee will depend on a variety of factors and be down to what effect it is having on your own personal life. If it is affecting your daily routine and stopping you from doing the things you want to do after trying a conservative approach such as exercise rehabilitation, then a surgical option may have to be considered. However, this is a last resort and there are many physiotherapy based options to try first.

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