How are the Meniscus Injured?

A meniscus tear is usually the result of either a traumatic incident or degeneration. Traumatic tears are most common in physically active people under the age of 45, while degenerative tears are more common in the over 40's age group.

The meniscus receive very little blood flow. In fact, most of the meniscus receive no blood flow at all, which makes recovery extremely difficult.

Most traumatic meniscus tears are the result of twisting the knee or a sudden impact to the knee. While degenerative tears are associated with the aging process and result from a breakdown in the collagen fibers that make up the meniscus.

What are the Signs & Symptoms of a Meniscus Tear?

The most common symptoms associated with a meniscus tear are pain and swelling around the knee joint. Tenderness at the injury site is also common.

Another common problem associated with a meniscus tear is 'joint locking.' Joint locking prevents the knee joint from either fully straightening or fully bending and is the result of a piece of the torn cartilage being lodged within the knee joint.

Treatment for Meniscus Injury

A minor meniscus injury is just like any other soft tissue injury and should be treated accordingly. This involves the application of R.I.C.E.R. (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment. The following two points are of most importance.

1. Rest & Immobilization: Once a meniscus injury is diagnosed it is important that the affected area be rested immediately. Any further movement or stress will only aggravate the condition and prolong recovery. It is also important to keep the injured area as still as possible.
2. Ice: By far the most important part. The application of ice will have the greatest effect on reducing bleeding, swelling and pain. Apply ice as soon as possible after the injury has occurred or been diagnosed.

How do you apply ice? Crushed ice in a plastic bag is usually best. However, blocks of ice, commercial cold packs and bags of frozen peas will all do fine. Even cold water from a tap is better than nothing at all.

When using ice, be careful not to apply it directly to the skin. This can cause "ice burns" and further skin damage. Wrapping the ice in a damp towel generally provides the best protection for the skin.

How long, how often? This is the point where few people agree. Let me give you some figures to use, as a rough guide, and then I will give you some advice from personal experience. The most common recommendation is to apply ice for 20 minutes every 2 hours for the first 48 to 72 hours.

These figures are a good starting point, but remember they are only a guide. You must take into account that some people are more sensitive to cold than others are. Also, be aware that children and elderly people have a lower tolerance to ice and cold. Finally, people with circulatory problems are also more sensitive to ice. Remember to keep these things in mind when treating yourself or someone else with ice.

Personally, I recommend that people use their own judgement when applying ice to them self. For some people, 20 minutes is too much. For others, especially well conditioned athletes, they can leave ice on for up to an hour at a time. The individual should make the decision as to how long the ice should stay on.

My personal recommendation is that people should apply ice for as long as it is comfortable. Obviously, there will be a slight discomfort from the cold, but as soon as pain or excessive discomfort is experienced, it is time to remove the ice. It is much better to apply ice for 3 to 5 minutes a couple of time an hour, than not at all.

During the first 24 to 72 hours after an injury, be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spas, Jacuzzi's and saunas. Avoid all movement and massage of the injured area. Also, avoid excessive alcohol. All these things will increase the bleeding, swelling and pain of your injury. Avoid them at all costs.

Meniscus Surgery

Surgery isn't always necessary for a meniscus tear and in some cases the individual can lead a totally normal life without any surgery at all. Your doctor or physical therapist can perform a number of tests to help determine the extent of the damage of the torn meniscus. An x-ray and MRI are two common tests used.

If surgery is necessary there are two options: a meniscus repair; or a meniscectomy.

	Meniscus Repair In some cases the meniscus can be repaired with surgery. Surgical repairs are only successful when the tear occurs in the vascular region (where there is blood flow) of the meniscus.
	Meniscectomy If the tear is in a part of the meniscus with no blood supply, (remember that most of the meniscus has no blood supply at all) surgical repair won't be affective. In this case a meniscectomy is performed to remove the torn portion of the meniscus and reform the remaining portion.

After surgery, expect to be on crutches for at least three weeks. Full recovery, using a comprehensive rehabilitation program will generally take about three to four months and athletes involved in high demand sports can be back on the field in about six to eight months.

For more detailed information on meniscus tears and meniscus surgery, visit the following sites.

	http://www.orthoassociates.com/meniscus.htm
	http://www.orthop.washington.edu/uw/tabID__3376/ItemID__161/mid__10313/Articles/Default.aspx

Meniscus Injury Prevention

Although it is important to be able to treat meniscus injury, prevention should be your first priority. So what are some of the things you can do to help prevent a meniscus injury?

1. Warm Up properly
   A good warm up is essential in getting the body ready for any activity. A well-structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. If you would like to know more about the warm up, visit: Warm-up Activities and Stretching Exercises.
2. Avoid activities that cause pain
   This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
3. Rest and Recovery
   Rest is very important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
4. Balancing Exercises
   Any activity that challenges your ability to balance, and keep your balance, will help what is called, proprioception: - your body's ability to know where its limbs are at any given time.
5. Stretch and Strengthen
   To prevent meniscus injury, it is important that the muscles around the knee be in top condition. Be sure to work on the strength and flexibility of all the muscle groups in the leg.
6. Footwear
   Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees stable, provide adequate cushioning, and support your knees and lower leg during the running or walking motion.
7. Strapping
   Strapping, or taping can provide an added level of support and stability to weak or injured knees.