In this video, we're going to look at lateral meniscus tears. We’ll first recap the anatomy
quickly, plus look at how you normally injure a lateral meniscus, because that will help you
understand the cure. Then we'll look at what the typical symptoms are. So, in other words,
how can you tell if you've got a lateral meniscus? Then, we'll look at the research and what it
says with regards to, do you actually need surgery, or can you get better without it?
And of course, we'll then look at conservative treatment and what it
entails and how you adjust it. And finally, what you can expect from healing times.
For those of you who don't know me, my name is Maryke. I'm one of the physiotherapists from
sports-injury-physio.com, where you get online physiotherapy assessment as well as treatment
for your injuries. Have a look at the Description of this video if you want the link to our website.
So, if you look at the picture that's on the screen at the moment,
there's two blue discs in between the bones in the knee joint, and those are your menisci. Now,
you have one on the inner side, the medial meniscus, and on the outer side, the lateral meniscus.
They are both made of cartilage, and they are C-shaped discs. Now, they are a little
bit concave, so that the top of the … or the femur at the top can sit into them better. So,
they allow a bit more stability in your knee when they are intact. They also act as shock absorbers.
The other interesting thing is that the … it's only the outer 25 to 30% of the
meniscus that actually has a blood supply. The inner 70% doesn't have a blood supply,
and it gets its nutrients and its oxygen from the fluid inside the joint. Now, this is why
movement is important, because our joints don't have arteries going in and out of them. They
require movement to push fluid out and bring new fluid in and, with that, the nutrients and oxygen.
And that is why movement is so important when you are recovering from a meniscus tear. Now,
something else you might notice is that there are ligaments on the inner side as well as the outer side
of the knee. On the inside, they actually attach to your medial meniscus, whilst on the outside,
they don't attach to the lateral meniscus. Now, why this is significant is,
as we bend and straighten our knee, our lateral meniscus is quite free to move into quite a few
directions, whereas the medial meniscus doesn't have that much movement to it; and this is why
the medial meniscus gets injured so much more easily than the lateral one. Now, the typical
way to injure a lateral meniscus is, usually it involves a forceful movement; so, it's a twisting
action with the foot planted, and quite a lot of force behind it. And because it's such a forceful
movement, usually, it is often accompanied by other injuries, like cruciate ligament injuries.
When you have a lateral meniscus tear, the main symptom will be pain over the outside of the knee.
Now, depending on whether you've torn the front part of the meniscus or the outer part or the back
of the lateral meniscus, your pain may go anywhere along this joint line. How do you find the joint
line? You find your tip of your kneecap; and you go straight down and you'll feel a little dent there;
you're on the patellar tendon now. And you just go next to it, and it dents in. And that's where
the joint line for the lateral side starts, and you can move your fingers all along that.
So, when you have a lateral meniscus tear, your pain will be somewhere along that line.
It may be that it’s a little bit deep, that you can't push a finger on it, but this is where the
pain will refer. Swelling can vary, depending on how severe your injury is. So, you may only
have a tiny bit of puffiness there, and other people may have a lot of swelling. Same thing for
walking. Some people struggle to just walk on flat ground, while others feel relatively comfortable,
and it's only when they go upstairs or downstairs that it becomes a problem. You may also find that,
standing with your feet planted and twisting on your legs can cause quite a bit of pain, because that
produces a twisting or torsion force on the injured meniscus. And same thing for
walking on uneven ground; that's usually a good idea to avoid that at the start. You may also
experience a popping or a clicking, and sometimes the knee can get stuck if it's a bucket handle tear.
So, does a meniscus tear really require surgery? The research actually shows, no.
Most stable lateral meniscus tears can heal really well without surgery. There's also evidence that,
if you look at the one-year follow-up of people who's had surgery versus ones who didn't,
their outcome is pretty much similar. And surgery seems to predispose people to getting
osteoarthritis earlier than if they didn't have surgery. So, there's a strong case to
make for first trying a good dose of conservative treatment before you opt for surgery. Now, if it's
decided that you do need surgery, then usually a surgeon will try and repair the meniscus first.
And that is by far the first choice, because that actually helps prevent osteoarthritis and things
in the future. But this can only happen if the meniscus has torn in a very specific part, where
it can actually heal, and that part where there is a blood supply. If it's torn in an area where it's
unlikely to heal, they may have to trim it away, and that’s called a meniscectomy. Now, the problem
with your lateral meniscus is that actually, they don't do that well after a meniscectomy
as a medial meniscus. And it's also the type of surgery that's more likely to predispose you to
getting osteoarthritis earlier. Interesting point: We used to think that ... or the argument was that, if
somebody has a cruciate ligament tear, which often goes with a lateral meniscus tear, they have to have
that cruciate ligament repaired, otherwise it can cause them to have meniscus tears in the future.
The research actually shows this is not the case; there's no harm in delaying anterior cruciate ligament
repair and first seeing if it wants to resolve on its own through rehab; it doesn't predispose
you to getting more meniscus tears. So, that's just interesting, if that perhaps applies to you.
However, there are cases that do need surgery, and one of the reasons may be the type of meniscus
tear that you have. If you have a bucket handle tear that's folding back on itself and blocking
your knee, or you've got an unstable meniscus tear, then you may actually require surgery. Also,
if your knee is super painful and you just can't get started with exercise in rehab,
surgery may also be an option. And then also, if you've tried conservative treatment for at
least six months, and you're seeing no progress at all, then again, surgery may be required.
So, let's look at conservative treatment for lateral meniscus tears. It comes in three
phases. And to be honest, it doesn't matter if you've torn your lateral meniscus or your medial
meniscus, the treatment for them is exactly the same. The first step is that you want to reduce
that initial injury, so you want to allow the swelling to settle, allow the injury to settle,
and just let your pain calm down a bit. And there are a few things that you can do to help it along.
The first is to obviously reduce the load on the knee, because remember, your meniscus carries
most of your weight, and it helps to absorb your shock while you're walking. Now that it's injured,
you just need to take a little bit of weight off it so it can get time to settle. So, something
that could be really useful is if you use some crutches or even just a stick. And it's funny,
patients often feel that, “Oh, no, no, no, no! I don't want to use a stick, because then I'm old!”
But what they don't understand is, if they use a stick and take some of the weight off,
they will actually recover more quickly, because they are allowing the body the space to be able
to repair. Whereas, if you now try and walk and put more pressure on that injured part, you just
cause the injury to be worse. So, please don't see crutches as something that's negative;
it's brilliant for early-stage rehab. Now, something else you could do is gentle movement.
People can sometimes be frightened of moving an injured knee, but to be honest, remember, you
don't have arteries going in and out of that knee. So, it can become really stiff and painful if you
try to keep it dead-dead still. Gentle movement - and I'm not talking being rough here, it's just
bending and straightening your knee on a bed - can really make it feel more comfortable and you can
even use your hands to help it. Now, I've made a whole video about exercises for meniscus tears, where
I've spoken and demonstrated the early-stage exercises for circulation, the later stage,
or the middle stage, exercises for strength, and then the later stage as well. So, if you want to
know the specifics of the exercises, I'm putting a link to that video in the Description
of this video. Icing your knee can be really useful to help reduce pain as well as swelling.
But that doesn't mean that you just plonk the ice on it and leave it on there for a long time,
because over-cooling things can also cause trouble. So, what you want to do is, you want to place the ice
on there for about 10 minutes. Always have a wet towel between your leg and whatever you're using
to cool it down. Then, you remove it for 10 minutes to allow your skin to just get a breather, and
then you can reapply for 10 minutes. And you can do that two or three times a day. Now, I'm putting
links in the Description of this video for ice packs that I find useful, because they've got straps and
things that tie them to your knee, but you can also just use a packet of frozen peas, because
that's brilliant; it doesn't mess all over you, and you can just mould it to your knee as well.
Then lastly, your doctor might prescribe you some medication.
Now, if your knee is really, really swollen and has an overactive inflammatory reaction,
then medication may be useful. But if your knee’s just a bit uncomfortable and you can bear it, it's
not too bad, I would say, stay away from taking medication. Anti-inflammatories have been shown to
perhaps delay the healing response. So, if you're going to take something for pain, paracetamol
may be the safer option. But speak to your doctor as to what alternative is best for you.
So, the second phase in treatment for meniscus tears is all about gradually increasing the
strength and the endurance of the meniscus again. So, just a quick recap. Once injured, this meniscus
now doesn't have all the strength and endurance to cope with the activities you want to do,
but as the weeks go on, the body will repair it, and it will make it strong - as strong as before,
but only if you give it the correct stimulus. So, the components in this phase are relative
rest plus strength training exercise. Now, what does "relative rest" mean? Relative rest means that
you reduce all your activities to a level that doesn't aggravate your knee. So, the question is,
what can you currently do that doesn't cause you knee to hurt a lot more or swell more in
the 24 hours afterwards? And we’re thinking of things like standing time, walking time, stairs,
walking distance, all of those things, plus your exercises. If you don't know what I mean with this
or you're struggling to figure out what is the right amount of activity for you, do speak
to a physio, because that's the bit that we can help with. Then, if we think of exercises
for meniscus tears, I said strength training earlier, but that's actually just one component.
Strength training is important, because the stronger your muscles are, the less force
goes through the knee. And we’re thinking that we want to be strengthening the front thigh muscles,
the quadriceps, the hamstrings, as well as the calf muscles. And remember, I've made videos about
this, or a video about this, in detail, which I'm linking to in the Description of this video.
But then, you also want to include exercises that connect your brain with your knee again,
because when we injure a body part, our brain loses some of the control. But you
can reset that control through simple things like balancing exercises, where you force your
brain to really take the control back there. Now, these exercises have to start at a very
low level that doesn't aggravate your knee. If your exercises are making you feel worse afterwards,
they are not the right ones for you, and they need to be adjusted. But then, as you grow stronger,
you need to adjust them to get to the level you need for your sport. So also, just as they can't
be too hard at the start, it doesn't help that you do the same things for 6 to 8 weeks and expect it
to be better. Because you need to … as you grow stronger, the exercises have to become more complex.
What you work up to will depend on what you do. If you're just a walker, your program will look very
different from somebody who also runs or plays football. And that's the final stage of the rehab
as well, that, once you've got the strength, once you've got control through balancing exercises,
you now have to ease back into your sport. And if you're a runner, this means doing run-walks
and slowly getting back into it, choosing your terrain well, that you stick to even ground,
avoid the uneven stuff for the start, avoid heavy downhills. Just keep it easy. Keep it slow.
If you're a footballer, it will mean that you start first straight line running, then start
doing a little bit of drills that require you to change direction, and finally speed it all
up until you can actually do sprints and change direction quickly. But this all happens over a
matter of several weeks, not just one or two days. So, you have to … because with injury management,
you've also got to remember, it's not just about the exercise you do, it's also about the
time that goes into it, because your body needs about 8 to 12 weeks to repair all of this. So,
it doesn't help to rush it too much. This leads nicely into, how long can you expect your recovery
time to take? Well, to be honest, it will take 8 to 12 weeks for a minor tear to a medium tear, and,
depending on your age ... so, a younger person will more likely fall in this category. But if you're
older or it's a more significant meniscus tear, it can take 6 to 12 months. Now, if you want to
know if conservative treatment is working or not, see how it reacts to conservative treatment within
the first 12 weeks. If you get to Week 12 and you can see, “Hmm, my knee is still painful, but I
am significantly better than what I was 12 weeks ago”, then I would say, keep on with conservative
treatment until you reach a point with just not getting better; only then consider other things.
But if you get to 12 weeks and you think, “I really can't bend it much and I can't do much
yet on it, it's not getting much better”, then it may be worth getting a review with your doctor
and just seeing if there's anything else that they can suggest. Brilliant! Hope you found this
useful! And remember, if you need more help with an injury, you're welcome to consult one of the
team via video call – the link to the website is in the Description of this video. Take care!