First, some anatomy. There are two menisci in each knee – the medial meniscus on the inside and the lateral meniscus on the outside. They sit on top of the shin bone, or tibia, and are basically like two calamari rings whose main role is shock absorption from the forces going through the knee on a daily basis
They can be damaged as a result of one particular incident, such as twisting when skiing or playing football, or they can also wear down gradually and it may be something innocuous that eventually results in pain, such as kneeling down gardening.
The symptoms include pain, swelling and tightness – the latter being particularly common around the back of the knee, although it can also be noticeable around the front.
There are a few options, but let’s start with conservative treatment. Menisci have a poor blood supply and don’t really heal well – so don’t look at it as a conventional ‘tear’ that needs to be repaired. Instead think of it as an inflammation that we want to settle.
So the first aims are improving the symptoms and the movement in the knee, which is not uncommonly restricted. This can involve some fairly simple joint mobilisation treatment given by your physio, accompanied by some exercises to improve the range and minimise any muscle deconditioning associated with rest.
Exercises may be as simple as tensing your quadriceps muscles (the ones on the front of your thigh) and doing repeated holds of about 10 seconds. Alongside this, a very simple bending and straightening of the knee can be beneficial, getting to the point of restriction and repeating for a couple of minutes. You should notice a very quick improvement in this range day on day.
As the symptoms settle you can then progress onto more challenging exercises such as various forms of squats, although it’s important to ensure that symptoms don’t flare up, so look out for any increase in pain in the subsequent 24-48 hours.
If there is a significant tear, particularly where this results in a loose flap of the meniscus which can further rub on various surfaces inside the joint, surgery may be required.
In most cases this tends to be a fairly straightforward surgery, the purpose of which is to shave away the flap, smooth out the tear and give the joint a bit of a clean out. Some physio is normally required afterwards to ensure a return to good muscle contraction, address any deficits that may have predisposed the injury in the first place, and make sure you are pain free and ready to return to your normal activity.