Meniscal Tear: Causes, Symptoms, Treatment and Cost

Meniscal tear is a common knee injury resulting from a sudden twisting action. It occurs when the meniscus, a type of cartilage in the knee that acts as a shock absorber, is torn due to excessive force being applied to it. The tear can be acute or chronic and can be complete or partial.

The types of meniscal tears include:

• Longitudinal Tear: This is a rip along a single length of meniscus tissue that can be caused by a twisting mechanism within the knee joint.
• Radial Tear: This is a tear that usually begins from one side and then crosses over to another side, or runs in a circular pattern around one or more points on the edge of the meniscus. This type of tear is often associated with sports-related activities due to its quick and sudden nature.
• Horizontal Tear: This type of tear creates an opening along the middle portion of the meniscus, which may lead to instability in the knee joint if not treated properly. It can be caused by shear forces in certain movements, such as those involved in football tackles and contact Sportstake.
• Slot Tear: This is a less common type of tear where there is an opening created along both sides of part or all of one edge of the meniscus; usually caused by direct trauma or compressive force from repeated activity such as running, jumping, squatting etc.
• Parrot-Beak Tear: This characteristics shaped tear resembles that like a parrot’s bill which may arise due to degenerative processes within the tissues; rather than direct trauma or sporting activities
• Bucket Handle or Complex Tears: These consist two or more types type tears forming together (e.g.; horizontal + longitudinal) creating this generally large flap like appearance at either end; commonly due to direct trauma such as twisting/rotation motion on/injuring both sides at once.

A meniscal tear can be caused by forcefully twisting the knee when it is bearing weight, or from wear and tear associated with ageing or injury.

Damage from sports activities such as soccer and basketball or direct contact trauma can cause a meniscal tear.

Poor flexibility, weak thigh muscles, and poor coordination are also common underlying causes for having a torn meniscus.

• Pain in the joint, especially when twisting or squatting.
• A popping or clicking sound from the knee.
• Dull ache in the knee, especially when walking up and down stairs or when getting up from a seated position.
• Joint swelling and stiffness after exercise or injury.
• Loss of range of motion or inability to fully straighten the knee.

• Improve leg strength through exercises focusing on leg muscles, glutes and hips.
• Improve flexibility and range of motion through regular stretching.
• Increase cardiovascular fitness to improve endurance.
• Proper squat mechanics while weight lifting.
• Train balance to better control knee stability.
• Wear proper footwear that improves grip and cushioning.

• Physical examination: A meniscal tear can be identified on physical examination when a patient reports a popping or locking sensation in the knee, localised pain and tenderness along the joint line, swelling and crepitus on movement.
• X-rays: Meniscal tears can be seen on X-rays, although they may be difficult to see without magnification. X-rays may show changes in the alignment of the knee joint caused by a meniscal tear, such as an abnormal space between the bones.
• MRI scans: Meniscal tears can be seen on MRI scans. On the scan, a tear is usually characterised as a fragmented section of meniscus with high signal intensity (bright white line) located within the meniscus. The severity of the tear can be determined by looking at how many fragments are present and how deep the tear is into the meniscus tissue.
• Blood tests: Certain blood tests may be used to assess other factors that may influence the diagnosis and treatment plan for meniscal tears, such as inflammation levels or infection.

• Knee instability: When the meniscus is injured, it can interfere with the normal stability of the knee joint and lead to instability.
• Joint weakness: Injury to the meniscus can affect the normal mechanics of leg movement, resulting in decreased strength and joint fatigue.
• Osteoarthritis: Loss or damage of the cartilage can lead to an increased risk of early-onset arthritis in weight-bearing joints like knees.
• Reduced range of motion: An injury to the meniscus can cause a decrease in range of motion due to pain and swelling associated with it, as well as impaired muscle function in the affected area.

• Applying warm oil or ghee to the affected area for 30 minutes every day is known to bring relief from pain, inflammation and swelling.
• Massage the painful area with some ayurvedic herbal oil such as castor oil or coconut oil for 10 minutes daily.
• Drinking ginger tea 2-3 times a day helps reduce inflammation, swelling and pain associated with a meniscal tear.
• Consumption of turmeric in the form of tea or supplements is also beneficial in managing meniscal tear symptoms.
• Drink apple cider vinegar diluted with water regularly to reduce joint pain, swelling and discomfort associated with a meniscal tear.

• Consume a balanced diet abundant in fruits, vegetables, and whole grains to maintain optimal vitamin and mineral consumption.
• To prevent inflammation, increase dietary consumption of omega-3 fatty acids contained in fish oils.
• Choose proteins such as lean meats, eggs, beans, nuts and seeds to promote healing and muscle growth.
• Drink plenty of fluids such as water or herbal teas to stay hydrated

• Avoid any type of high-fibre food such as whole wheat bread, oatmeal, nuts and beans.
• Reduce or avoid dairy products like cheese and milk, which can increase inflammation.
• Limit consumption of fatty meats such as beef and pork, fried foods, processed foods like chips and sweets which tend to cause weight gain around your knees.
• Reduce consumption of alcohol as it may further worsen the injury symptoms.

• Rest and ice: Resting the affected area for several days to weeks can help reduce swelling, pain and allow the body to begin healing. Regular use of ice may also reduce inflammation, alleviate pain, and accelerate recovery.
• Medications: Medication might be recommended to reduce inflammation or pain.
• Physical therapy: Exercises that promote function, mobility, and reduce knee stiffness.
• Arthroscopic Partial Meniscectomy: It involves the removal of a small portion of the torn meniscus through tiny incisions in the knee with the help of an arthroscope.
• Arthroscopic Meniscus Repair: This procedure can be used to repair some meniscal tears, and involves suturing and reattaching the torn edges of the meniscus back together.
• All-Inside Meniscus Repair Technique: Involves using arthroscopic instruments to suture specific parts of torn fragments directly back onto adjacent structures without making any outside incisions in the joint or attaching sutures through tissues outside the joint.
• Open Meniscectomy: Performed when there is extensive damage to all or most of a meniscus leaving only shreds, which typically can't be repaired with an arthroscopic approach so part or all of it has to be removed through open surgery involving larger incisions in order to gain access to poorly visualised areas by arthroscopy alone.

To diagnose and treat a meniscal tear, it is important to consult an orthopaedic doctor who has experience in treating knee injuries.

An orthopaedic doctor will be able to examine the knee, evaluate the extent of the tear, discuss treatment options and recommend appropriate rehabilitation exercises.

• Non-steroidal anti-inflammatory drugs (NSAIDs): Meniscal tears are often treated with NSAIDs. Non-steroidal anti-inflammatory medications lessen pain and inflammation, which in turn lessens the swelling that results in the afflicted region. Common NSAIDs used for this purpose include ibuprofen, naproxen, and aspirin.
• Corticosteroids: Corticosteroids are a type of medication used to help reduce inflammation in the body. They can be used to treat meniscal tears, but typically only when other forms of treatment such as physical therapy have been unsuccessful.

• It typically takes 6 to 8 weeks, depending on the severity of the tear, for patients to recover from a meniscal tear.
• To achieve complete healing, patients may need physical therapy and/or surgery to strengthen the affected muscles.
• Additionally, rest and protection of the knee are important during this time period.

• Depending on how severe the meniscal tear is, the results of treatment may differ.
• Generally, medical treatments like rest, physical therapy, bracing and medication can provide short-term relief from pain and swelling but may not always be a permanent solution. Even with surgery, some residual pain or discomfort may remain.
• Sometimes, the condition may worsen over time due to further injury or age related wear and tear.

• Rest is important to allow the body to heal and give the damaged tissue time to heal properly.
• Physical therapy may help the muscles in the surrounding area get stronger, increase flexibility, and reduce discomfort and swelling.
• Other non-operative treatments, such as weight management, appropriate exercises, and injections may also be used to reduce pain or improve knee stability and function prior to or after treatment if needed.
• Doctors may prescribe anti-inflammatories such as ibuprofen or steroids to reduce swelling post-surgery while they may advise against anti-inflammatories before the musculoskeletal procedure has been completed due to their potential of increasing risk of bleeding during surgery.

The cost of meniscal tear treatments in India can vary based on the treatment option chosen and the type of care provider.

Generally, treatments such as arthroscopic surgery, rehabilitation and physical therapy, anti-inflammatory medications, lifestyle modifications, and assistive devices are typically included in a meniscal tear treatment plan.

Typically, the cost for each of these options can range from around 10-20k INR depending on factors like the patient's location and quality of services.

• Pain: Pain around the torn area or in the knee joint can occur after treatment and may last for days to weeks following the procedure.
• Stiffness: It's possible for the knee joint to grow stiffer and harder to bend.
• Swelling: Swelling in the knee joint is common after any surgery and treatment of a meniscal tear can cause additional swelling that lasts for several weeks post-procedure.
• Weakness: Meniscus tears can weaken the muscles around the knee, reducing support and stability in the joint area.
• Infection: Post-surgical infection can occur with any orthopaedic procedure and should be treated with antibiotics as soon as possible to avoid further complications.

Meniscal tears may result in consequences including 'knee instability, joint weakening, and osteoarthritis,' the treatment for which can take anywhere from a few months to years, depending on how severe the condition is, so if you experience any, you should see a doctor right away.