Menisci are semicircular fibrocartilages inside the knee joint. Knee is a composed joint, where thigh bone (femur) meets with shinbone (tibia) and calf bone (fibula) from the side. In front is the joint included with patella (kneecap), which works along with the thigh muscles as a pulley. In order for the thigh bone and shinbone to fit in together better, we have two crescent shaped menisci in between them. They move back and forth while the knee moves and at the same time they change their shape. In between the menisci are stretched ligaments, which strengthens the whole joint.
Menisci dampen the impacts, transfer the body weight from the trunk and thigh to the leg and it protects the knee cartilages against tearing.
OCCURRENCE OF THE INJURY
Given the fact that the knee joint is fairly complexive, the injury often occurs when we fall down (injury while skiing, incorrect jumping, or wrong step). The most common mechanism injury is the rotation of the shinbone and calf bone against the thigh bone. During this movement the ligaments tend to get pulled and it can even lead to injury of the menisci. It can result in a rupture or tearing of the menisci. this completely loose or partly torn piece can block and interfere in the movement.
During injury the patient usually feels a sharp pain, you may also hear a breaking sound and feeling like your knee suddenly popped up. If it’s an injury of the meniscus and pulled ligaments, the synovial cavity which is between the thigh bone and shinbone will be filled with synovial fluid. In short amount of time after the injury the knee will start to swell in the front and sides, according to the speed of the swelling we can determine how serious the injury is. Because of the pain, the knee cannot be fully or completely under pressure. The patient feels unstable and uncertain (especially if the anterior cruciate ligament will be severed). Sometimes the knee is somewhat blocked in a slight flexion position, which causes the surrounding muscles due to the pain reflexively pull back. This increased muscle pressure invokes continuous pain in the knee.
EXAMINATION BY A DOCTOR
It is certainly good to fix the knee with a flexible bandage and visit a doctor as soon as possible. Doctor will perform functional maneuvers, which will reveal what kind of injury occurred in the knee. Sometimes it can be implemented with imaging methods such as magnetic resonance, CT or ultrasound. On the X-ray image the condition of the bones will become more clear, but it won’t show the condition of the soft tissues, therefore it is unnecessary to demand it.
According to the severity of the of the problem the doctor decides between conservative and surgical treatment. If the meniscus is significantly damages, the surgery is recommended. It is ideal as well to prepare yourself and your surroundings on the rehabilitation, because the operation can be performed even after few months. During arthroscopic operation the damaged meniscus is according to its condition sewed together or the damaged part is removed and the damaged cartilage will be cleaned. The knee will be then fixed in orthosis. After about 2 weeks from operation, the patient starts with rehabilitation, which can take according to the condition 4-10 weeks. Apart from soft techniques, mobilizing and exercising the muscle power, other procedures such as hydrotherapy can treat swellings and activate the joints to mobility, application of electric stimulation or magnetotherapy to support the healing process does not have any significant effect. Medicaments and creams are often applied - non-steroid antirheumatics for stimulation of weakened muscles, treating swellings and pain.
Sometimes the doctor chooses a different strategy, where he will first let the patient go through rehabilitation and according to the success of the therapy he might think about surgery. If the doctor thinks about operation, he takes into account the pain intensity and the size of the injury, age of the patient, active involvement in physical activity, motivation and accompanied illnesses.
HOW CAN PHYSIOTHERAPY HELP YOU
Following the clinical examination we offer an individual physiotherapeutic plan. If the meniscus has been damaged, it is optional to keep a peaceful regime for about one month up to 6 weeks along with using orthosis or taping, which will help you to keep the activity of the receptors in the muscles, joints as well as soft tissues even during fixation of the joint for optimal regeneration and healing. Applying the focused and radial shock wave therapy is very effective in this period of time because they are combined in their effects and speed up the healing process, lower the pain and help in the treatment of edemas in the joint area. Mechanical and manual lymphatic drainage is very effective from the start in treatment of swelling knee, which we support with application of the kinesio tape. As soon as the knee will be less painful, we can start with physiotherapy, where we focus on the activation of the quadriceps muscle, stability of the knee and we will remove reflexive spasms, in the muscles on the back of the thigh (hamstrings). If the movement in the knee is not blocked, we can activate other muscles in the knee area and start with exercises in a so called muscle chains, which will secure us the centered position of the bone in the knee joint, (the surface of the supporting bones have the biggest contact surface). Damaged meniscus is healing faster during such treatment and the operation doesn’t have to be necessary. We developed this combination of physiotherapy and radial shock wave therapy and called it Physiotherapy All-Inclusive. If we want to support the healing of the soft tissues even more, we can choose a treatment with focused shock wave therapy, which we offer in combination with physiotherapy as FOKUS All-Inclusive.
Video example of physiotherapeutic examination of the knee
Instructions for exercises against knee pain:
- First aid during knee pain
- Exercises during knee pain
- Exercises during knee pain with exercising device
- Exercises for stabilization of the ankle and knee
- Exercises for stabilization of the ankle and knee with exercising device
- Torn anterior cruciate ligament (ACL)
- Torn anterior cruciate ligament - what to do immediately after the injury
- Torn anterior cruciate ligament - conservative therapy or surgery
- Operative methods by a torn anterior cruciate ligament (ACL)
- Post-operational physiotherapy by reconstruction of the ACL ligament
- Damaged knee after injury on inline skates - treatment
Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic
Source: Clinical experience from a private practice in the physiotherapeutic field, FYZIOklinika