Meniscus injuries are common in the sporting population and even older adult population (above 40). The meniscus are fibrocartilaginous structures that help absorb force and shock through the knee joint, ultimately playing a vital role in overall knee health from degenerative changes to the articular surface. They are attached on top of the articular surface of the tibia (shin bone), where they help increase the congruency of the knee joint. The ends of the femur (thigh bone), the femoral condyles sit on top of the two menisci. Due to their crescent/ C-shaped anatomy, they help reduce axial stress and rotational forces through the knee. An acute injury to the meniscus occurs when the absolute stress applied axially (compressive force), combined with a forceful rotation of the femoral condyle, exceeds the menisci’s ability to resist this stress.

Young athletes who play change of direction sports like Australian rules football, soccer, rugby league, rugby union, netball, basketball and hockey are at an increased prevalence for sustaining an acute injury to their meniscus. The older population (>40) commonly presents with a new onset of knee symptoms, however they have likely already had asymptomatic features of degenerative menisci damage. This population may present to the clinic with no real acute injury mechanism. What is important to note is that these ‘degenerative changes’ are normal findings in the aging population. Exercise and good lifestyle factors will help reduce the risk of these normal changes becoming symptomatic.

The medial meniscus tear is more common than the lateral meniscus tear. This is believed to be due to its increased size and the lack of mobility compared to the lateral. It also has attachments to the medial collateral ligament (MCL) of the knee and the anterior cruciate ligament (ACL). As ACL injuries are quite common in change of direction sports, an concomitant injury to the medial meniscus often occurs.

Can the meniscus heal?

Healing capacity and potential is determined by where the tear occurs on the meniscus. If the tear is located on the peripheries of the meniscus, this has a great chance of healing due to adequate blood supply. However, the meniscus have a poor blood supply centrally on the crescent. If these tears do not respond to conservative management then surgical intervention is recommended. When deciding if surgery is the best treatment option, we will take into account your preferences and associated symptoms that may warrant early surgery. These symptoms may include a severely locked knee, restricting range of motion. Furthermore, a clunky knee that is painful and not responding to about 3-6 weeks of conservative care, will likely warrant surgery.

Evidence of conservative management

There is an abundance of research supporting conservative care for meniscus injuries. These have largely been shown when comparing exercise rehabilitation with an arthroscopic partial meniscectomy in the older degenerative population. What has largely been found in the research is that arthroscopic partial meniscectomy is no better than a sham surgical procedure! Exercise rehabilitation has been shown to have positive clinical outcomes in this population.

Thankfully there has been recent research on the young adult population, who have suffered an acute meniscus tear. When comparing early surgery or exercise rehabilitation in the young adults, up to “74% achieved desirable outcomes with conservative care” (Skou et al, 2022). With these results in mind and with surgery being an invasive procedure with complications, young adults without a severe meniscus tear should trial conservative management before surgery.

At The Reform Lab Osteopathy we provide holistic care and are a point of difference due to our rehabilitation setting. We provide comprehensive rehabilitation services inside the elite gym Project Reform.