What does a torn meniscus feel like?

Menisci are rubber-like c-shaped structures that work like cushions or shock-absorbers in the knee joint. There are two menisci in the knee joint: medial meniscus (located on the side of the knee that is closer to the other knee i.e. the inner edge), and lateral meniscus (located on the side of the knee that is further away from the other knee i.e. the outer edge). Before answering the question “What does a torn meniscus feel like?”, let’s first look at the mechanism of meniscus tears.

Mechanism of the injury
•There will usually be a history of trauma. However, in some cases you may have perceived the trauma as insignificant.
•There will often a history of “popping” or “locking” or “clicking” of the knee during the trauma.
•The mechanism usually involves a quick and sudden twist of the partially or fully flexed knee. Usually the foot is firmly planted on the ground (with your full weight on it) while the knee is bent e.g. while lifting something heavy, playing tennis, playing football, playing basketball, and other sports. This is also known as pivoting.
•The mechanism of the injury may involve squatting repeatedly.
•The tear may be degenerative i.e. due to age related wearing out of the meniscus that makes it more susceptible to injury even with minor forces. For example, the injury may occur when getting up from a squatting position. Sometimes in these older people with this gradual degenerative disease, they may be unable to pinpoint a particular incident that resulted in the injury. i.e. there is no single causative event. 

Symptoms – What you will feel around your knee.
Symptoms are the things that you will feel and therefore complain about if you have a meniscus tear on your knee. Symptoms therefore go to the heart of answering that important question, “What does a torn meniscus feel like?”

1)Pain.
•The pain is around the joint line (a line that passes through the joint).
•It’s location, whether medial (the side of the knee that is closer to the other knee) or lateral (the side of the knee that is further away from the other knee), gives an indication of whether the tear is in the medial meniscus or lateral meniscus.
•The pain is worse on attempting to twist or rotate your knee.
•The pain may be intermittent if the tear is not treated. i.e. it resolves in 1 -2 weeks but then comes back later when you have a twisting injury or when you overuse the joint.


2)Mechanical Complaints.
•After the meniscus tears, a piece of it may remain loosely attached and mobile within the joint, or it may be free due to displacement within the joint resulting in it floating in the joint space. This interrupts the smooth movements of the knee joints and the result is various mechanical complaints that include locking (inability to straighten the knee), buckling (a sensation of giving way), catching, pinching, clicking, etc.
•Mechanical complaints are most pronounced in severe meniscus tears.


3)Swelling.
•This usually not immediate, but occurs the next day. It then worsens over the next 2 -3 days.
•It is due to joint effusions.
•It may also be associated with joint stiffness, joint warmth, joint redness, and joint deformity.
•In some cases, there may be no swelling.
•In degenerative tears (tears that occur due to age-related weakness/brittleness of the menisci), the swelling may be recurrent.


4)Joint Stiffness
•This occurs due to a combination of the above symptoms: pain, mechanical complaints and swelling.
•You will experience difficulty in fully straightening your knee.

There are 3 levels of severity of meniscus tears: mild, moderate and severe. The above symptoms will vary based on the severity of the meniscus tear. 

Signs – What the doctor will find on examining you.
•Poor range of motion. Two things cause this to occur: mechanical impairment of the joint due to menisci fragments, swelling and pain of the joint results in restricted movement.
•Joint line tenderness. This occurs in 77 – 86% of cases of menisci tears.
•Swelling around the joint. This occurs in about 50% of cases. 

Diagnosis
Your doctor will perform several maneuvers on your knee that help in the diagnosis. An MRI will confirm the diagnosis. 

Management
Management depends on the severity of the tear i.e. whether it is mild, moderate, or severe.
•Mild injuries often resolve in 2 -3 weeks with conservative management via the RICE protocol and anti-inflammatory pain killing medication. The RICE protocol involves Rest to avoid excessive weight bearing, Ice-pack to reduce pain and swelling, Compression of the knee to prevent swelling (with elastic bandage, knee straps, or knee sleeves) and Elevation.
•Moderate to severe injuries often require surgery (after the initial conservative management) to repair the meniscus, or excise the displaced meniscus fragment (partial meniscectomy), or excise the entire meniscus (total or subtotal meniscectomy) with or without meniscal reconstruction / transplant.
Post-operative rehabilitation and physiotherapy help with further recovery of joint function.

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