Sport injury series: Meniscal tears Q&A

Bhupinder Mann With summer on our doorstep, we are becoming more active and prone to sports injuries. Our Q&A series will cover the more common sports injuries, how to prevent them or treat them.

Mr Bhupinder Mann, Consultant Orthopaedic Surgeon at BMI The Chiltern Hospital and BMI The Shelburne Hospital, offers his insights on a rather common sports injury: the meniscal tear. Mr Mann explains how we can injur this area, what are the treatment options and the recovery. 

Mr Bhupinder Mann
The meniscus is a c-shaped structure inside the knee joint. Its function is to protect the knee joint. Injury to the meniscus can occur from relatively low velocity twisting mechanisms through to more high velocity sporting injuries..

Mr Bhupinder Mann
A torn meniscus classically causes mechanical symptoms in the knee. These include pain, locking (an inability to fully extend the knee), giving way and clicking.

Mr Bhupinder Mann
Often the history and examination is strongly suggestive. There is often a twisting and indirect knee injury with a delayed onset of swelling. An instantaneous swelling is often suggestive of an anterior cruciate ligament rupture. 

On examination an inability to crouch is often present. 

The gold standard is to obtain an MRI scan which provides an unrivalled view of any structural derangement within the knee.

Mr Bhupinder Mann
Acutely one requires rest, elevation and ice packing along with the usual pitch side first aid measures. Physiotherapy including massage, range of motion , strengthening and proprioceptive work may be beneficial. 

Early intervention in the form of arthroscopic surgery is indicated in young athletes especially when there is a repairable meniscal tear. In such cases the meniscus is repaired with keyhole sutures. This is a fully tissue preserving technique. 

In cases where the site and morphology of the tear are such that repair is not possible a partial menisectomy is performed. This is a very gentle trimming/shaving away of the damaged tissue down to a stable edge until the c-shape is reconstituted.

Mr Bhupinder Mann
The benefit is very often a return to the premorbid functional level. Overall it’s a very safe procedure which is performed as a daycase under general anaesthesia. Risks include infection, bleeding, numbness, nerve damage, non resolution of symptoms, stiffness, swelling, redo procedure, clots and embolism.

Mr Bhupinder Mann
A useful way to look at it is that surgery is the first half. The second half which is equally as important is the therapy. This is often divided up into phases. 

The first phase focuses on soft tissue massage, wound healing, range of motion and strengthening exercises. In the second phase cardio and proprioceptive work is added in. In the third phase more aggressive plyometric and sports specific work is encouraged.