Knee pain is very common and in a lot of cases is very effectively treated without the need for surgery for most cases. It can be very frustrating as it's especially common after increasing exercise and often arises a few months into making some good progress. Before you know it, the knee pain is rapidly affecting your progress, whether that's weightloss, strength or cardiovascular fitness. There are lots of potential causes of knee pain, but one of the most common causes is injury or irritation of the meniscus.
What is the meniscus? Simply put the meniscus is specialist cartilage within the knee, similar in appearance and consistency of a rubber washer. It is generally considered as two separate structures; medial and lateral..or inner knee and outer knee. It's function is stability and shock absorption. Functionally there are two main types of meniscal injury; traumatic and degenerative. Traumatic type injuries usually can be traced back to an incident. Commonly an awkward twist or fall and is associated with instant pain and a pop. The knee will probably swell and be very sore for a week or so. Often there will be bone bruising and depending on the force of the injury ligaments such as the ACL may be injured. The other type of mensical injury is degenerative tears. These happen more commonly in older people. In this case "older" is from 35 (incidently my age at the time of writing this, who knew I was considered older) These injuries happen for no known reason, the knee may swell up after overdoing it with pain usually on the inside of the knee. You won't normally feel sharp pain or a pop. These degenerative tears probably happen due to the meniscus being a thinner and weaker due to aging. Both of these types of injuries can heal by themselves depending on where they occur in the meniscus and whether it has a good blood supply. Even if the tear can't heal often it can settle down and be symptom free. Lots of people have small meniscal tears and don't know about it. Physiotherapy can be helpful to manage the symptoms of swelling and stiffness. Getting back to activity, regaining strength and movement is always the goal. Prolonged rest isn't recommended and return to activity is highly individual. Building up muscle strength and control of the entire leg is key. Often people who acquire meniscus injuries have a hard time with exercises such as single leg squats and lunges. Having poor control on one leg likely stresses the meniscus in harmful ways and improving these qualities will only be of benefit. New research around managing swelling and pain in the early stages recommends against the use of anti inflammatory drugs (nsaids), ice and corticosteroid injections as blocking inflammation early on can interfere with normal healing. The best way to reduce excessive swelling without side effects, is lots of pain free movement and massage may help with this. Very rarely if the meniscus tear is large or can interfere with the joint. The main symptom of this is locking. The analogy I use is imagine putting a marble in the hinge of a door. This is more than just painful stiffness, the joint will feel jammed! This is one of the few times your physiotherapist should recommend a referral for an MRI. Scans are usually only needed if surgery is on the cards and that is based on specific symptoms. The surgery performed for the meniscus is called partial menisectomy via keyhole surgery. The meniscus is tidied and trimmed, removing loose bits or flaps. Previous surgeries performed for the meniscus included full menisectomy and washouts. These are no longer preformed due to being ineffective and / or more harmful than useful! Before the symptom of locking or perhaps alongside, the knee might have a painful catching sensation, but this may be also due to other problems around the knee such as poor alignment of the knee cap or osteoarthritis, both of which can't be treated with meniscus surgery. To conclude, meniscal injuries are probably in the top 3 of all knee pain I see. As a rule of thumb it's always better to rehab these injuries as even if it doesn't improve with physiotherapy having a strong and flexible knee will only help the knee recover after surgery if it comes to that.
Karl Humphreys HCPC Band 7 physiotherapist