PRIDE Physiotherapy – Meniscus

Neil - Doctor of PhysiotherapyEvidence0 Comments

southport physiotherapy physio pain rehab

Inside the knee there are two crescent-shaped wedges of cartilage called meniscus. One on the inside, one on the outside. They exist to provide some cushioning between the thigh bone (femur) and shin (tibia) and their shape guides the way in which the knee moves as it bends. Although it’s a large hinge joint, it also has a ‘screw’ mechanism as the joint moves in and out of being locked out straight.

It’s not uncommon for the cartilage meniscus to become damaged. The names of various rips and tears describe their appearance, for example ‘bucket handle’ and ‘parrot’s beak’, and sometimes they just start look a bit frayed and worn in appearance.

The typical symptom of a ‘problematic’ meniscal tear is a clicking sensation or locking, which is referred to as a mechanical symptom. Changes to the meniscus, tears included, don’t necessarily cause pain and changes in the cartilage don’t necessarily cause mechanical symptoms. The challenge however lies is the belief that the ‘issue is in the tissue’ because the evidence doesn’t support that view.

Historically, the management of meniscal tears and things which don’t appear to ‘look good,’ is to shave, trim, cut or remove the problematic piece under anaesthetic in a hospital theatre. If the tear which shouldn’t be there is cut out, then the pain and locking (believed to be coming from it) should disappear right!? Generally speaking, manual therapists use manual therapy, medical practitioners use medication and surgeons use surgery. If a surgeon sees a suspect looking meniscus, it’s entirely feasible that they may recommend surgery. It is after all what they do.

I’ve stood next to a shoulder surgeon in theatre and watched him cut the bicep tendon of an elderly man because the tendon looked slightly frayed (it looked just fine to me). He suggested that its appearance was sufficient to be the cause of the gentleman’s pain and simply cut it saying “he doesn’t need it, it’s just a remnant of evolution”.

This article demonstrates that the common process of sticking scopes into knees to “tidy up” meniscal tears doesn’t improve mechanical symptoms.
People in pain typically want a panacea. For those with mechanical knee symptoms and a concurrent meniscal tear, a partial menisectomy isn’t it.

Food for thought.

http://annals.org/article.aspx?articleid=2490532

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