Meniscal Injuries
Eric North, ATC
Hughston Athletic Training Fellowship
In athletics injuries to the knee are commonplace especially in collision sports such as football or contact sports like basketball and soccer. There are many different structures in the knee that can be injured from ligaments to cartilage to bone. Of these structures one commonly injured is the meniscus.
What is the meniscus? The meniscus is a fibrocartilage structure in the knee that deepens the articular surface where the tibia and femur meet. There are two menisci per knee, a lateral and a medial. These fibrocartilage structures are oval in shape and sit atop the tibia to cushion axial stresses placed on the knee, as well as maintain the spacing of the tibia and the femur. As well as helping to reduce stresses placed upon the knee, the medial meniscus is actually attached to the medial capsule of the knee. In each meniscus there are three different zones of vascularity or blood supply that play an important part in healing, the outer third of the meniscus is the most vascular and therefore has the best chances of healing, the middle third of the meniscus has minimal blood supply to it and therefore has greatly reduced chances of healing, and the inner third is completely avascular and cannot be healed due to its lack of blood supply. As with other cartilaginous structures in the body, the menisci can be torn and damaged due to the stresses that athletes place upon their bodies.
How is it injured? The medial meniscus is injured much more commonly than the lateral meniscus due largely to its connection to the joint capsule of the knee. The most common mechanism for injuring the meniscus occurs when the athlete is weight bearing and the knee experiences a rotary force with the knee fully extended or flexed. An example of such an injury would occur when an athlete makes a cutting motion while running, causing the meniscus to distort and tear. During these movements the meniscus becomes trapped and pinched in between the articulating surfaces of the femur and tibia.
What to look for? An athlete who thinks they may have an injury to their meniscus should see their athletic trainer or physician as soon as possible. Following an injury to the meniscus there is usually swelling and pain along the joint line, loss of motion in the knee, locking, catching and giving out of the knee.
How is it treated? There are three options for treatment that depend on the severity and the location of the injury. A mild injury or sprain of the meniscus can be treated conservatively with the RICE (rest, ice, compression, elevation) principle as well as anti-inflammatory medications and crutches. Once swelling has decreased strengthening and range of motion exercises can begin. In the case that there is a tear of the meniscus, surgical intervention is often warranted. When surgery is necessary there are two options, surgical repair or partial removal of the meniscus (menisectomy). Surgical repair is used when damage to the meniscus is in the outer third of the meniscus where there is a strong blood supply and post-surgical healing can occur. Menisectomy is necessary when the damage to the meniscus occurs in the inner third of the meniscus where there is no bloody supply and post-surgical healing cannot occur. Return to full activity can be achieved in as little as two weeks for a menisectomy, while a repaired meniscus will take between 5-6 weeks of immobilization followed by a rehab program to restore strength and range of motion. It should be noted that partial removal of the meniscus can lead to joint degeneration over time.
References:
Anderson MK, Hall SJ, Martin M. Sports Injury Management. 2nd ed. Philadelphia, PA; 2000:460.
Prentice WE. Arnheim’s Principles of Athletic Training. 12th ed. Boston, MA: McGraw Hill; 2006:633.
Starkey C, Ryan J. Evaluatoin of Orthopedic and Athletic Injuries. 2nd ed. Philadelphia, PA; 2002:228.
| Eric North, ATC is a first year graduate student and recipient of the Hughston Athletic Training Fellowship Program in Columbus, Georgia. He received his Bachelors Degree in Health Management with an option in Athletic Training from Southeast Missouri State University in December of 2007, where he graduated with Magna Cum Laude Honors. While attending Southeast, Eric worked with the Redhawk’s football, men’s and women’s basketball, softball, volleyball and tennis teams, as well as spending a semester working at Cape Central Senior High in Cape Girardeau, Missouri. Eric completed an internship with the University of Wisconsin – Whitewater Summer Athletic Camps in the summer of 2007. Eric was a member of Phi Eta Sigma and the Health, Human Performance and Recreation Honor Society and is an active member of the National Athletic Trainers Association (NATA). He currently serves as the Head Athletic Trainer at Shaw High School in Columbus. |
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