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Meniscus-related Knee Pain

  • Method Health
  • Jun 2
  • 13 min read



What is a “meniscus”?

The menisci are two “C” shaped structures semi-fixed to the top of your shin bone in the knee joint. Together as tough hoop-like structures, the menisci help absorb and spread load through the knee, just like the ligaments and muscles around the knee. Around a third of the meniscus has a great blood and nerve supply so not all meniscus changes have the same affect.  




How common is meniscus pain?

Meniscus pain can affect people of all ages, depending on what initiated the knee sensitivity. For those younger than 45, it is the most common cause of knee swelling, whereas for those older than 45, if symptomatic, it is more commonly a secondary consequence of a knee osteoarthritis (OA) flare-up rather than the primary cause of knee pain and swelling.


Clues or common symptoms? 

New meniscus pain can occur after a “traumatic” event, such as after a sudden twisting or fall from a height onto the knee, which can be more confidently linked to a change in the meniscus appearance, well-intended but scarily labeled “tear” or “lesion”. Sometimes in these settings, meniscus changes occur along with ligament sprains or bony injury of the knee.


More often, meniscus pain can also occur after an “atraumatic” event like doing something you have done hundreds of times, previously felt as harmless like walking, running, lunging, or other movements of your active hobbies. In these cases, having isolated meniscus changes without also having knee osteoarthritis is rare. Again, most mistakenly get told they have meniscus pain when they are also having a knee OA-related joint flare-up The Role of the Meniscus in Knee Osteoarthritis: a Cause or Consequence? - ScienceDirect (See our Method Health article for more about managing knee OA flare ups). Both traumatic and atraumatic causes of meniscus pain present similarly, with knee bending pain +/- swelling, a sense that the knee “will give away” and the hard edges of the knee joint can be tender to touch with your hands The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears - PubMed.


Joint feelings during movement such as “clicking”, “locking” or “catching” or the knee fully “locking” in a bent position can occur, which most of the time is due to swelling, rather than the rarer event of the meniscus shape change interfering with knee bending and straightening Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear: A Secondary Analysis of a Randomized Trial - PubMed (nih.gov) As swelling and movement improves, joint “noise” or “locking” will reduce without any need for surgical intervention. Sometime they do not “unlock”, which is where more invasive care might be needed Association of specific meniscal pathologies and other structural pathologies with self-reported mechanical symptoms: A cross-sectional study of 566 patients undergoing meniscal surgery - PubMed (nih.gov)  + Conundrum of mechanical knee symptoms: signifying feature of a meniscal tear? - PubMed (nih.gov) If similar presenting conditions causing swelling and pain, including a bony fracture, ligament sprain, or other metabolic joint conditions like gout or joint infection, are not likely, and you have some or all of the clues already described, the diagnosis can be made and you can start planning management. Medical imaging is not needed for the diagnosis, as most often imaging does not affect non-surgical management choices, which is the form of management that will benefit most Comparison of Accuracy in Expert Clinical Examination versus Magnetic Resonance Imaging and Arthroscopic Exam in Diagnosis of Meniscal Tear - PubMed. Imaging is helpful just in cases where surgery will be helpful (nuanced indications for this are discussed later) or as a prerequisite to an knee injection if the knee is really really irritable A prospective study comparing the accuracy of the clinical diagnosis of meniscus tear with magnetic resonance imaging and its effect on clinical outcome - PubMed If you have already received imaging, it might be worth chatting to one of our physios at Method Health about the chances your imaging findings were incidental and likely present in your knee already, which is common, before your known or unknown trigger for knee pain and seeking medical care Meniscal root tears: a silent epidemic | British Journal of Sports Medicine + Degenerative meniscus tears should be looked upon as wrinkles with age--and should be treated accordingly - PubMed (nih.gov) + Meniscal abnormalities in the asymptomatic population at MR imaging - PubMed 


What is wrong?

In the cases of a traumatic knee injury, meniscus change is obviously due to the high-energy impact of the event. Our immune system reacts to this change, increasing swelling and lots of inflammation in the joint, which in the short term can give you symptoms that are a nuisance but helpful for long-term resolution of knee joint health. In atraumatic and likely a meniscus and knee OA flare-up context, intolerable lifestyle factors have likely accumulated to cause the knee to become sensitive as an overreactive response from your “neuro-immune” systems, and cells in and around your knee try to adapt to these intolerable stressors Arthritis Web Seminar Series Lecture. The meniscus changes seen in most people without pain, can be thought of like kindling for a fire, not sufficient to cause knee pain, but when combined with oxygen (lots of recent negative mental stress, poor sleep, being overweight, reduced regular knee exercise) and then lots of heat (too much, too soon, too fast) can contribute to a fiery knee joint flare up that can take weeks and months to settle. 



What can I do about it? 

Let's start with our non-surgical recommendation, which is recommended for most folks with meniscus pain, even in the long term:


What can Physiotherapy or Exercise Physiology at MH offer?

  • We can offer individual advice on lifestyle medicine to help you modify physical activities to tolerate keeping up with life with knee pain. Knee pain, flare-ups, or joint surgery should not stop you from doing the things you love. We can guide you through a high-quality exercise program to complete at our gym or yours.

  • We can help you create a flare-up plan so any future knee flare-ups do not have a large impact on your life.

  • If you have had persistent knee pain and are very confused about why you still have it, we can help you make sense of the pain, highlight areas of management to prioritise or be more optimistic about, and give you individual guidance to assist in managing and resolving it.

  • We can help you reduce your perceived need for injections or joint surgery if you do not wish to receive these management options. We can increase your realistic, evidence-informed expectations of how injections or surgery might help you. 

  • We can also help support your physical and mental preparation and return to your valued activities with less pain and discomfort if you elect for surgery.

  • If you have already had knee surgery, we can work with your surgeon to help you ensure normal recovery, create meaningful lifestyle change and complete an exercise program that can reduce the risk of you developing or worsening knee OA, reduce your perceived need for further joint surgery in the future and help you get back to the activities you value with high tolerance. 


Busting common beliefs about the meniscus:

 
 
 

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