Meniscus Injury Showdown: Physiotherapy vs Surgery

What is a Meniscus?

The menisci are two pieces of fibrous cartilage, like the cartilage found in your ears and nose.

They are crescent or moon shaped tissues that lie between the knee between the bones of the thigh (femur) and shin (tibia).

Your meniscus acts like shock absorber and provides stability to the knee joint.

It absorbs and distributes the force and enables it to function under loads during walking, running, jumping, pivoting and making rapid direction changes.

It is a fantastic piece of tissue in your body!

How does a tear happen?

A meniscus is usually traumatically injured when someone has direction change with a slightly bent knee.

Younger patients will report this injury occurring traumatically either while playing sport, a slip/trip or contact with another person or object.

Older patients may not notice a specific moment or incident. Like all our joints degeneration occurs naturally as we age and the meniscus is no different.

"Meniscal tears are common within older people, BUT are not always the the cause of your knee pain"

Kyle Wells: Fighting Fit Physiotherapist

What are the signs and symptoms?

The history of a painful twist with a bent knee can give a good indication of the likelihood of a meniscal tear.

Like most knee injuries, there will be symptoms of pain and swelling of the knee which you might notice the day after, or you might not be able to fully straighten or bend your knee after it.

There may also be experiences of popping, clicking or locking of the knee joint.

What type of Injury to the meniscus is this? READ ON TO FIND OUT!

A FightingFit physiotherapist will use a through history, assessment and special tests like Thessalays or McMurrays test to help confirm a meniscal tear diagnosis.

Types of Meniscus Injuries?

There are many types of meniscal injuries depending whether the initial injury was traumatic or degenerative.

Symptoms that develop 24-48 hours following the injury, may have minimal swelling, full range of movement and mild pain can be indicative of a minor/moderate injury.

Some meniscal injuries build up over time due to normal wear and tear as we age.

While a severe meniscal injury, ie one with a twisting injury can be more severe with pain, swelling and significant limitations in range of motion, even sometimes resulting in a locked knee need to be seen to immediately.

Some meniscal injuries have intermittent and spontaneous “locking”, this can be indicative of a bucket handle tear.

Kyle Wells: Physio

Do they heal?

There are two zones of blood supply for the meniscus. These are called the Red Zone and the White Zone

Red Zone – The outer zone has a good blood supply both from vessels and the fluid inside the knee, a disruption to the meniscus in this zone has a good chance of healing on its own or when surgery is done to repair it.

White Zone – This inner zone only gets nutrition from the fluid inside the knee. Therefore, it will not be effective healing on its own.

Surgical vs Physiotherapy Treatment?

Surgical

The aim of surgical treatment is to preserve as much of the meniscus as possible and is based on multiple factors:

Improvement with conservative management? If there has been little improvement in range of motion, pain and/or function with weeks of conservative management, then surgery maybe indicated (but be careful your previous therapist might have just sucked at their job)

Is it a small tear?
Meniscus tears that are less than 5mm, in the red zone have a good chance on healing on their own. Even if they aren’t in the red zone, white ones tend to just settle on their own too. So wait and see is the first option!
How old are you?
Younger patients will generally heal quicker and have better outcomes than older patients, but don’t stress older people with the right physio will get better too!
Where is the tear?
The location of the tear can affect healing times or surgical accessibility.
What kind of tear is it? A longitudinal tear is easier to repair than both the radial tear or flap tears . A bucket handle tear with severe symptoms will be a more likely candidate for surgical repair

Good surgeons will opt for a period of Physiotherapy treatment to see whether surgery is appropriate.

Physiotherapy

Physiotherapy management of meniscal injuries has good success rates and improvement in function over six to eight weeks depending on the person and injury.

Fighting FitPhysiotherapy uses an individually tailored treatment to restore function.

When working alongside a Fighting Fit Physiotherapist we will:

Reduce pain and inflammation, normalise joint range of motion and muscle length
Begin a specific and graded exercise program to strengthen your knee muscles (especially the quadriceps and hamstrings)
Continually build on the strength of your core, gluteal, and lower limb muscles
Improve your proprioception, balance and function when walking, running, squatting or playing sports.
And most importantly, getting you back to what you want to do while minimising the chance of reinjury

Collaboration between your Physiotherapist, GP and Surgeon is the best way to determine whether surgical or non-surgical treatment of meniscal injuries is required

Final thoughts

Don’t rush into surgery.

It is an option that can always be used at a later date if conservative management is not reaping the outcomes you and your therapist want.

As a physiotherapist I advocate a period individually tailored physiotherapy management first.

In the long term a patient can have better results delaying or not messing the meniscus.

Brenda Samosa

05:52 07 Nov 24

I had a really bad shoulder and had been seeing a different physio for 3 months (from a different place) I got told Tyson was good. After just a few sessions the movement was coming back. I’m 66 and was worried I would have to stop surfing. But with a lot of help from Tyson I’m back in the waves ( thank you so so much)

Cyana Ferguson

08:16 30 Oct 24

Steve Harris

22:33 15 Oct 24

Great team, all friendly, super helpful and first class clinical advice and a big shout out to my Physio Noah with my shoulder issue

Andrea Bell

05:33 19 Sep 24

These guys are the best in the biz 🎉

Ryan Brockett

04:20 18 Sep 24

Shout out to Max from fighting fit physio. He helped me out massively straight after shoulder surgery and back into work and sports in no time. Couldn’t recommend anyone better!

Scotty

08:31 31 Jul 24

Five star service from Max & the team!
Professional & very thorough, you know that patient outcomes are of the highest priority.
I highly recommend this business.

Riley Wilson

08:27 14 Jul 24

Be AWARE they’ll immediately try to commit you to multiple follow up sessions after your initial consultation. This happened to me and then I later found out that as it just so happens, they have a cancellation policy that says you have to pay 100% of the consultation fee for cancelling. They failed to tell me this when they were pushy in committing me to 6 sessions after my consult, so that was a really nice little surprise.

I was already uncomfortable with how pushy they were in having me commit to so many sessions, so when I heard about the policy I just cancelled all together. So, I can’t speak further to the quality of their service throughout therapy phase. FYI this was also a few months ago now, it’s possible (though unlikely) they may have changed the policy. Just ask the question.

Megan Shelley

06:51 03 May 24

Fighting Fit Physiotherapy is hands down the best physio I've encountered. Having tried multiple physios for various injuries, I always find myself coming back to them. Their expertise consistently exceeds expectations, helping me get back to my sport faster than I thought possible. Their personalized approach and attention to detail make all the difference. I could not recommend a better or more exceptional physio team!

Gina Matthews

08:41 24 Mar 23

Can't recommend this place high enough. I was in so much pain with my knee an had been for months through advise an exercises I'm now looking forward to returning to gym an back riding my horses in endurance thank you so much

Courtney Halse

01:36 29 Nov 22

Kyle was knowledgeable, personable and professional. He saw me through my second pregnancy and continued to work with me until 6 months post partum on issues with my back. Would recommend anyone to go and see him.

Also shout out to Georgia on the front desk. She makes you feel welcome and brings a sense of warmth to the place!

Alli Davenport

08:07 04 Nov 22

After hip replacement surgery in February I wanted toget back into weight training legs, I started with Mitch 18 weeks ago and after a lot of hard work and sweat I am able to safely train again, I cannot thank Mitch enough for his support,encouragement and knowledge. The staff are friendly and helpful and I always looked forward to my session's

Robert Parkinson

10:50 15 Aug 22

This is the second time I have been treated by the team at FFP.
As a health professional myself I have been impressed with the level of care I have received from all members of the team.
The personalised treatment and rehabilitation programs have produced excellent results and I have completed both programs pain free and feeling stronger than before my injuries.
During the program there was constant communication and follow up and they were very accommodating with my work schedule.
All in all it was a very holistic experience and I would highly recommend the service.

Kiri Canavan

07:30 08 Jun 22

Tyson was amazing! We came up with an 8 week plan at my first consultation with weekly check ins and updates to exercises. 8 weeks later, I am pain free and able to train harder than ever. Highly recommend and the staff are all fantastic and super accomodating!

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