Treating a Meniscus Injury:

Once your medical professional has diagnosed your condition, they will recommend the most effective treatment for your meniscus injury. They will consider your activity level, age, the location and type of your meniscus injury, as well as when it happened, the symptoms you experience and any other associated knee injuries, when determining whether conservative or surgical treatment options are more appropriate. Conservative treatments are generally recommended for partial, stable and degenerative meniscus tears. Surgical options are used more often for larger, complex or displaced tears.

During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your knee area until your pain and inflammation settle. Scar tissue will often develop as a result of injuries once acute inflammation begins to decrease. As your damaged knee tissues heal this dead, fibrotic tissue will develop instead of forming brand new healthy tissue. This tissue adheres to your muscle fibers, tendons, ligaments, fascia, nerves, and joints causing pain and preventing them from moving properly (this limits your range of motion, flexibility and strength).

Some small meniscus tears have no symptoms at all and may disappear on their own. Other small tears will subside with conservative treatments, especially if your knee is stable and doesn't lock. These tears are often located on the outer edges of your meniscus and have access to a lot of blood supply, which helps them heal quicker (ultrasound therapy is very effective in increasing blood supply in this area, see below for more details).

You will generally notice great knee improvement within 6 to 12 weeks; however it can take months for you to return to normal. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results. If you start using your knee before it has a chance to heal properly (even though it may feel better), you can end up doing a lot more damage than good!

Younger patients tend to have higher success rates with meniscus injuries than older individuals, as their conditions are generally a result of trauma to healthy tissue rather than degeneration over the years. Individuals with a discoid meniscus will often receive conservative treatments if they experience no major pain. However, surgery is often used if symptoms do not subside as they grow.

Conservative Meniscus Injury Treatments:

To decrease inflammation and relieve pain for a chronic or diagnosed meniscus injury, adhere to the URICE philosophy within the first 48 - 72 hours

• Ultrasound around your injured knee for 5 minutes, 3 times per day. This is best accomplished with a personal, therapeutic ultrasound device.
• Rest your knee and limit your activity (if you are able to move your knee); you may want to use crutches or a cane to prevent weight bearing on the joint.
  
  
• Ice your knee 2-3 times/day for approximately 15 - 20 minutes at a time (do not apply ice directly on your skin, rather wrap it in a cloth or towel) to reduce blood flow to your injured area.
  
• Compress your knee if possible by adding light pressure to minimize swelling (make sure the compress is snug, but not too tight as it could cause numbness, tingling or more pain).
  
• Elevate your knee above chest level to relieve the pressure from swelling and allow fluid to drain from your injured area

If you do not have access to ultrasound therapy or you have experienced an acute knee injury and/or have not been diagnosed, adhere to the RICE philosophy within the first 48 - 72 hours.

Ultrasound therapy is a great therapeutic option to decrease pain, inflammation and soft tissue (muscle, ligament, tendon, connective and nerve tissue) damage experienced with a meniscus or knee injury. This can be received using a portable, home ultrasound device (self-administered) or by seeing a physiotherapist. The treatment is safe, easy, painless, and generally requires between 5 Ð 10 minutes. It is based on a form of deep tissue therapy, which is generated through high frequency sound waves (that we can not hear). These waves send vibrations deep into your body and raise the temperature of your soft tissue. The waves are delivered through a hand held transducer and medicinal conductive gel that are used together in a slow, circular motion on your skin over the injured area. You may experience a slight tingling or warm sensation during the process as a result of the gel; this enhances the therapeutic effects of ultrasound (Phonophoresis).

Ultrasound therapy increases collagen and tissue elasticity, which in turn promotes circulation (blood flow) and brings oxygen and nutrients to your injured knee area. This cleans your tissue by getting rid of cell waste products and allows your meniscus injury to heal correctly. If not treated properly injured tissue can heal with a weakened state, which can lead to scar tissue or calcification. If used on an ongoing basis, ultrasound will help to improve your range of motion by breaking down any scar tissue that may form in the knee area. Ultrasound waves penetrate deep into your tissues, relax your muscles, decrease chronic inflammation and accelerate your recovery rate, so you can return to your daily activities as soon as possible.

Pain and anti-inflammatory medication (NSAIDs - Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain. The use of ultrasound in conjunction with NSAIDs can greatly improve the effect of this medication and can help to heal your meniscus injury quicker. However, NSAIDS aren't recommended for long term use, as they can cause gastrointestinal difficulties, trigger other side effects and even inhibit the body's natural ability to heal itself.

Some health professionals have also recommended natural supplements such as Glucosamine, MSM, Chondritin, or Hyaluronic Acid to help strengthen your injured tissue.

Once the initial inflammation has decreased, you can provide pain relief and improve your knee function by alternating a cold and hot compress to increase the blood flow to the area. Gentle massage around the injured knee area or small flexing or extending knee movements (if not painful) will also help increase blood flow, oxygen, nutrients, and will prevent stiffness.

To increase your comfort and prevent further damage you may want to use a compression or stability knee brace, which will help support the area and reduce stress on the injured tissue. These braces can be used until the injury is gone or during contact/active sports for additional stability. However, they should not be worn at all times, as they can limit muscle development, cut off circulation and impede healing of your muscle tissue.

If pain and inflammation persist, you can see your physician to investigate cortisone/steroid injections or topical medications, which may help reduce swelling and inflammation. However, these should be used with caution and never in conjunction with ultrasound therapy.

Physical Therapy is a beneficial way to help decrease pain in the soft tissues, restore atrophied muscles and improve knee and leg strength and mobility. The type of physical therapy and the duration will be dependent on the extent of your meniscus injury.

Once your pain starts to diminish, a physiotherapist will also set up an individualized knee and leg strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return to performing your normal routines. Individuals will often exercise or lift weights on their own to try and build up their strength; however in doing so, they can do more damage. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is effective. For best, long-term results use ultrasound in conjunction with physical therapy and an exercise program.

Rehabilitation for meniscus injuries that receive conservative treatments often adhere to the timeframe noted below, however they are specific to the individual:

• First 2-4 days - URICE, crutches and/or a cane for protective weight bearing while walking until swelling goes down.
  
• 2-4 weeks after - flexion/extension exercises for motion and strength (no rotation), ultrasound therapy and physical therapy.
  
• 4-6 weeks after - strengthening and stretching exercise program, ultrasound therapy and return to activities, if symptom free.

Evaluate how you use your knee in daily activities to determine if you can decrease stress on the injured tissue. This may involve changing your technique, using correct or supportive equipment (proper shoes, knee braces) and/or implementing ergonomically-sound structures to help you perform your tasks more effectively and safely (prevent you from squatting or bending your knee as much). Taking more frequent breaks during your work or activities can also alleviate stress on your knee joint. Speak with a professional in the specific activity or work setting to get the proper information.

Your progress will be observed for approximately 2 - 3 months; if no symptoms are experienced after this time, no surgery is generally required.

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