An 18-year-old competitive hockey player presented to the clinic 1 day after being clipped by an opposing player, causing the player to feel a “pop” in the left knee and have immediate pain on the medial aspect of the knee joint. MRI of the left knee revealed a grade 2 medial meniscus tear and grade 1 medial collateral ligament (MCL) sprain.
Meniscal injuries are a common injury seen in sports. The menisci are thick, cartilaginous, that are attached to the tibia and serve as “shock-absorbers” of the knee. There are two menisci in each knee: one on the medial and lateral side. A medial meniscus injury is generally more common and is often accompanied with some form of MCL injury because of the direct attachment that the MCL has to the medial meniscus.
There are 6 classifications of meniscus tears:
– Radial tear: The most common tear. It occurs in areas that have little to no blood circulation, making healing on its own difficult. Surgery is often required.
– Horizontal tear: Generally easier to repair, especially if the tear is on the outside edge of the meniscus.
– Incomplete tear: Often signifies early stages of degenerative changes. Surgery is not usually required.
– Complex tear: Involves multiple tear patterns. Surgery is usually required.
– Flap tear: A flap of the meniscus is loose, causing a “catching” sensation in the knee. Surgical removal of the flap helps resolve the pain and catching.
– Bucket Handle Tear: Like a horizontal tear but generally larger and often blocks the ability to bend the knee. Urgent surgery is necessary to restore knee motion capabilities.
Management of meniscal tears are generally based upon severity level and patient activity level. Severity of meniscus tears can be classified by grades 1-3. Grades 1 and 2 are often managed non-surgically while grade 3 usually require surgery. Initial non-surgical treatment options include limiting weight bearing activities, icing, NSAIDs, and physical therapy to PrP.