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Can a meniscus tear heal on its own? Is going back to sport possible?

"Can a meniscus tear heal on its own? Can I still go back to sports after a meniscus tear without going through surgery?" This is a common question we get everyday.



What is a meniscus?


(Image taken from google)



It is a fibrocartilaginous structure found between the thigh bone (femur) and shin bone (tibia). There are two menisci in each knee covering the inner and outer surfaces partially. They are known as the medial and lateral meniscus, both shaped as C and U wedges respectively. These rubbery cartilages act as shock absorbers in the knee joint during walking, running, jumping etc. They also help stabilize the knee joint and aid in smooth gliding of the bones during motion.



How does a meniscus injury happen?


The meniscus can get injured as a result of twisting or pivoting of both the thigh bone and shin bone during weight bearing movements. This is why it is commonly found in athletes who play sports such as football, badminton, basketball etc that require an incredible amount of switching directions while running or when the knee is slightly bent. If the knee joint lacks stability, the twisting of the thigh bone when the shin bone is grounded can result in a shearing force on the meniscus. A meniscus tear is usually accompanied by a ‘pop’ sound. This is followed by pain that is especially significant when pressure is being put onto the knee joint. Swelling and a limitation in movement depending on the severity of the tear can also occur during the acute stage of injury. A clear sign of a meniscus injury usually involves difficulty or pain when straightening the knee fully or bending it (as if there is a block in the joint). Imagine slipping a folded piece of paper in between the hinges of a door and closing it, there may be some resistance in doing that.


There are a few common types of tears for the meniscus:


(Image taken from google)



A traumatic meniscus tear is normally clean cut while a degenerative one appears frayed. A radial tear in the meniscus is the most common of all tears and is normally the most difficult to heal naturally. This is because the inner part of the meniscus is avascular, meaning it has less blood supply to the area. With this being said, recovery does not come easily as tissues need adequate blood supply for repair. The outer zone known as the red zone has an abundance of blood supply which allows tears in that area to heal naturally.



(Image taken from google)


Can a meniscus heal on its own? Or is surgery crucial?


The answer is yes. As mentioned in the section above, different types of tears depending on the location and pattern of injury determines a meniscus’s ability to regenerate. Studies have shown that conservative healing of the meniscus can take up to 6-8 weeks. This includes rest, ice, pain management and modification of activities during the first few weeks after the injury. However, if pain still persists after 12 weeks and a scan detects a larger tear, surgery may be recommended. Despite the possibility of a meniscus healing spontaneously, precautions should still be taken to avoid worsening the tear. If an athlete goes back to sports or someone goes back to laborious tasks at work without the meniscus being able to withstand the pressure in the knee joint, degeneration such as osteoarthritis can result even at an early stage and worsens as they age.



Can I still walk or go back to sports with a torn meniscus without surgery?


If someone is still able to move the knee joint normally without pain despite a tear, daily activities such as walking, standing or even using the stairs is completely fine. Those who experience swelling or limited range of motion may use crutches initially until pain and swelling has reduced. However, going back to sports may take a while. Most movements in sports involve bearing weight on a single leg and twisting with both legs grounded. Hence, specific strengthening exercises and proprioception training is needed before an athlete is safe to go back on the field.





References:

  1. Babu J, et al. (2016). Diagnosis and management of meniscal injury. rimed.org/rimedicaljournal/2016/10/2016-10-27-sports-babu.pdf

  2. Shiraev T, et al. (2012). Meniscal tear: Presentation, diagnosis and management. racgp.org.au/afp/2012/april/meniscal-tear/

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