Meniscus tear

With a wear-related tear and no locking, a build-up exercise programme over three months is as effective as keyhole surgery — that is well studied. It is different with a true injury tear in a young person or when the knee locks.

If the knee can no longer be fully straightened because something is caught in it, that belongs looked at quickly — then an operation can be the right thing and sensible early on.

The muscle at the front loses strength within days and is the most important protection for the meniscus. Straightening the leg while seated, squats within the pain-free range, cycling with little resistance.

In the acute phase with a swollen knee, cool it; later, when it is mainly stiff in the morning, warmth before moving does better.

When walking, several times the body weight acts on the knee, on stairs even more. So every kilo less does noticeably more here than elsewhere.

In degenerative meniscus tears without locking, comparisons show no difference at twelve months between arthroscopy and an exercise programme. With a trapped meniscus and true locking it is different. From forty, about one in three has a meniscus tear on MRI with no complaints; from sixty, nearly one in two. After a repair, protection lasts four to six weeks; after partial removal, loading is possible sooner.

Painkillers and cooling take the irritation away — they stitch no tear. Whether it is repaired or trimmed depends on blood supply: only the outer rim of the meniscus has a blood supply and can heal; the inner part cannot. In tears without locking and in wear, comparisons show no difference at twelve months between arthroscopy and an exercise programme — one of the clearer findings of recent years.

Slightly swollen after training means the load was more than the joint tolerates at the moment. After a partial removal there is less cushion, and the knee reports earlier. It can be measured with the stroke test: lying down, stroke upwards on the inner side below the kneecap, then stroke the outer side downwards — if a wave returns on the inner side, there is fluid. Grade 0 no wave, 1 small wave, 2 returns already while stroking, 3 tense. Compare the morning before training with the morning after: if the grade is higher, it was too much. Then less weight, fewer repetitions, no jumps — without stopping altogether.

Fluid in the joint brakes the front thigh muscle through a reflex — already in an amount barely visible from outside. So the knee does not only swell, it also becomes less secure, and a less secure knee is loaded more again at the next session. After swelling, start without movement: leg straight, tighten the thigh, pull the kneecap up, hold ten seconds, ten times. If the muscle fires more weakly on the operated side, that is the damping — it recedes with the swelling.

Heel test: on your back, both heels on a rolled towel, legs relaxed. If the back of the knee stays higher on the operated side, extension is missing. That comes before any strength exercise — a knee that does not straighten fully loads itself slightly askew with every step. If extension is missing lastingly, even without swelling, it should be examined, not trained away.

A point that can be shown exactly on the inner or outer joint line, painful on pressing and on deep bending — unlike a diffuse pain over the whole kneecap.

The movements that hurt are very characteristic: turning while standing, getting up from a squat, getting out of the car, going down stairs.

A knee that suddenly cannot be fully straightened, or a catching that releases with wiggling. That is the sign that makes an operation more of a question than usual.

In young people a twisting event usually stands at the beginning. From about forty tears also arise without a cause, as part of wear — and then an operation usually brings less than exercises.

A knee can feel locked without anything catching: stiff and braked because swelling or pain hinders the movement. This pseudo-locking improves as the swelling recedes. True locking comes back, even without swelling, and often releases only with a click or a shake. The distinction decides whether patience or an examination is the next step.

If an operated knee swells warm and reddened, with fever or increasing pain at rest, that is not a training matter but a call to the clinic the same day — the more procedures on the same joint, the more so. Likewise a swelling that turns tense within a few hours: that points to blood in the joint.

A meniscus tear produces no inflammatory values. If they are raised and the knee is hot and tense, an inflamed or infected joint is at issue.

If the pain comes in attacks with redness rather than on twisting and bending, gout belongs considered.

With several joints involved, morning stiffness and swelling without an accident, a rheumatic cause is looked for.

Without vitamin D only a fraction of the calcium from food is taken up. It is the value that is most often too low with bone and joint complaints.

The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.

Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.

Bone is a third protein scaffold, and the muscles that hold it need protein too. In older people too little protein is more common than too little calcium.

Needed for building calcium in and for vitamin D to work. A lack slows both — even when calcium and vitamin D are supplied in sufficient amounts.

The best-selling joint preparations and the best studied. The large GAIT trial found over two years no advantage over dummy treatment; only in severe pain did a subgroup show something. Tolerable, expensive, and on a tear in the meniscus they do not act — cartilage and meniscus are two different tissues.

For tendons and ligaments there are pointers from small studies when 15 g are taken about an hour before loading, together with vitamin C. For the meniscus itself this is not studied — from the middle third onwards it is barely supplied with blood, and what is not supplied with blood no preparation reaches.

After an operation or during rest the thigh muscle breaks down quickly, and a low level speeds that up. The strength in that muscle decides the later knee more strongly than any ingredient — vitamin D only holds the groundwork for it.

Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.

The meniscus loses water content and elasticity after menopause — which is why it then often tears without an accident, on rising from a squat. A tear without an event is the rule after fifty, not the exception.

With diabetes meniscus and cartilage heal less well, and the results after an operation are measurably weaker. That is one of the points that belongs mentioned before a procedure.

Ligament tissue needs 6–12 weeks and collagen as building material; vitamin C is needed to cross-link it. 1.2 g protein per kg a day covers the need — in a good nutritional state supplements add nothing beyond that.

In degenerative tears from about forty exercise therapy matches arthroscopy in several studies — the same result after two years. With a locked knee this does not apply.

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