INJECTION THERAPY FOR MENISCAL CARTILAGE TEAR

What is a meniscal (cartilage) tear?

A meniscal (cartilage) tear is a frequent knee problem that affects people of all ages. It’s frequent in those who participate in impact sports like jogging, and it’s more common in people who participate in twisting sports like football, tennis, and squash. Localized pain, swelling, and a restriction in bending and/or straightening your knee are all symptoms of this condition.
You will feel discomfort on the inside of your knee if the medial meniscus (located on the inside of the knee joint) is torn. You will feel discomfort on the outside of your knee if the lateral meniscus (located on the outside of the knee joint) is torn. If both menisci are ripped, you will have pain on both the inside and outside of your knee. If you’re having what’s known as’mechanical’ symptoms, you could need a surgical opinion. When the knee joint becomes stuck or ‘locked’ in one position and/or you suffer a painful ‘catch’ in the joint, these are known as’mechanical’ symptoms.
 
A thorough clinical examination and an MRI scan are required to diagnose a meniscal injury. If you have a meniscal tear, the first line of treatment is physiotherapy, which will likely include advise on activity modification as well as rehabilitation exercises to help you regain full range of motion and increase the strength and stability of your knee joint.
 
An ultrasound guided injection can provide fast pain relief if your pain does not improve with physiotherapy or if you are unable to participate in treatment because your knee is swollen and painful. Steroid and hyaluronic acid (HA), injections are the alternatives offered. The best injection for you will be determined by a number of parameters, including your age, functional level, sports ambitions, precise diagnosis, and whether you have osteoarthritis (OA) as a result of your meniscal rupture.

What are the signs and symptoms of a torn meniscus (cartilage)?

A meniscal (cartilage) tear causes the following symptoms:
 
  • Depending on whether it’s a medial meniscus tear (pain on the inside of the knee joint) or a lateral meniscus tear (pain on the outside of the knee joint), pain will be felt on the inside or outside of the knee joint (pain on outside of the joint)
  • When bending and straightening the knee, there is swelling and constriction.
  • Locking and catching are mechanical indications.
If this sounds like you, keep reading…
 What other symptoms could be mistaken for meniscal (cartilage) tear?
If this does not sound like your discomfort, there are a number of different conditions that can cause pain similar to a meniscal (cartilage) rupture, including:
 
  • Pain in the patellofemoral (knee cap) joint
  • Patella tendinopathy (jumper’s knee) 
  • Bursitis of the pes anserine
  • Knee osteoarthritis 
  • The iliotibial band (ITB) Runner’s knee (friction syndrome)

Osteoarthritis of the knee vs meniscal (cartilage) tear

A meniscal tear causes pain on the inside of the knee, can cause swelling, and is commonly accompanied by movement restriction. If you have osteoarthritis of the knee, these symptoms are very similar, and these two disorders frequently coexist, especially in those over the age of 40 or 50. Osteoarthritis is characterised by a slow onset of pain and stiffness, whereas a cartilage tear is typically triggered by a twisting injury in people under the age of 40.
 
Osteoarthritis (OA) of the knee is more common in older people, and it causes more diffuse (all-over) knee discomfort. Furthermore, those with knee osteoarthritis are more prone to have discomfort and stiffness in the morning, and it takes around 30 minutes for the knee to loosen up. Meniscal (cartilage) tears are less likely to cause morning stiffness and pain.
 

What is a meniscal tear?

The meniscus is a C-shaped cartilage that sits between the knee joint and can tear if you twist your knee in an unusual way. It gives the joint stability and cushioning. A medial (within the knee) and lateral (outside the knee) meniscus are present. There are anterior and posterior horns on each meniscus. The most common meniscal tear occurs in the medial meniscus’s posterior horn.

Unusual twisting and rotating movements to the knee that strike the cartilage, such as during a football tackle, are common causes of meniscal tears. An acute meniscal tear is what this is called. They can sometimes happen for no apparent reason, especially as we age, and are known as degenerative meniscal tears.
Meniscal rips come in a variety of shapes and sizes (see image below). The only method to determine what type of tear you have is to undergo an MRI scan.

Is a meniscal tear treated with an injection?
Meniscal tears usually heal after a period of rest and rehabilitation. Only if you have certain ‘mechanical’ issues is surgery recommended. Locking of the knee and a severe loss in range of motion are possible signs. Unless pain is accompanied by these’mechanical’ symptoms, surgery is not recommended.

Injection treatment is recommended for a select group of individuals for whom surgery is not an option and discomfort is restricting their range of motion and function. An injection does not cure the tear, but it helps relieve the joint’s discomfort and inflammation. An injection can provide you with a pain-free window of opportunity to work with your physiotherapist to strengthen your knee and restore normal joint mechanics.

The discomfort associated with a meniscal tear is frequently caused by inflammation of the joint lining rather than the tear itself. The synovium is the lining of the joint. Joint synovitis occurs when the synovium becomes inflamed. The best technique to diagnose synovitis is using a diagnostic ultrasonography.

Before we consider injectable therapy, we will always perform a diagnostic ultrasound of your knee at Joint Injections. This also assists us in injecting the correct location of the knee. The ultrasonography prior to injection is included in the price.

The ultrasound scan will also determine how much fluid, or swelling, is present in your joint. A joint effusion is a collection of excess joint fluid. If your knee is swollen a lot, we’ll ‘aspirate’ it to get rid of all the excess fluid. This usually results in a quick and positive improvement in your pain and range of motion.
Meniscal cysts, which can develop as a result of a meniscal tear, can also be seen with ultrasound. Meniscal cysts are tiny fluid-filled pockets that form on the surface of the meniscus. The cyst can be evacuated under ultrasound guidance. This can be a very effective pain-relieving technique.

When should a steroid injection for a meniscal tear be considered?
Before any injection, each patient is thoroughly evaluated to verify that the treatment is appropriate for them.

Injection treatment should only be explored if your discomfort isn’t getting better and you’re having trouble doing things like walking, kneeling, going up and down stairs, and/or squatting. We also meet a lot of clients who are unable to participate in sports, such as football, cricket, or going for a run, because of knee pain.

If your pain is preventing you from participating in a physiotherapy programme, an injection can assist to relieve the discomfort and provide you a window of opportunity to continue with your activities.

If you’ve had knee pain for less than 6 weeks, injectable treatment is unlikely to help.

Many orthopaedic surgeons we work with would frequently try one injection for a meniscal injury before recommending surgery. This can often help you avoid surgery and minimise your pain. A group of patients with a meniscal tear and osteoarthritis in their knee joint is also present. Meniscal surgery with osteoarthritis has a poor result, thus these patients are unlikely to be offered surgery. An injection followed by a course of physiotherapy can help this group.

We recommend that you take the following steps before considering a steroid injection:

  • Prevent or minimise your running, for example, to avoid or reduce aggravating movements and activities.
  • Consider using an anti-inflammatory cream. Because the joint is so superficial, topical medicine applied to the painful area may be beneficial (speak to a pharmacist)
  • Physiotherapy to increase the range of motion of your knee joints and the strength of your leg muscles, particularly the quadriceps muscle (the muscle on the front of your thigh)
  • Wear a light neoprene brace if necessary.
  • Allow time for the body to recuperate. Before considering injectable therapy, we recommend waiting at least 6 weeks.

What injection is effective for meniscal tear?
We have a staff of highly specialised physiotherapists at Joint Injections who do ultrasound-guided injections for meniscal problems. Steroid or hyaluronic acid injections are the two most common choices.

Injection of Steroid
Steroid is a powerful anti-inflammatory that is injected into your knee joint under ultrasound guidance. This guarantees that the medicine is delivered to the proper location. We use ultrasound guidance for all of our injections to ensure accuracy and effectiveness. A local anaesthetic is also given to alleviate any pain that may be experienced during the process.

Injection of Hyaluronic acid
Hyaluronic acid is a lubricant that occurs naturally in the body. It is not considered a medication and is a safe and effective alternative to steroids. Although hyaluronic acid has anti-inflammatory qualities, it is not as effective as steroids. It works by lubricating and increasing the joint’s shock-absorbing qualities. Ostenil Plus and Hyaluronic Acid are the products we use. These hyaluronic acid formulations have the largest molecular weight of any on the market. Both injections are one-time events.

For a meniscal tear, how many injection are allowed?
Most of our patients simply need one injection to relieve their pain and finish their therapy. If the pain reappears, we may need to repeat the injection, but this is uncommon. Injections of hyaluronic acid can be done on a yearly basis.

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all knee disorders. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.