Meniscus Tear Causes
The knee is one of the most complex and largest joints in the body. Not only can you flex and extend your knee, you also have the ability to rotate the knee horizontally. The knee provides both strength and flexibility during leg movements, while being loose enough to allow the freedom for quick movements and changes in directions. This strength and flexibility in the knee also makes it more risk for have an injury.
Any one can suffer from a meniscus injury but those that are at greater risk are:
- athletes who play contact sports such as football, rugby, hockey
- athletes that have highly repetitive activities that stress the knee (such as running and skiing)
- frequent activities where a lot of time is spent in a squatting position (i.e. construction labor, carpet-laying, warehouse worker, gardening)
Although knee injuries are more common in women than men, men experience more meniscus injuries and tears (approximately 2.5 males: 1 female). This is believed to be due to men's participation in more aggressive sports and manual activities. For tears due to activity, meniscal injuries in men occur most often between the ages of 31 to 40; for females meniscal tears usually occur between 11 and 20 years.
The most common causes of meniscus injuries in young people is acute trauma to the knee whereas degeneration of the knee joint tissue is the most common cause in seniors. In either case, a piece of the meniscus can loosen or tear and move around in your joint interfering with your normal knee movement and function. A person with a discoid meniscus is also at greater risk of experiencing a meniscus tear or damage.
The most common location for a meniscus tear is in the back of the knee and on the inner side of the knee. In medical terms this means that of the two meniscus in the knee (lateral vs medial), the medial meniscus is more likely to tear. Further to this, the tear is more likely to occur near the posterior horn - which is located at the back of the knee.1
Meniscus Tear Caused By Acute Trauma
Forceful blows to the knee occur most frequently during activities such as rugby, football, baseball, soccer, basketball or racquet sports when you twist your knee, or slow down too quickly. A meniscus injury can occur during a hit if the knee is forcefully rotated while the foot is firmly planted and bearing weight. A meniscus tear can also occur from hyperflexion or hyperextension of your knee (flexion or extension beyond your knee's normal range of motion). A sudden fall on the knee without protection. Hyperflexion or hyperextension can occur during a car accident, while participating in sports or exercising, or during other low-impact activities if the knee is unstable.
Regarding the medial meniscus, young athletes are more likely to suffer a medial meniscus tear combined with a medial collateral ligament (MCL) injury. When the medial meniscus tissue is stressed and pulled, a 'bucket-handle' tear might happen. The most common location for injury is to the posterior horn of the medial meniscus, and longitudinal tears are the most common type of tear that happens.
Regarding the lateral meniscus, young athletes are more likely to suffer a lateral meniscus tear along with an anterior cruciate ligament (ACL) injury. The center or middle body of the lateral meniscus stretches outward when force is applied because it's anchored at the 2 ends (anterior and posterior) while the middle floats freely in the joint. This is why it's more likely for the lateral meniscus to tear in half and possibly rip so severely that it hangs by one thin fiber.
These types of tears generally affect athletes or those under 40 years of age. A medial meniscus tear will frequently occur along with other injuries such as an MCL and/or ACL tear. A combined knee injury is usually seen in contact sports when an athlete gets hit on the outside of a bent knee. A lateral meniscus tear will result more often from a knee that is bent (flexed) excessively and experiences full weight bearing, while the thighbone is turning outward; seen in sports such as skiing.
Meniscus Tear Caused By Degeneration of the Meniscus
In younger people, the meniscus is very flexible and pliable like a new rubber tire. As we age the meniscal tissue weakens and becomes less flexible, more brittle and develops small cracks much like those seen in an old car tire (fibrocartilage). Once a meniscus is degenerated significantly, the weak meniscus can become injured with only slight trauma, such as getting down into a squat. Sometimes there is no one event that can be blamed for the cause of a meniscus tear due to degeneration. Unfortunately, the blood supply to the menisci decreases by 20% by the age of 40 and the body's ability to heal itself becomes reduced. As a result, it is more difficult to heal a tear caused by deterioration than an acute trauma that occurs earlier in life. Approximately 60% of people over 65 years of age will experience some form of degenerative meniscus tear. (source Medscape.com - web resource for physicians and other health professionals.)
Normal wear and tear on the knee tissue can also lead to osteoarthritis. If osteoarthritis sets in, the body releases a chemical substances in the joint cavity which further breakdown and weaken soft tissue, including the meniscus.
Meniscus Tear Caused By A Discoid Meniscus
A discoid meniscus is known as an abnormally shaped meniscus in the knee. The misshapen meniscus occurs during formation - in the fetal stage of growth. If you have a discoid meniscus, you will find that the menisci are flat and disc shaped rather than crescent shaped wedges. Due to its shape, a discoid meniscus is at a greater risk of tearing than a regular shaped meniscus.
There are three types of discoid menisci:
- Incomplete. The meniscus is slightly thicker and wider than normal.
- Complete. The meniscus completely covers the tibia.
- Hypermobile Wrisberg. This occurs when the meniscofemoral ligament that attaches the meniscus to the tibia is absent. Without this ligament, even a fairly normally shaped meniscus can sometimes slip into the joint and cause pain, as well as locking and popping of the knee.
A discoid meniscus generally occurs in the lateral meniscus (1.5-3% of the general population) but can appear in the medial meniscus (0.1-0.3%). There is a greater frequency of discoid menisci reported in people of Asiatic descent with approximately 17% lateral discoid menisci reported. A discoid meniscus is generally found in children less than 11 years of age but the meniscus will often change to a c-shape with maturity, so children will usually grow out of their symptoms.
If there is a tear present in a discoid meniscus, one or more of the following symptoms may be experienced:
- clicking, snapping, buckling and/or locking of the knee joint
- decreased range of motion
- joint pain and tenderness
- atrophied quadriceps (a shortening, weakening and wasting away of the quadriceps muscle)
A discoid meniscus has also been referred to as "snapping knee syndrome". Some people may go through their entire lives with a misshapen meniscus and ever experience any problems.
Should You Seek Medical Attention?
It is recommended that you see a physician with any continued discomfort and/or pain in your knee or if you experience any of the symptoms below:
- Increased or constant instability or inflammation of the knee (swelling, pain, heat or redness) that lasts longer than 2-3 days.
- Locking, catching or buckling of your knee on a regular basis, or very limited range of motion (can't fully extend, bend or rotate your knee or lower leg).
- Constant clicking, popping or grinding sounds in your knee.
- Unable to participate in activities or work due to the pain or limited range of motion.
- Knee looks deformed or you have significant bruising around the joint.
- A traumatic accident may have broken or dislocated a bone.
- Any other unusual symptoms.
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1."Posterior Horn Medial Meniscus Tears - Howard J. Luks, MD". 2019. Howard J. Luks, MD. Accessed July 24 2019. website.