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Meniscal tears are common among athletes who experience repetitive running, twisting and cutting on the field. As these activities regularly occur on the soccer field, it's no surprise that soccer players are among athletes most often experiencing meniscal tears.
Understanding the Anatomy of the Meniscus
The meniscus is a half moon shaped piece of cartilage between the weight bearing joint surfaces of the femur (thigh) and the tibia (lower leg). It is wedged shaped and is attached to the lining of the knee joint along its edge. A healthy knee has two menisci. The lateral meniscus is on the outside, and the medial meniscus is on the inside. Together, they act as shock absorbers and stabilizers in the soccer player's knee.
The meniscus is, for the most part, avascular. This means, the meniscus doesn't bleed if cut and doesn't have blood vessels inside. The exception lies at the edge where the meniscus joins to the vascular knee lining, providing the outermost 30 percent of the meniscus with a blood supply. As a result of this avascularity, a torn meniscus can't heal unless the tear is small and confined to the peripheral vascular zone. Similarly, the nerve supply providing pain and sensation to the meniscus is, for the most part, limited to the zone where the blood vessels are located.
Older soccer players may tear their meniscus from experiencing trivial trauma, such as twisting the knee, squatting, or from repetitive activities such as running. These activities can place extra stress on the knee joint. The meniscus has a tendency to degenerate with age, which can make older soccer players more susceptible to meniscus tears. An early arthritic change in the knee joint often takes place in conjunction with degeneration of the meniscus.
Diagnosing an Early Meniscus Tear
Pain, swelling and mechanical symptoms like catching or locking in the knee joint are often symptoms of a meniscus tear. A physician can diagnose a meniscus tear by evaluating a soccer player's history and by conducting a physical examination of the player's knee.
An orthopedic surgeon may order further diagnostic studies like an MRI (Magnetic Resonance Imaging), which provides a three dimensional image of the interior of the knee joint. A minimally invasive surgical procedure called arthroscopy may be needed to inspect the meniscus and, at this time, the tear will be repaired.
Treating a Meniscal Tear
Deciding to repair the meniscus is based on many factors, including: the location and pattern of the tear, the soccer player's age, and predictability of whether the injury can heal. In young athletes with certain patterns of injury, repairing the meniscus tear through arthroscopy may be necessary. In older athletes, certain patterns of tears are not suitable for repair and respond to conservative treatment options such as physical therapy. If these treatments are not successful, and the athlete is still experiencing pain, surgery may be the next step.
Arthroscopic Repair of a Meniscal Tear
Arthroscopy is performed on an outpatient basis and takes one hour or less. Based on the location of the tear, the orthopedic surgeon decides either to remove or repair the tear(s). To remove the tear (called a meniscectomy), the surgeon uses various small instruments that cut out only the torn portions of the meniscus. The remaining meniscal rim is balanced and contoured to provide a gradually tapered transition into the area of the resection. The surgeon tries to leave as much normal meniscal cartilage as possible because it is an important shock-absorbing structure.
After surgery, the athlete remains in recovery for approximately two hours and is sent home with pain medication. Follow up with the physician occurs within the next week. With a proper rehabilitation program, a soccer player usually can expect to return to the field within four to six weeks after the meniscectomy.
Benefits of Meniscus Repair
The meniscus does play an important role in a soccer player's knee. However, once torn and unable to be repaired, many of the beneficial effects of that structure are lost. If a tear is causing pain and impaired function, removing the tear is the treatment of choice.
Dr. Edwards is an orthopedic sports medicine specialist at the Ohio Orthopedic Center of Excellence in Columbus, Ohio. He specializes in lower extremity sports medicine with an emphasis on soccer injuries.
