Torn knee cartilage? Is it under the knife or can you continue running? What is a cartilage tear?
A meniscus is a piece of cartilage that provides a cushion between your thigh bone (femur) and the shin bone (tibia). There are two C-shaped menisci in each knee joint, an inner one (medial meniscus) and an outer one (lateral meniscus).
The menisci are commonly referred to as your knee “cartilage” and they protect the bones from wear and tear (arthritis). The cartilage transfers load, aids joint stability and most importantly acts as a shock absorber. If as a runner you experience a cartilage tear, it is likely to greatly affect your training regime.
How common are cartilage tears and how does it happen?
Every year around 10,000 people in the UK have knee cartilage tears which require treatment and this is more common within the running population. Knee cartilage injuries are a growing source of knee pain in runners, perhaps due to the rising average age of runners. During running especially, the knee cartilage is subjected to impact forces which are as much as 4 to 8 times higher than during walking.
Cartilage tears can be traumatic in nature, where there is a history of a slip, fall or sudden twist of the knee which is beyond what the cartilage can withstand. Alternatively, runners can experience an age related degenerative tearing of the cartilage which usually starts more slowly. The symptoms of a cartilage tear most commonly include pain or tenderness along the inner or outer knee joint line with localised swelling, with or without intermittent clicking, popping, or locking of the knee.
It is important that an experienced physiotherapist assesses your knee through a detailed examination to confirm the correct diagnosis for your pain. The clinical tests for a knee cartilage tear are fairly reliable and a knee MRI scan is only needed in the minority of cases.
You have a higher risk of suffering a cartilage tear if you-
1) Have reduced muscle strength around your knee from a previous injury.
2) Regularly have a high running mileage.
3) Repetitively run on hard surfaces, such as road running instead of mixing your surfaces to include grass, bark or treadmill.
4) Suddenly increase your running mileage.
5) Have poor foot biomechanics ie flat feet which lead to poor knee stability or high arches which result in poor shock absorption, causing more stress to pass upwards through the knee cartilage. In either case, insoles can help both foot types.
Physiotherapy management of knee cartilage tears:
Once the diagnosis of a cartilage tear has been confirmed, it is vital that the physiotherapist establishes why the cartilage tear occurred in the first place, especially if it occurred without any definite trauma or injury. The risk factors mentioned above must all be considered and addressed by the physiotherapist to minimise the chance of re-injury in the future. Here at Apex Clinic we treat cartilage tears in runners on a daily basis and we recommend the following regime to get you back to running, painfree in the quickest time period-
1) The Mulligan “Squeeze” Technique
This is a manual physiotherapy technique which originated from Wellington, New Zealand and involves the physiotherapist manually applying pressure over the painful knee joint line which in turn will help to encourage the torn meniscus into a better position for optimal healing. It can be extremely effective and can produce dramatic results.
2) Knee joint mobilisations
Manual knee joint mobilisation techniques will help to break up unnecessary scar tissue in the joint and will restore full range of knee movement. These techniques also increase the knee circulation which promotes healing.
3) A tailored home exercise program
A home exercise program is vital to strengthen the muscles surrounding the knee, especially the quadriceps and hamstrings. Further exercises to strengthen the lower limb globally including the calves, hips and pelvic muscles are also important. All of these muscles work together to support the knee, which will help to reduce the pressure on the joint. The exercises will later be progressed into impact exercises.
4) Proprioception (balance) exercises
Individually tailored proprioceptive exercises are important during your rehabilitation to allow an increased awareness of your sense of knee joint position or where your knee joint is in space. Restoration of this after injury is vital to enhance recovery and help prevent reoccurrence.
When can I return to running?
A cartilage tear will usually take up to 6-8 weeks to fully heal. Depending on the size of the cartilage tear, if you are free of pain and knee swelling on a day to day basis you can usually try a gentle and gradual return to running on a soft surface after 4-6 weeks. If the cause of your injury was related to overuse, you must amend your training regime with guidance from your physiotherapist to prevent re-injury.
Surgery for cartilage tears?
In the majority of cases, cartilage tears can be treated successfully with the correct physiotherapy regime and you should be able to gradually return to your previous training level. For more significant tears, surgery may be required if conservative treatment has failed. A surgical cartilage trim or repair is usually successful however, it’s advisable to try treating the cartilage tear conservatively first, as surgery on knee cartilage is a risk factor for earlier development of knee arthritis (osteoarthritis).