Today on Banged Up Bills, we will detail the ever common meniscus tear. This post will identify what the meniscus is, it’s function, and the severity of a tear which could affect whether a player misses weeks or the season. This is an injury that we have seen in past seasons and will continue to see.
Last season, we saw TE Charles Clay and WR Kelvin Benjamin both tear their meniscus during different points of the season with varying availability following the injury. Clay missed 3 games while Benjamin missed 2. Clay required surgery to fix his issue immediately while Benjamin was able to tough it out the rest of the season with eventual surgery. There are many reasons why there are differences in meniscus tear management despite the same outcomes.
To understand proper management of the meniscus after injury, the structure must be understood. The meniscus is two concave structures that are c-shaped and lie over the tibia in each knee. The meniscus is comprised of a medial and lateral meniscus and act as shock absorbers during activity. These meniscus also help deepen the joint so that the femur can articulate with the tibia, providing stability. During meniscus tears, a rotational force is applied to the area while the knee is bent and causes a shearing motion, causing a portion of the meniscus to tear.
- Credit: physio-pedia.com
There are various types of tears which include but are not limited to: complete or partial, horizontal or vertical, longitudinal or transverse. Acute tears are more likely to present as longitudinal/bucket handle and radial tears most likely seen in football players. Symptoms of a meniscal tear typically consist of pain, tenderness, and swelling, locking or clicking during knee movement, and initially difficulty in placing weight through the knee. Meniscal tears are typically seen in conjunction with MCL sprains/tears and ACL tears due to the rotational forces through the knee during impact.
Overall, these types of injuries can slow up a player but not entirely derail their season. Several tests to identify meniscal tears include Apley’s, McMurray’s, joint line tenderness, and Thessaly’s test all assist in identifying whether a meniscal tear is present. However, these tests are not always reliable or specific which means they may identify pain and restrictions but will not be able to identify type or severity of tear. These tests replicate the mechanism that would cause the meniscal tear. This typically warrants further imaging such as MRI to identify specific lesions which will determine the appropriate interventions.
Once a tear has been identified, the type of tear can affect healing rates: longitudinal tears heal better than radial; simple tears heal better than complex; traumatic and acute tears heal better than degenerative. Based on location and length of tear will determine proper management. The meniscus has several “zones of vascularity” which include: red-red zone, red-white zone, and white-white zone. The red-red zone has the highest blood supply and lie on the outermost portion of the meniscus. The red-white zone is the area that connects the red-red and white-white zone and contains some blood supply. The white-white zone has a poor blood supply and demonstrate the poorest area for healing. If the tear is small, conservative management or a meniscectomy may be performed to remove to remove the offending piece. If the tear is larger, then a suture repair of the meniscus is warranted and an extended rehab is required.
- Credit: physio-pedia.com
Regardless of whether surgery is required, rehab typically consists of restoring range of motion, controlling swelling/pain, and restoring strength to the knee. Once the immediate objectives are met, then further increasing strength and return to play activities are initiated to ensure that the athlete can play at their full abilities. In the event of WR Kelvin Benjamin, he was able to play through his minor tear due to effective rehab and an understanding of the type of tear which most likely allowed him to rest, recover, and eventually return to full participation knowing the tear was stable enough to play through. In the event of TE Charles Clay, his tear may have been blocking motion and been more severe, warranting surgery to remove the offending piece before rehab could begin.
In the option that surgery is performed during the season, recovery times for a meniscectomy can last anywhere from 2-6 weeks or even longer based on the severity of the tear and corresponding damage. In the event of a major tear, surgery is indicated and recovery time can last for up to 3 months which could end a season for most players depending on the time in the season it was torn. The preferred method years ago used to be cut out the offending piece. However, surgeons later found out that each time they cut a piece out, it accelerated arthritic changes in the knee which reduced healing and the ability for players to return to full health for a prolonged career. They have also found recently that surgeries do no better than rehab alone when compared to long term results in the normal population. However, surgery is still recommended when a return to sport is necessary and will quicken the recovery in dealing with the NFL.
Meniscal injuries are still concerning but can still allow a player to play through the injury despite requiring further interventions in the future. If a player sustains a meniscus injury, they will miss some time but can return to play later in the season with favorable results after testing and a positive response to rehab. Despite returning to play, there are still instances where players will not be 100% and their production will noticeably decrease. Overall, a concerning but not season ending injury.
Continue to check back regarding further updates and injuries throughout the season. Follow on Twitter @BangedUpBills, Facebook at Banged Up Bills, on Reddit at u/BangedUpBills and www.bangedupbills.com. As always, thank you for reading and GO BILLS!
