Meniscal root lesion
The meniscal root is the area that attaches the meniscus to the tibia. When it is damaged, the meniscus may not distribute loads in the knee as effectively, which can lead to pain and alter joint function.
Treatment depends on the type of injury, its age, the condition of the cartilage, and the individual's goals. A clinical examination and appropriate imaging allow for discussion of the options, with meniscus preservation being prioritized whenever possible.
UNDERSTANDING KNEE OSTEOARTHRITIS
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This is the area located on the inner side of the knee and is the most frequently affected by osteoarthritis. Its wear and tear can cause internal pain and gradually lead to leg deformity.
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Located on the outer side of the knee, this compartment is less frequently affected. Its wear and tear can cause lateral pain and gradually alter the leg's alignment.
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This joint is located between the kneecap and the femur. When it is affected, pain often appears when climbing stairs, squatting, or after sitting for a long time.
RECOGNIZING THE SYMPTOMS
A tear in the meniscal root can cause pain located on the inside or back of the knee. The signs vary depending on the mechanism of the injury and the overall condition of the joint.
- Pain on the inside of the knee — It can be accentuated during walking, stairs, squatting or prolonged support.
- Pain in the back of the knee — Some people feel it especially when they bend their knee or put weight on it.
- Swelling — An effusion can appear after exertion or a painful episode.
- Embarrassment to back it up — Walking or changing positions can become uncomfortable.
- Cracking or catching sensations — These sensations may occur, but they are not sufficient to confirm the diagnosis.
Symptoms may appear after a twisting motion or significant bending. They can also develop gradually, particularly when tissues are weakened. An inability to bear weight, significant swelling after an injury, or a truly locked knee warrants prompt evaluation. In case of acute pain or injury, see page Meniscus and cartilage: symptoms and treatment can help you identify situations that require medical advice.
Causes and mechanisms
Knee osteoarthritis is not solely related to age. Several factors can weaken the joint, increase the stress on the cartilage, or promote premature wear.
A twisting or bending movement
An injury can occur as a result of twisting the knee, a sudden movement, or deep bending while bearing weight. Pain may be immediate or appear within hours.
A progressive weakening of the tissues
Some injuries appear without significant trauma. Over time, tissues can become more vulnerable to normal stresses. An ordinary movement can then trigger symptoms.
The consequences on the meniscus and cartilage
A torn root can leave the meniscus less securely held and promote its outward displacement. The distribution of loads within the joint can then be altered. The extent of these changes depends in particular on the condition of the cartilage, the alignment of the limb, and the presence of other injuries.
Pain alone is not sufficient to distinguish a nerve root lesion from other types of meniscal damage. meniscus tear presents different types and locations, which are not all treated in the same way.
MAKE THE RIGHT DIAGNOSIS
The diagnosis is based on the history of symptoms, examination of the knee, and analysis of images. The goal is to confirm the lesion and assess the overall condition of the joint.
01 — Understanding the circumstances
The doctor specifies how the pain appeared, where it is located, whether it follows a particular movement, and whether the knee has swollen or locked.
02 — Examine the knee
The examination assesses mobility, pain on palpation, the presence of effusion, and stability. No single clinical test can, on its own, confirm a nerve root lesion.
03 — Take X-rays if necessary
X-rays do not directly show the meniscal root, but they help to assess the alignment and condition of the joint surfaces, particularly in cases of suspected osteoarthritis.
04 — Analyze the MRI
MRI allows examination of the menisci and other structures of the knee. It helps to pinpoint the location of the lesion, any displacement of the meniscus, and the condition of the underlying cartilage and bone.
The diagnosis depends on the correlation between your symptoms, the clinical examination, and the imaging.
Initial care
While awaiting evaluation, the goal is to reduce painful stress without systematically immobilizing the knee.
Temporarily adapt the movements
Stop activities that significantly worsen the pain, especially deep bending, repetitive twisting, and exertion with the knee bent sharply. Maintain tolerated movement if weight-bearing is still possible.
Relieve pain and swelling
Applying a cold compress wrapped in a cloth can help reduce discomfort. Pain relievers or anti-inflammatory medications should be chosen based on your medical condition and the advice of a healthcare professional.
Use a walking aid if necessary
A splint or crutches are not always necessary. They may be considered if the pain makes weight-bearing difficult, after an assessment of the situation.
In cases of intense pain, marked swelling after trauma, or knee locking, a Specialized knee evaluation in Geneva may be indicated.
Conservative treatment
A meniscal root tear does not automatically lead to surgery. Non-surgical management can be considered depending on the symptoms, the condition of the cartilage, the age of the tear, and the patient's needs.
Adapt the activities
Temporarily reducing painful movements helps prevent excessive stress on the knee. Activities are then gradually resumed depending on the evolution of symptoms.
Supporting recovery through physiotherapy
Physiotherapy can help preserve mobility, strengthen thigh muscles, and improve movement control. The program should be tailored to the pain and the characteristics of the injury.
Follow the progress
Monitoring takes into account pain, swelling, walking ability, and the capacity to resume daily activities. Reassessment is useful if symptoms persist, worsen, or permanently limit weight-bearing.
The decision is based on knee function and all the examinations, not on the MRI alone. To understand the criteria that guide this decision, consult when meniscus surgery can be considered.
surgical treatment
Surgery may be considered when a nerve root lesion is confirmed, symptoms are significant, and the knee's condition suggests the possibility of functional improvement. It is not suitable for all situations.
REPAIR THE ROOT WHEN IT CAN BE PRESERVED
Depending on the injury and the quality of the tissues, the surgeon may recommend arthroscopic repair. The principle is to reattach the nerve root to the tibia, often using sutures and a bone fixation system. The technique depends on the anatomy and the findings during the surgery.
CHOOSE THE RIGHT TIME AND THE RIGHT INDICATION
Age, the duration of the injury, the condition of the cartilage, knee alignment, symptoms, and activity goals are all taken into account. In cases of advanced osteoarthritis or tissues that are difficult to repair, repair may be less appropriate. Therefore, the decision requires an individualized assessment.
REALISTIC GOALS
Meniscus repair aims to restore attachment and function as much as possible. Healing is not guaranteed, and recovery requires rehabilitation as well as temporary protection of weight-bearing or flexion, according to the chosen protocol.
To learn more about the principles of the intervention, see the page knee arthroscopy and minimally invasive surgery.
Rehabilitation and resumption of activities
Rehabilitation depends on the treatment performed, the quality of the tissues, any associated injuries, and the progress of the knee. After repair, weight-bearing and flexion guidelines are defined by the surgeon and physiotherapist.
01 — Protect the knee
Initially, movement and weight-bearing may be limited depending on the repair. Crutches or an orthosis are used only if the protocol specifies them.
02 — Gradually regain mobility
Flexion and extension are performed within the prescribed limits, without forcing significant pain.
03 — Restore strength
Physiotherapy gradually reintroduces muscle strengthening and functional exercises adapted to the knee's tolerance.
04 — Resume daily activities
Walking, stairs and movement are reintroduced depending on the quality of support, movement control and the absence of sustained worsening of symptoms.
05 — Consider sport
Sports activities can resume when knee mobility, strength, balance, and control are sufficient. Sports involving pivoting or deep flexion should be resumed cautiously and according to the advice of the healthcare team.
Resumption of activity depends on functional criteria and the progress of each knee; no timeframe is guaranteed. The page on the rehabilitation after knee surgery presents the general principles of recovery.
A strategy tailored to each patient
Dr. Benoît Coulin takes into account the location and age of the lesion, the symptoms, the patient's age and activity level, the condition of the cartilage, the alignment of the knee, and any associated injuries. These factors allow for a comparison of the benefits and drawbacks of conservative treatment versus potential repair.
Physiotherapy and activity modifications may be appropriate in some situations, but they cannot reattach a torn nerve root. Repair can preserve the meniscus when feasible, but it requires a protective period and gradual rehabilitation. The choice is made after discussing the results of the examination and imaging.
«"Preserving the function of the meniscus begins with precisely understanding its injury."»
FREQUENTLY ASKED QUESTIONS
Could your knee pain be related to an injury?
of the meniscal root?
A clinical examination combined with appropriate imaging helps to determine the origin of the pain, to assess the condition of the meniscus and cartilage, and then to discuss a strategy adapted to your situation.
