Meniscus injury
The menisci are two crescent-shaped cartilage cushions between the thigh bone and the shin bone. They distribute load, absorb shocks and give the knee stability. When one of them is injured, the knee loses part of this cushioning function.
The injury happens in two quite different ways. In younger people it is usually a twist of the loaded knee, for example in football, skiing or basketball, often with a clear moment that the person remembers. After the age of forty, however, the meniscus can tear gradually, due to wear, and sometimes a squat or getting out of a car is enough.
Pain at the side of the knee, at the level of the joint line, is typical. With a meniscus injury, swelling often only appears the next day, not immediately. People describe catching, a feeling that the knee locks for a moment, and unsteadiness on the stairs.
Fresh injury or wear
The difference between the two pictures is not academic. It determines what treatment makes sense and what you can expect.
A fresh injury in a younger person is often also associated with an injury to a cruciate ligament or the joint cartilage, so the whole knee is assessed, not just the meniscus.
A degenerative tear in an older person is often part of wider wear of the knee. The same finding on a scan then means something different, as meniscus tears at this age are common even in people without pain.
When not to book an appointment but to seek emergency help
The following situations are not for booking an orthopaedic examination but for an emergency department the same day: the knee has locked in a bent position and you cannot straighten it, the knee has swollen severely within a few hours of the injury, you cannot put weight on the leg or the joint is visibly deformed.
If the knee is visibly deformed after an injury, if you cannot move the leg or if you cannot control the pain, call 112 and do not try to drive yourself. A trapped piece of meniscus mechanically blocks the joint, and rapid swelling can mean bleeding into the joint or a fracture.
A fever with a red, hot and very painful knee requires immediate treatment, as it may be an infection of the joint. With sudden pain, swelling and warmth in the calf, also consider a venous thrombosis and seek help the same day. If this is accompanied by shortness of breath or chest pain when breathing in, call 112.
What the examination involves
The orthopaedic surgeon is first interested in the mechanism: what you were doing, which way the knee twisted, whether you heard a pop, when it swelled and what limits you most.
This is followed by a clinical examination assessing fluid in the joint, range of movement, tenderness along the joint line and stability of the ligaments, with tests that put load on the meniscus. The hip is also checked, as pain often travels from there into the knee.
X-ray imaging, which is available at Medicinski center Ljubljana, shows the state of the joint surfaces and the degree of wear, but does not show the meniscus. MRI is not a routine test. It makes sense when its result would change the treatment decision, and the doctor will tell you at the examination where to have it done.
How it is treated
For degenerative tears without locking of the joint, guided physiotherapy with strengthening of the thigh muscles is, for most people, at least as successful as an arthroscopic procedure. That is why the path almost always starts there.
Surgical treatment makes sense mainly with mechanical locking of the knee, a trapped piece of meniscus and fresh injuries in younger people, where repair of the meniscus by suturing is considered. Preserving the tissue is important in younger people, as a removed part no longer performs its cushioning function.
In every case, part of the treatment is a gradual return to load: first settling the swelling and restoring range of movement, then strength, and finally movement specific to your sport or work.
The orthopaedic examination is self-pay; you do not need a referral. Appointments are booked with the clinic that runs the service.