Meniscus Injury: Treatment Options for Stuck Knee Pain

The left knee sometimes feels like it gets stuck?

Hello, I accidentally missed a step while going down the stairs at work, and at that moment, the outer soft area of my left knee was very painful.
I couldn't straighten or bend my leg, and it felt like something was pulling, but it was also very painful.
Later, I had X-rays and an MRI, and the doctor said that the bones were fine, but there was a slight injury to the meniscus, although the extent was small, and I could start with physical therapy.
The physical therapy included ultrasound, electrical stimulation, and acupuncture.
Now, the pain has indeed improved, but occasionally when climbing vertical stairs, turning left, or relaxing my knee, my left knee feels like it's getting stuck again.
Although it doesn't hurt as much as it did at the time of the injury, I still can't fully extend or bend my leg.
Is this caused by the meniscus injury? If surgery is not an option, what other physical therapy treatments could help?

Yusheng, 30~39 year old female. Ask Date: 2020/09/30

Dr. Chen Yongxue reply Orthopedics

Meniscus injury can cause swelling and locking of the knee joint.
If the condition is not severe, conservative treatment and proper care may suffice.
However, a meniscus tear cannot heal on its own.
In severe cases, such as when the joint is locked, please seek surgical treatment promptly.
Thank you.

Reply Date: 2020/09/30

More Info

Meniscus injuries are common knee problems that can lead to significant pain and functional limitations. The meniscus is a C-shaped cartilage in the knee that acts as a cushion between the femur (thigh bone) and the tibia (shin bone). When you experience pain and a sensation of the knee getting "stuck," it can often be attributed to a meniscus tear, especially if the injury occurred during a twisting motion, such as stepping off a stair.

Based on your description, it seems that you have already undergone imaging studies, including X-rays and MRI, which confirmed a minor meniscus injury without any significant damage to the bones. The initial conservative treatment approach, which includes physical therapy modalities like ultrasound, electrical stimulation, and acupuncture, is often the first line of management for such injuries. These treatments aim to reduce pain and inflammation, improve range of motion, and strengthen the surrounding muscles.

However, the persistent sensation of your knee getting "stuck" or locking, especially during activities like climbing stairs or turning, suggests that there may be a piece of the torn meniscus that is moving into the joint space, causing mechanical symptoms. This is often referred to as a "bucket handle tear," where a portion of the meniscus becomes displaced and can obstruct normal knee movement.

If conservative treatment does not lead to satisfactory improvement, surgical options may be considered. Arthroscopic surgery is a minimally invasive procedure that allows the surgeon to visualize the inside of the knee and repair or remove the damaged meniscal tissue. The decision to proceed with surgery typically depends on several factors, including the severity of the tear, the presence of mechanical symptoms (like locking), and the overall impact on your daily activities.

In terms of physical therapy, if you wish to avoid surgery, you can explore additional rehabilitation strategies. These may include:
1. Strengthening Exercises: Focus on strengthening the quadriceps and hamstring muscles, which can help stabilize the knee joint and reduce the load on the meniscus. Exercises like leg raises, squats, and lunges can be beneficial.

2. Range of Motion Exercises: Gentle stretching and range of motion exercises can help maintain flexibility in the knee joint. Activities like cycling on a stationary bike can also promote movement without putting excessive strain on the knee.

3. Balance and Proprioception Training: Incorporating balance exercises can help improve stability and prevent further injuries. This can include exercises on a balance board or single-leg stands.

4. Activity Modification: Avoid activities that exacerbate your symptoms, such as deep squats or high-impact sports. Instead, consider low-impact activities like swimming or cycling that are less likely to irritate the knee.

5. Manual Therapy: Techniques performed by a physical therapist, such as joint mobilization or soft tissue massage, can help alleviate pain and improve mobility.

6. Use of Braces: A knee brace may provide additional support and stability, especially during activities that provoke symptoms. However, it's essential to ensure that the brace does not cause discomfort or exacerbate your pain.

If your symptoms persist or worsen, it is crucial to follow up with your orthopedic specialist. They may recommend further imaging or a referral to a sports medicine physician for a more detailed evaluation of your knee. Ultimately, the goal is to restore function and alleviate pain, allowing you to return to your normal activities without limitations.

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