The knee has two shock-absorbing cartilages both known as the meniscus. This includes the medial (inner) meniscus and lateral (outer) meniscus.

A meniscus football injury is usually caused as a result of twisting. They can also occur as part of a combination with other injuries to the ACL, medial and lateral ligaments. To help the knee glide and bend, the body has articular cartilage (this coats the ends of the bones). If this gets damaged then arthritis can be likely in the future. 

Meniscus tears tend not to be acute, so don't often stop an individual playing at the time the injury occurs. The knee pain in football gradually comes and goes, with the symptoms usually occurring the day after, or two days after the injury, when the knee swells up and becomes more painful.  

What are the symptoms?

The common symptoms are pain to the inner or outer side of the knee, along with swelling. The player will normally limp and the pain can be made worse by twisting, squatting or kneeling.

The diagnosis can be made clinically when the symptoms shown by the injured player are examined by a surgeon. These can be confirmed with special tests such as a Magnetic Resonance Imaging scan (MRI scan), which show meniscal tears.

The menisci have a poor blood supply and, therefore, are difficult to heal once they are torn. 50% of lateral meniscal tears can become asymptomatic (show no obvious problems) over time, even though the tear is still there. However, an aggravating activity can cause the problem to flare up. Medial meniscus tears, usually once symptomatic (where there is pain, and problems present) remain so, although the condition can change in intensity. 

Is there a solution?

Treatment of these injuries may initially involve trying to reduce the inflammation caused by the tear and therefore, the pain and swelling, by injecting a steroid into the knee. This can be used on players who are in the middle of a season to try to get them to reach the end. This is something that has been commonly abused in the football 'dark ages' of the past.

Players were getting regular injections before every game; this was something that shouldn't have happened. Thankfully, with an advanced understanding of the associated problems with mismanagement of cortisone, this is believed to be eradicated.

When the player remains symptomatic (has pain and problems), then a meniscus operation may be needed, involving keyhole surgery (arthroscopy) of the knee. This allows instruments to be placed into the knee to allow the tear to be repaired. Some tears are not repairable, however, and if this is the case, the torn part of the meniscus is removed.

Exercises from physiotherapists need to be done after a football injury. Following the surgery, a player undergoes rehabilitation to reduce swelling, regain motion and regain leg strength. They are advised to go through a programme of gentle exercises that they would normally do during a game of football before they return to proper training and full match play.

The meniscus operation is now considered a minor surgical procedure, however, unfortunately, some degrees of damage are so severe that the injury can prevent a footballer playing in the top flight competitively.

There are now injections that players have directly into the knee that act as a lubricant. Unlike the cortisone of the past, they don't mask the injury, they aid active recovery. Because of the nature of the required gliding movement of the knee, they are normally repeated every 6-months to maintain the joint.