Cutting Edge Issue 2 - Page 72

By Nigel Kettle BSc(Hons)Ost GOsC Registered Osteopath Cartilage injuries in the knee T he knee is the joint between the femur (thigh bone) and tibia (shin bone). In 1999, after studying for four years full-time at the British School of Osteopathy – the country’s oldest osteopathic school – Nigel qualified as a registered osteopath with a 2.1 Bachelor of Science Honours degree. In addition to having his own clinic in East Sussex, he works in private practices in Kent, Reigate and Epsom in Surrey. As a teacher, he is currently principle lecturer in Osteopathic Technique at Surrey Institute of Osteopathic Medicine, a Recognised Qualification (RQ) Osteopathic Degree Course based in North East Surrey College in Ewell. 70 | CUTTING EDGE There are two tough, free moving, cartilage structures between these two bones, one on the medial side of the knee joint, one on the lateral. Anatomically called the ‘menisci’ they sit precisely onto the top of the tibia which is fairly flat, so the bottom surface of the meniscus is flat, whilst the top surfaces faces the two round ends of the femur, so they are cupped to accommodate this shape in effect the menisci make the two bones fit together better. To clarify this a little further; the menisci are wedge shaped, half-moon, C-shaped structures, the inside of them is thin and has no blood supply, whilst the outside is much thicker but does have a blood supply to it. This all becomes important when they become damaged as without a blood supply they cannot heal. The ‘menisci’ allow body weight to be distributed effectively through the knee joint and so permit the tibia and femur to move relative to each other in a smooth and efficient manner. They also act as shock absorbers and guiders of movement through their attachment points located around the middle of the joint. Meniscal tears or a torn cartilagewhat exactly do we mean? This is where much confusion arises as the ends of the femur and tibia both have hard cartilage covering them, as well as the fibrous cartilage that makes up the menisci. What most people mean when they talk about a ‘torn cartilage in the knee’ are the menisci most of the time. Traumatic injuries are a common cause of meniscal injuries often as a result of twisting motion of the knee whilst under load and in a flexed position. Rapid squatting movements, lunges and jumping activities also cause problems. Another consideration is as people become older they have more wear and tear in the weight bearing joints, specifically knees and hips and this not only affects the hard cartilage at the end of the bones but in the natural course of things the menisci also become ‘frayed’ on their thin inner edges and can develop tears and splits within them through their entire width. There are a number of symptoms in meniscal injuries ranging from the obvious pain and swelling, to locking of the joint, sometimes ‘cracking and clicking’ sounds from the joint and of course a restriction of normal movement. This is all to do with driving the joint surfaces together. As they are compressed the damaged meniscal cartilages (which at this point has lost its integrity) and may as a result be leaving floating detritus