Knee Cartilage & Meniscus Injuries: Types, Symptoms and Chiropractic Support

The knee contains two different types of cartilage: The articular cartilage and the meniscus. They have different structures and roles to keep your knees healthy, and can become injured in different ways.

Articular Cartilage

The articular cartilage is a smooth, slippery layer of cartilage that covers the ends of the bones in the knee joint (like the femur, tibia, and the underside of the patella). It acts like a low-friction, protective layer, helping the bones glide effortlessly over each other during movement, which is essential for pain-free knee motion and joint longevity. It directly lines the joint surfaces – where bones meet.

Injuries to the Articular Cartilage

Illustration of knee joint's articular cartilage showcasing its smooth surface and critical role in joint movement and load-bearing.

When the articular cartilage gets damaged, it can lead to pain, swelling, stiffness, and limited mobility in the knee.

Focal Lesions

This is the most common acute injury we see here in the clinic. These are isolated areas of damage, often caused by a one-off twist, fall, or direct impact to the knee. Athletes or active individuals are more prone to these, especially from sports that involve sudden stops or direction changes. This can also happen from a sudden increase in joint loading – for example, taking up a new hobby – without gradually easing into it to give the cartilage and joints time to adapt to the new pressures. Symptoms can include sharp pain, swelling, catching or locking, and discomfort during activity.

Osteoarthritis

Over time and with age, the collagen type that makes up the cartilage changes, and it becomes less hydrated (like our skin!). Less water content means it becomes less slippery and less able to cushion against natural stressors. Over time, wear and tear can gradually cause a breakdown and subsequent reduction in the articular cartilage. This can happen at different rates in different people and is related to factors such as weight, inflammation and loading to the joint. Find out more about osteoarthritis from one of our previous blogs here. Previous injury or altered joint function is known to increase abnormal loading on the cartilage and contribute to increased cartilage degeneration.

Inflammatory Arthritis

Occasionally the knee can be involved and inflamed in systemic inflammatory arthritis such as rheumatoid arthritis and reactive arthritis.

Osteochondritis Dissecans (OCD)

A condition where a piece of cartilage, along with a thin layer of bone underneath, becomes loose due to a lack of blood flow. It’s more common in young athletes and can lead to joint instability or even loose fragments in the joint. The knee can commonly become locked in a position, if the fragment gets stuck.

The Meniscus

The meniscus is formed from two C-shaped pieces of a tough, flexible type of cartilage known as fibrocartilage. They are known as the medial and lateral menisci, and sit between the thigh bone and shin bone. They are particularly dense, making them more durable than the articular cartilage. The meniscus acts like a shock absorber and stabiliser, cushioning the joint, distributing weight, and helping with balance. It lies within the joint capsule itself so when irritated can cause the capsule to swell and making the whole knee look puffy.

Illustration depicting the anatomical structure of the meniscus, highlighting its two horns.

Injuries associated with the meniscus

Acute tears

These commonly occur due to a twisting movement on the knee whilst weight bearing, for example when turning on the spot quickly. We often see these injuries in the sporting environment or during training. This can also happen during everyday movements like squatting or lifting, particularly in older adults where the cartilage is more brittle. Pain is often felt in the moment of injury in association with a pop sound. There is then a subsequent swelling with stiffness, and pain with or inability to weight bear on the knee involved.

Chronic/Degenerative Tears

As we age, the meniscus becomes more brittle. Over time and with increased loading, the meniscus can develop microtears that cause altered motion and inflammation. Degenerative tears are more commonly seen in older adults due to age and use-related wear and tear, often occurring without a clear injury and often develop slowly.

Meniscus injuries can range from mild to severe but should never be ignored. Early diagnosis and appropriate treatment help protect the joint from long-term damage and maintain normal knee function.

How Can Chiropractic Care Help

A chiropractor assesses the function of a patient's knee joint during an examination.

Unlike muscles or bones, articular cartilage and the menisci have a poor blood supply, so they can take a long time to heal. Whilst chiropractors don’t directly treat a torn meniscus, osteoarthritis or damaged cartilage, they can play a key role in managing symptoms, giving lifestyle advice and improving overall joint mechanics.

Your chiropractor can assess and address joint restrictions not only in the knee but also in related areas like the hip, ankle, and lower back, which may be compensating for the injury. Restoring proper movement patterns can reduce stress on the knee and help prevent further strain on the meniscus.

Check out March's blog for more information about normal joint motion.

When there is severe cartilage injury or damage, your chiropractor can refer you back to the GP or for further investigations to guide onward referral to the appropriate health care professional.

Strategies that may support cartilage healing or reduce irritation include:

1. Reducing Inflammation: Icing an area for 20 minutes can help

2. Activity Modification: Knowing your limits is key! Whilst using the joint helps to maintain motion, it is often a good idea to use the knee within your tolerance levels. Overusing

   the knee can reinflame the cartilage and affect the healing process.

3. Strengthening Muscles and Providing Stability: Physical Activity is also a contributing risk factor. Regular and consistent exercise enhances muscle strength and increases the ability to deal with stresses and forces placed on the joint. Balance exercises also help to adapt to destabilising movements. Exercises that are recommended include Yoga, brisk walking, and cycling. Check out our Social Media channels for some exercise ideas!

4. Weight Management: Higher weight will put increased loading on the knee joints. Weight gain from excess body fat can also increase the production of inflammatory chemicals leading to a state of chronic low-grade inflammation, and increased pain sensitivity.