By Jed Russell, Physiotherapist
Why Nick Kyrgios Withdrew From the Australian Open this January: A Physiotherapist’s Perspective
As many would be aware (and perhaps a little devastated!), Aussie tennis player Nick Kyrgios had to withdraw from the 2023 Australian open due to an existing knee injury that he has been battling through several grand slams.
The injury that caused Kyrgios’s withdrawal is something called a parameniscal cyst which begun growing after a minor tear in Kyrgios’s lateral meniscus. This has become a major problem in the past few weeks for Kyrgios, which comes with terrible timing. Many people understand cysts to be relatively harmless and parameniscal cysts are rare, so many fans might be wondering why Kyrgios needed to withdraw.
If this sounds like you, you’ve come to the right place!
Firstly, we need to discuss, what exactly is a meniscus?
A meniscus is a C shaped piece of cartilage located deep in your knee joint between the thigh bone (femur) and the shin bone (Tibia). The role of the meniscus is shock absorption when undertaking activities like walking, running, and jumping.
Lateral meniscus tears are very common among athletes who participate in sports that involve pivoting and directional change at speed. Agility-demanding sports can come at a great cost for an athlete’s knees. But, a meniscal tear is also a very common injury in the general population, usually occurring after a fall, twisting or rotation movement whilst weight bearing. As age increases, so does the risk of meniscal injuries. This is due to natural deterioration of the cartilage over time. For an elite athlete natural deterioration and this kind of injury can be a devastating cocktail!
Depending on how bad the meniscus tear is can be estimated depending on the type of symptoms you get. If it is torn to the point that it has created a flap, as you walk or stand up you may notice a clicking or clunking sound. This is often associated with a sharp pain in the knee. This pain is due to the meniscus flap getting caught between the two contact points of the Tibia and Femur.
Now that we know the nature of a meniscus injury, what does it mean to have a Parameniscal Cyst?
All cysts are essentially a fluid-filled area, and a parameniscal cyst is one that forms on the outside of the meniscus. This occurs due to a meniscal tear hanging around for a while, allowing the fluid inside the knee joint to leak out and getting trapped because it will not be allowed back in by the meniscal flap. Bear in mind, these are quite rare. A parameniscal cyst only occurs in 2-5% of patients who have suffered a meniscal tear.
Many parameniscal cysts are often very small and cause no trouble, however, when they become larger, they can cause pain and make it very difficult to compete at the highest level. This is the where Kyrgios’ knee injury sits, affecting his agility and comfort on the court. For the braver readers, click HERE to see what was drained from Kyrgios’ parameniscal cyst only 4 days before the Australian Open.
As physiotherapists, how would we assess you if we were suspecting a meniscal injury?
We would begin with a subjective background as to how the injury occurred. As mentioned above, these can be either due to the nature of a sport you play or perhaps natural or advanced deterioration within the knee. We look to investigate whether there was a rotation, pivot or twisting that occurred. We also want to know about where the knee pain is located and whether there is any locking, clicking or clunking that can be heard when moving or weight-bearing on the knee.
We will then conduct an objective assessment to determine the amount of movement your knee has and feel for any painful areas or bumps. From there we may choose to conduct a few special tests, designed to see whether the meniscus has been injured.
If we determine that a meniscus injury has occurred, how would we treat it?
In the initial stages of recovery, we look for conservative management. We will likely recommend rest, ice, elevation, and compression to reduce the inflammation and swelling in the area. Depending on the severity, we may also suggest a knee brace to restrict how much movement the knee can do and provide some additional support. If the injury is progressing well and moves beyond the initial stage of recovery, we will set up a progressive strengthening/exercise program that focuses on the muscles of the lower body. This plan is individualized for every patient, so that it suits your injury and also your abilities and lifestyle. If a Parameniscal cyst is also involved (which as we’ve mentioned is very rare), we would focus on the meniscus injury and the cyst will often subside without further action needed.
If the meniscal tear is severe and can’t be treated with conservative management, the surgical route may be needed. This option is also often needed for high-level sportspeople like Kyrgios due to the nature of the sport. More serious meniscal tears and subsequent parameniscal cysts are treated with an arthroscopic keyhole procedure, where the meniscus is fixed and the cyst is removed. Other surgeries can be done to simply drain the cyst, but they are often ineffective because they don’t fix or focus on the root cause of the cyst developing, which is the meniscus damage. So if Kyrgios elected to have this procedure rather than the more serious keyhole procedure, he may also need to withdraw from future Australian Opens! Luckily with his experienced and knowledgeable support team this won’t happen.
After these surgical procedures, it is still vital to return the knee to good health by retaining the knee range of motion and appropriately supporting the knee by strengthening the muscles around it. This is where your physiotherapist does their best work to help with your long term recovery, not just the 6 weeks post-surgery.
Of course, the length of the recovery varies significantly depending on the individual presentation. After a thorough assessment, we would be able to make a close estimate of how long your recovery will be. Kyrgios is aiming to return to tennis in late February-early March after he undergoes knee surgery next week. Kyrgios fans, keep your eyes peeled for his return!
If you suspect that you have a meniscus injury, or any knee injury, come see one of our amazing physiotherapists. They can assess you and get your recovery started, supporting you throughout your journey. Or, if you’re wanting to prevent any injuries in the future we would love to support you. Call us on 8352 3582, or book online using this link > https://www.physiowest.net.au/book-online/! We can’t wait to treat you.