A PATIENT’S GUIDE TO MENISCAL INJURIES

INTRODUCTION

The meniscus is a commonly injured structure in the knee.The meniscus are cartilage rings found on both the inside and outside of the knee.They sit between the femur(thigh bone) and tibia(shin bone) and act as a shock absorber in the knee.In addition,they provide some stability to the joint.

HOW IS THE MENISCUS TORN?

Acute meniscal injuries occur when the knee is suddenly twisted and forced forward into a bent position whilst the foot is still in contact with the floor.A portion of the meniscus can be torn by this combination of twisting and compression forces on the knee.these injuries are seen commonly in sports that involve twisting and turning.The menisci can also develop degenerative tears and it is common in older patients.

SIGNS AND SYMPTOMS

Acute meniscal injuries usually result in immediate pain followed by a gradual buildup of swelling in the knee and limited movement. sometimes the knee can also lock in a position if a part of the meniscus gets trapped within the joint.degenerative tears may present with similar symptoms to an acute injury,although on occasions patients may only experience pain without noticeable swelling or movement restrictions in the knee.

DIAGNOSIS

Many time the diagnosis of a meniscus tear can be made through the physical examinations. However, MRI can be helpful to confirm the tear and rule out any other injuries to the knee.

A set of X-rays may be ordered to evaluate the knee for arthritis or a fracture of the bones.even if the MRI was already performed,the X-rays are usually necessary for a complete evaluation.

TREATMENT OPTIONS

NON-SURGICAL

Initial treatment for a torn meniscus focuses on decreasing pain and swelling in the knee. Rest and anti-inflammatory medications, can help decrease these symptoms. You may need to use crutches until you can walk without a limp. Some patients may receive physical therapy. Therapists treats swelling and pain with the use of ice,electrical stimulation and rest periods with your leg supported in elevation. Exercises are used to help you regain normal movement of joints and muscles.

CORTISONE INJECTION to resolve the pain and swelling.

Whether or not you are a good candidate for a conservative treatment will depend on the type of tear,age of the tear,and your activity level.

If your symptoms do not resolve,then you may require SURGICAL TREATMENT.

SURGICAL PROCEDURE

  • Meniscal surgery is performed by arthroscopy.
  • The arthroscope is a small fiber optic instrument that is placed into the knee joint through a small incision.
  • The camera is then viewed on a TV monitor,and pictures can be taken.
  • The arthroscope allows complete evaluation of the knee joint including the patella,the cartilage surfaces, The meniscus,the ligaments (ACL and PCL) and the joint lining.
  • Small instruments ranging from 3-5mm in size are inserted through an additional incision and injury can be diagnosed and damaged tissue can be repaired or removed.

POST SURGICAL REHABILITATION

Rehabilitation proceeds cautiously after surgery on the meniscus and treatments will vary depending on whether you had part of the meniscus taken out or your surgeon repaired or replaced your meniscus. Patients are strongly advised to follow the recommendations about how much weight can be borne while standing or walking. After a partial meniscectomy,your surgeon may instruct you to place a comfortable amount of weight on your operated leg using a walking aid. After a meniscal repair,however,patients may be instructed to keep their knee straight in a locked knee brace and to put only minimal or no weight on their foot when standing or walking for upto six weeks.

PHASE I(0-4 WEEKS)

GOALS

  • Protection of the post-surgical knee
  • Restore normal knee extension
  • Eliminate swelling and reduce pain
  • Restore leg control

PRECAUTIONS

  • Patient may wean from walker to stick and to no stick as long as the knee is in the locked knee brace and there is no increase in pain for 4 weeks.
  • Knee brace locked for all weight bearing activities for 4 weeks.
  • Knee flexion should be limited so that the movement does not create any posterior knee pain.

THERAPEUTIC EXERCISES

  • Knee extension on a bolster or towel roll.
  • Heel slides.
  • Quads sets.
  • Knee flexion of the edge of the table.
  • Straight leg raises with locked knee brace.
  • 4 way leg lifts in standing with brace on for balance and hip strength.

PHASE II(4-8 WEEKS)

GOALS

  • Single leg stand control
  • Normalize gait
  • Good control and no pain with functional movements,including step up/down,squat,partial lunge(between 0-60degrees of knee flexion)

PRECAUTIONS

  • No forced flexion with passive range of motion with knee flexion or weight bearing activities that push the knee past 60degrees of knee flexion.

THERAPEUTIC EXERCISES

  • Non-impact balance and proprioceptive drills.
  • Stationary bike.
  • Gait drills.
  • Hip and core strengthening
  • Stretching for patient specific muscle imbalances
  • Quadriceps strengthening,making sure that closed chain exercises occur between 0-60degrees of flexion.

PHASE III(2-3 MONTHS AFTER SURGERY)

GOALS

Good control and no pain with sport specific movements,including impact.

PRECAUTIONS

  • Post activity soreness should resolve within 24 hours
  • Avoid post activity swelling
  • Avoid posterior knee pain with end range knee flexion.

THERAPEUTIC EXERCISES

  • Impact control exercises.
  • Movement control exercises beginning with low velocity single plane activities and progressing to high velocity multi plane activities.
  • Hip and core strengthening
  • Sport/work specific balance and proprioceptive drills.