Meniscus Tears Treatment and Rehabilitation Joseph Noah, MD Suncoast Orthopaedic Surgery And Sports Medicine

Meniscal Anatomy Medial and Lateral Semilunar in shape Essential in distributing load and reducing joint forces Act as secondary stabilizers of the knee Lateral more mobile Medial is secured to capsule throughout

Meniscal Anatomy Popliteal tendon passes through hiatus on the lateral side Makes the lateral meniscus more mobile Medial meniscus is most likely injured Only outer 1/3 is vascular (poor blood supply)

Meniscal Anatomy Blood supply most abundant at periphery Affects how certain tears are treated, resection vs repair Explains why most meniscal tears don’t heal on their own

Meniscus Tears Can be traumatic Younger patient Associated with rapid twisting injury with foot planted Patients may sense a slight “pop” or click. Most times patient can continue to play or complete task (unless associated with ligament injury)

Meniscus Tears Can be degenerative Usually involves the medial meniscus Older individuals No real traumatic event Knee suddenly became painful May have some mild associated OA on x-ray

Meniscus Tears Exam/Diagnosis Pain Mild knee effusion Joint line tenderness Decreased motion Catching or locking McMurray’s test Apley compression test Xrays MRI

Meniscus Tears Diagnosis MRI has become the gold standard imaging for intra-articular injury Allows for accurate diagnosis (also can reveal associated ligament injuries) Can help reveal prognosis for surgical treatment (bone edema, AVN or chondromalacia)

Meniscus Tears Tear Patterns Bucket handle tear Radial tear Horizontal cleavage Oblique (Parrot beak) Longitudinal tear (peripheral) Complex tear (combined radial and horizontal tear)

Meniscus Tears Traumatic tear treatment Traumatic tears in high demand individuals usually continue to limit activity or cause pain Generally recommend arthroscopic treatment (usually partial resection) Surgery not urgent except when there is associated “locking”

Meniscal Tears Traumatic tear treatment Meniscus tears in the periphery can sometimes be repaired (preserves entire meniscal tissue) Location and configuration of the tear is important in determining success Postop rehabilitation significantly longer for repair

Meniscus Tears Degenerative tear treatment Degenerative tears can initially be treated non-operatively Rest/Ice NSAIDS Injection Physical therapy Visco supplementation Arthroscopy (some insurance companies view surgery as experimental)

Meniscus Tears Degenerative tear treatment Many outcome studies dispute the efficacy of arthroscopy in patients with underlying OA Is the pain from the tear or exacerbation of OA? Associated bone edema, early avascular necrosis (AVN)

Meniscus Tears Degenerative tear treatment The presence of a tear does not necessarily equate with source of the pain These patients best treated non-operatively, at least initially Surgery, when necessary, may include arthroscopy with subchondroplasty Consider partial knee arthroplasty if pain persists

Meniscus tears Degenerative tear treatment Subchondroplasty is a newer procedure to try to treat the bone in addition to the meniscus tear Pin is inserted into the subchondral bone under x-ray and calcium/phosphate compound injected

Meniscus tears Degenerative tear treatment Material requires 8-10 minutes to cure Recovery time longer than standard arthroscopy (hurt longer) Can also be used in delayed healing of stress fractures Results are mixed (limited long term data)

Meniscus Tears Rehabilitation Physical therapy for partial menisectomy is generally uncomplicated Regain of motion Quad and hamstring flexibility/strength Gradual return to activity in 4-6 weeks

Meniscus Tears Repair Rehab Protocol Physical therapy for meniscal repairs is more complex (isolated repair not associated with ACL) Rehab protocols differ and the data is limited All protocols limit flexion and include some degree of early immobilization

Meniscus Tears Repair Rehab Protocol Goals of treatment are accepted Control pain and swelling Initiate knee motion Activate Quadriceps Protect repair

Meniscus Tears Repair Rehab Protocol (0-6 weeks) Postop brace locked in full extension WBAT in brace with crutches Start gentle ROM exercises 0-90 degrees Quad sets Heel props Sitting heel slides Ankle pumps Hip Abduction Short arc quads Straight leg raise

Meniscus Tears Repair Rehab Protocol (6-12 weeks) Progress ROM beyond 90 degrees Discontinue brace if full extension achieved Avoid pivoting or squatting Stationary bicycle Wall slides Lunges 0-90 degrees Standing hamstring curl Can use ankle weights to add resistance Seated leg press 0-90 degrees

Meniscus Tears Repair Rehab Protocol (12-16 weeks) Full weight with normal gait pattern Full painless ROM Focus on single leg strength Begin light jogging/running Sport specific drills Healing time will depend on location of tear (blood supply) Healing better when performed with ACL reconstruction Overall success rate is 80-85%

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