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

2. 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

3. 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)

4. 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

5. 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)

6. 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

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

8. 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)

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

10. 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”

11. 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

12. 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)

13. 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)

14. 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

15. 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

16. 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)

17. 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

18. 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

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

20. 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

21. 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

22. 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%

23. THANK YOU