Meniscal tears of the knee brigham and womens hospital. The repaired meniscus would benefit from weight bearing forces to compress and. The first phase is designed to protect the repair and allow for maximal healing. Conservative treatment for meniscus rehabilitation. Meniscal injuries can be the result of a forceful, twisting event in a young athletes knee or it can insid. A meniscus tear is often caused by a single acute injurysuch as a sudden twist or quick turn during sports activity. Dec 23, 2016 explaining the 4q model today, which i incorporate in my training sessions. The medial meniscus is semicircular in shape and the lateral meniscus is almost a complete circle. Treatment for a torn meniscus often begins conservatively, depending on the type, size and location of your tear.
There are two in each knee and can be damaged under pressure. Injury to the menisci has been found to significantly alter the complex biomechanics of the knee, and thus affect the health and longevity of the native joint. When reading the cocorahs rain gauge, the inner cylinder has markings to the nearest 1100th of. A 12week supervised exercise therapy program for young adults with a meniscal tear. Meniscal tear meniscus injury meniscus injuries your knee has 2 menisci. Anterior horn meniscal repair using an outsidein suture. While the main reason most people give for electing to have surgery is the desire to return to a favorite sport with a stable knee joint, surgery also helps pro. Knee arthroscopy with meniscus repair rehab protocol. The meniscus is a piece of cartilage strong tissue between your thighbone and shinbone. To open a pdf file you will need compatible software such as adobe reader. Rehabilitation exercises a meniscus tear is a common knee joint injury. Physical therapy pt and exercises for a meniscus tear rehab. Diagnosis and management of meniscal injury jacob babu, md, mha.
The protocol may be modified depending on the location and extent of the meniscal tear and subsequent repair. The aim of phase 3 of a meniscus tear rehabilitation program is to ensure full range of movement in the knee, regain normal strength with the ability to perform a full squat and start to return to running and normal training. Rehabilitation of fractured knee cap, bruised bursa and. Sports injury medicine department 9250 sw hall blvd. Specific changes in the program will be made by the. Meniscus tear aftercare instructions what you need to know. When the meniscus root is repaired there will be a prolonged. Rehabilitation following a meniscus repair has to be more conservative, however, despite research saying otherwise, there are still many rehabilitation protocols floating around the orthopaedic and sports medicine world that recommend limiting weight. The traumatic type of meniscal injuries is most often sportsrelated. This concept is useful during rehabilitation of the repaired meniscus. In the younger population, your knee meniscus is usually torn traumatically, by twisting on a slightly flexed knee. Also great exercises to do if you have a meniscus tear. The meniscus is a wedge shaped cartilage ring found on both the inside and outside of the knee between the femur thigh bone and tibia shin bone. As reported by majewski, injuries to the menisci are the second most common injury to the knee, with an incidence of 12% to 14% and a prevalence of 61 cases per 100,000 persons6.
Oct 21, 2010 the rubbery meniscus cushions the knee, but a twist or pivot can tear this cartilage. If you just found out that the pain and swelling in your knee is a torn meniscus, you probably have a decision to make about how to treat it. The menisci are important structures within the knee that play a critical role in maintaining proper stability, load distribution, and joint lubrication. Rehabilitation depending on the severity of the damage the rehabilitation process may take from 412 weeks. Pdf the outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play rtp.
They may also prescribe physical therapy and antiinflammatory. Meniscal tear incidence may be as high as six per population 6. What is rehabilitation and recovery like for a patient with a meniscus. It can be torn if you suddenly twist your knee while bearing weight on it. If the torn meniscus is removed, the patient is usually up and walking within a day or two of surgery, and back to normal activities within several weeks. As we get older the meniscus weakens and tears can occur more easily, even from something as simple as squatting or stepping off a curb onto an uneven surface. The lateral translates 9 to 11mm in the anterioposterior plane. The orthopedic surgeon may modify the time frames and weight bearing status, as necessary, to allow adequate healing time. A 12week supervised exercise therapy program for young. Meniscus tears will not show up on xrays so your physician may also order a mri of the knee. Radial tears sometimes can be fixed, but it depends on where they are. Meniscus tears and repair advanced orthopaedic centers.
This blood supply is necessary for a tear or a repair to heal. Sportsrelated meniscus tears often occur along with other knee injuries, such as anterior cruciate ligament acl tears. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear. One of humanitys most common injuries during sports is an injury to the knee joint meniscus. It also acts as a bumper and can help prevent abnormal motion in the knee especially if your ligaments are loose or injured. Nov 15, 2019 the meniscus is a cshaped piece of tough, rubbery cartilage that acts as a shock absorber between your shinbone and thighbone. The meniscus can be injured in many ways and on different locations flap tear, bucket handle tear, vertical tear, horizontal tear, complex tear, thus causing a variety of histories and different clinical findings.
If you have a tear in the white zone of the meniscus, repair surgery usually isnt done, because the meniscus may not heal. Division of sports medicine, department of orthopaedic surgery, north shore university hospital, and orthopaedic associates of manhasset, manhasset, new york abstract increasing emphasis on the comprehensive reconstruction of the knee and on restoration of knee function after. The purpose of this clinical commentary is to provide a brief background on meniscal root anatomy. When a meniscus is repaired, the tear is approximated using stitches to allow the tear to heal.
Tears involving the anterior horn are increasingly recognized as an important. Lowload long duration stretching for extension with heat if needed. The meniscus is a crescentshaped piece of cartilage that is located between the femur and the tibia. Pdf rehabilitation and return to play following meniscal repair. After meniscal surgery, rehabilitation with a physical therapist or athletic trainer is needed to restore range of motion, strength, movement control and guide the athletes return to sport. Pdf most of the documents on the racgp website are in portable document format pdf. A meniscus tear is a tear in the cartilage of your knee. Pdf meniscal injuries represent one of the most frequent lesions in sport practicing and in particular in soccer players and skiers. Feb 03, 2020 a meniscus tear is a tear in the cartilage of your knee. As we get older the meniscus weakens and tears can occur more easily, even from something as simple as.
The rehabilitation guidelines following meniscal repair at our institution are divided into three phases and are outlined in table 2. These files will have pdf in brackets along with the filesize of the download. The menisci act as shock absorbers in the knee, and provide stability to the joint. Common tears include longitudinal, parrotbeak, flap, bucket handle, and mixedcomplex. Because the menisci weaken and wear thin over time, older people are more likely to experience a degenerative meniscus tear. Rehabilitation following a meniscus repair is more significant than if the torn piece of meniscus is simply removed through a procedure called a partial meniscectomy. Meniscus repair rehabilitation the following protocol is a guideline for rehabilitation following meniscus repair.
Tears associated with arthritis often improve over time with treatment of the arthritis, so surgery usually isnt indicated. Racgp meniscal tear presentation, diagnosis and management. In his epidemiological study conducted on 17,397 patients in germany and switzerland, soccer, followed by skiing, are the sport with an increased risk of meniscal injuries. The authors have reported the efficacy of the rehabilitation programs and the results of meniscus repair and transplantation in many studies. Athletes, particularly those who play contact sports, are at risk for meniscus tears. In many cases, a surgical procedure called arthroscopy is used to repair or remove a torn meniscus. Tears are noted by how they look, as well as where the tear occurs in the meniscus.
How well the knee will heal and whether surgery will be needed depends in large part on the type of tear see figure in appendix and how bad the tear is. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much. Vertical tears longitudinal tears are most often traumatic. How well the knee will heal and whether surgery will be needed depends in large part on the type of tear and how bad the tear is. The outer onethird of the meniscus has a rich blood supply. Repair of isolated horizontal meniscal tears with allinside. Be sure to rotate your leg outward laterally slightly to gain a better activation of the medial inner side of the quadriceps. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much strength and flexibility in your knee as possible. Op rehabilitation protocol the following is a protocol for postoperative patients following an isolated meniscus repair. Department of exercise, health, and sports science.
Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet. For most tears, some simple exercises can help maintain muscle strength in the front of the thigh quadriceps, back of the thigh hamstr. Com meniscal cartilage tear top view femur thighbone tibia shinbone medical meniscus front view of knee lateral meniscus torn what are the symptoms. The meniscus can be torn anterior to posterior, radially parrot beak, or can have a bucket handle appearance. Symptoms of a degenerative meniscus tear include swelling, pain along the joint line, catching and locking. This injury has been observed in various populations, and it could be due to traumatic out of which. Phase 1 010 days wear a compressive brace or support to protect and help reduce the swelling. Jan 21, 20 he highlights the importance of walking with crutches in a longleg brace for about 6 weeks after meniscal transplant and complex meniscus repairs extending into central onethird region but not routinely after repair of a peripheral meniscus tear. Players may cause a tear by squatting and then twisting the knee. Manual muscle testing may reveal a proximal or distal weakness or. If the tear is closer to the middle, there is no blood supply, so healing will not occur. A torn meniscus is one of the most common knee injuries. Meniscus injury is very common in knee traumatology.
If you do not have it you can download adobe reader free of charge. The treatment chosen will depend on the location of the tear, the athletes sport, ligamentous stability of the. Your meniscus is a piece of cartilage that is located in your knee joint. Occasionally a patient may be able to regain function through rehabilitation without surgery progressing to knee arthritis. Whats best for you depends on what the tear s like. Meniscus repairs located in the periphery heal rapidly, whereas complex multiplanar repairs tend to heal more slowly and require greater caution.
Knee arthroscopy with meniscus repair rehab protocol longitudinal bucket handle tears this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Meniscus repair rehab protocol orthopaedic medical group. Small meniscal tears commonly medial tears will often lead to a quicker rehabilitation period than a more complicated tear, especially if the lateral meniscus is. Rest and elevate the knee when not doing your rehabilitation exercises. Meniscus tears symptoms and treatment orthoinfo aaos. Any activity that causes you to forcefully twist or rotate your knee, especially when. Nonoperative treatment of degenerative posterior root tear of the medial meniscus. For most tears, some simple exercises can help maintain muscle strength in the front of the thigh quadriceps, back of. Evidence based management of meniscal tears kenneth g. Behrens, md abstract meniscal injury is a common cause for presentation to the emergency department or primary care physicians office. Pain and swelling are the most common signs of an injury to your meniscus. Another study23 following the effect of supervised exercise therapy on 37 patients with degenerative tears of the medial meniscus found. Patient guide to meniscus injuries what is the meniscus. Lateral meniscus rehabilitation partial or complete meniscectomy this is suitable for athletes who have had part or all of the cartilage meniscus taken out following a lateral meniscus tear.
When doctors and patients refer to torn cartilage in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much strength and. Meniscal repairs located in the vascular zones of the periphery or outer third of the meniscus are progressed more rapidly than those repairs that are. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving. To avoid placing stress on the meniscus repair, do not bend your knee beyond 90. Rehabilitation guidelines for meniscal repair uw health. A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. However, headtohead comparison of programs in a randomized design is needed to determine if this specific program is significantly better than other interventions. Meniscus rehab exercises the physical therapy advisor. The meniscus helps to cushion your knee joint and keep it stable.
When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. Meniscus tears are among the most common knee injuries. This paper follows the research and rehabilitation of myself janine noopetch 42yrs old, using pilates after suffering an impact injury to the knee, resulting in a simple fracture of the patella, a lateral tear to my meniscus, bruised bursa of the knee and dislodged osteophytes. Most often degenerative tears are surgically removed. The meniscus is a crescent shaped specialized cartilage that helps cushion the knee and distribute to forces of walking, running, etc.
Lots of leg workout in this session using a combination of lunges. Oct 28, 2016 meniscus tear repair was applied to the right knee in 15 cases and to the left in 12, medial in 21 77. Brian krabak and susanne michaud talk about the injury and their approach to getting patients. Rehabilitation is initiated immediately postoperatively. Meniscus repair rehabilitation program gundersen health system. When an unstable fragment from a buckethandle tear moves into the intracondlar notch it blocks full extension of the knee joint. The preoperative symptom of the patients and examination findings are presented in table 2. Rehabilitation guidelines for meniscal repair of root and. But partial meniscectomy may be done if torn pieces of meniscus are causing pain and swelling.
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