Transcript Meniscal Tears

Meniscal Tears
By : Mehdi Masumi
Objectives
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You will be able to identify the two menisci in the knee
You will know the most common mechanisms of
meniscal tears
You will be able to recognize and evaluate a meniscal
tear
You will know the proper treatments and rehabilitation
for a meniscal tear
You will understand the requirements for an athlete to
return to play
You will learn various stretches and strengthening
techniques for prevention
The Knee Joint
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The knee joint has two
menisci, a lateral and
medial
They are fibrous cartilage
They rest on top of the
tibia in shallow
indentations
The lateral meniscus is on
the outside of your knee
and the medial the inside
Functions of the menisci
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Aid in lubrication and
nutrition of the joint
Act as shock
absorbers
Evenly distribute
weight throughout
the knee
Allows for smoother
motions between the
femur and tibia
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The inner 2/3 of the
menisci are avascular
(without blood supply)
The remaining outer
1/3 is vascular (with
blood supply)
Mechanisms of injury
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An acute twisting injury from
impact during a sport
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Usually the foot stays fixed on the
ground and the rest of body
rotates
Getting up from a squatting or
crouching position
Loading the knee from a fixed
position
Injuring the meniscus
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There are several types of tears
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Vertical
Radial
Horizontal
Degenerate
Complex
Horn
A loss of any part of the meniscus causes
uneven weight distribution and can lead to early
wear of the knee
The lateral meniscus is not attached as firmly to
the tibia as the medial meniscus, making it less
likely to become injured
Meniscal injury stats
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Meniscal injuries occur in 15% of ACL injuries
80% of patients with a history of ACL tears will
likely tear their meniscus with incidences of
instability of the knee
70.7% of meniscal injuries are to the medial
meniscus
Almost all meniscal injuries ages 20 and under
are sports related 11 out of 12 cases
Ages 20-29, 64.5% were sports related
Ages 30-39, 30.6% were sports related
Ages 40-49 and 50-59 only 19.6% and 14.3%
were sports related
What to look for?
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Not all meniscal tears are symptomatic
If there are symptoms you could look for:
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Swelling
Pain along the joint line (tenderness)
Pain when squatting, kneeling or pivoting
Locking of the knee
Loss of full knee extension
How can the coach help?
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If there is a possible meniscal tear 80-90% of
the time an athlete will remember the
mechanism of the injury and may report a “pop”
or a “snap”
You could ask the athlete if there is pain when
weight bearing, or bending of the knee
You could also ask the athlete if they are having
any locking in their knee or trouble extending
the knee all the way
When there is a meniscal injury
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As a coach in the event of a meniscal
injury you should
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Ice the area in pain
Limit movement of the knee joint (rest)
Keep weight bearing limited to a tolerable
level of pain for the injured knee
Sometimes a splint can be applied for comfort
Rehabilitation options
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There are two common ways that a meniscal
tear can be repaired surgically
There is also a non surgical option because the
menisci are partially vascular they have the
ability to heal themselves
Why choose surgery?
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Surgery is usually advised for a few
different reasons
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The location of the tear, if the tear is in a
avascular zone it will most likely not heal itself
If the tear is longer than 5-8mm
If the pain limits activities of daily living
Or if the individual is not happy with their
level of function
Surgical techniques
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The more common technique is arthroscopic
partial menisectomy, which consists of removing
the torn fragment of the meniscus
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This reduces irritation, but can effect the weight
distribution in the knee
The other option is an arthroscopic repair, which
requires suturing the meniscus back together
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This option attempts to conserve the meniscus in
hopes of preventing the early onset of arthritis
Road to recovery
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Whether you choose the surgical or conservative
approach, the rehabilitation is similar
The rehabilitation time frames can vary
depending on the individual and the severity of
the tear
The protocols may vary depending on the
surgical approach and physician. A common
protocol may include the following
Steps to recovery
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The patient may be full weight bearing right
after the surgery with or without crutches
Initial symptoms can be reduced using certain
modalities and manual techniques
Stretching/ flexibility exercises focusing on
hamstrings, quadriceps, hip flexors, hip
adductors and calf muscles
Strengthening
Balance training
Dynamic exercises/plyometrics
Initial physical therapy
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The first few sessions of physical therapy may
consist more of modalities and some manual
techniques to address inflammation, pain and
ROM such as:
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Heat/ice
Ultrasound
Electrical stimulation
Manual stretching
Scar and patella mobilizations
Passive range of motion for full knee flexion and
extension
Retrograde massage to decrease swelling
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Once pain and swelling are reduced the
sessions mainly focus on increasing the
strength and flexibility of the lower
extremity as tolerated
The progression will vary depending on
the individual
Some examples of stretching and
strengthening exercises are illustrated in
the following slides
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Hamstrings
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Quadriceps
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Calf muscles
Stretching
Stretching continued
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Hip flexors
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Hip adductors
Strengthening
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Focusing on strengthening the muscles around
the knee is essential in rehabilitation
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Quad sets
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Heel raises
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Leg extension
Straight leg raises (in all planes)
Leg Curl
Balance
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Balance can
sometimes be
compromised after an
injury or surgery
Here are some
balance exercises that
can help
Dynamic exercises/plyometrics
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Progression to more
dynamic sports specific
exercises helps with
the transition back into
sports
Return to play
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This can vary widely from athlete to
athlete
When the athlete can participate in sport
specific exercises without pain or
weakness
Full ROM is apparent in the injured knee
Collaborate decision between athlete,
physical therapist and physician
Prevention
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The prevention of meniscal tears is very
similar to the rehabilitation
Research has shown that more flexible
and stronger joints are less likely to get
injured
The athlete would continue stretching and
strengthening the lower extremities
Bibliography
Learmonth, DJA. “Aspects of the knee: meniscal injury and surgery.” Trauma. 2000. Vol. 2
p. 223-230
Gilbert, Rob. Ashwood, Neil. “Meniscal repair and replacement: a review of efficacy.”
Trauma. 2007. Vol. 9 p. 189-194
Lento, Paul. Akuthota, Venu. “Meniscal injuries: A critical review.” Journal of Back and
Musculoskeletal Rehabilitation. 2000. Vol. 15 p. 55-62
Boyd, Kevin. Myers, Peter. “Meniscus preservation; rationale, repair techniques and results.”
The Knee. March 2003. Vol. 10 Iss. 1 p. 1-11
Brindle, Timothy. Nyland, John. Johnson, Darren. “The Meniscus: Review of Basic Principles
With Application of Surgery and Rehabilitation.” Journal of Athletic Training. Apr-Jun.
2001. Vol. 36 p. 160-169
Drosos, G.I. Pozo, J.L. “The causes and mechanisms of meniscal injuries in the sporting and
non-sporting environment in an unselected population.” The Knee. April 2004. Vol. 11
Iss. 2 p. 143-149
Magee, David. “Orthopedic Physical Assessment 2nd edition.” Philadelphia: W.B. Saunders
Company, 1992