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 ID: 998669
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1. Meniscus Tears Treatment and RehabilitationJoseph Noah, MDSuncoast Orthopaedic SurgeryAnd Sports Medicine
2. Meniscal AnatomyMedial and LateralSemilunar in shapeEssential in distributing load and reducing joint forcesAct as secondary stabilizers of the kneeLateral more mobileMedial is secured to capsule throughout
3. Meniscal AnatomyPopliteal tendon passes through hiatus on the lateral sideMakes the lateral meniscus more mobileMedial meniscus is most likely injuredOnly outer 1/3 is vascular (poor blood supply)
4. Meniscal AnatomyBlood supply most abundant at peripheryAffects how certain tears are treated, resection vs repairExplains why most meniscal tears don’t heal on their own
5. Meniscus TearsCan be traumaticYounger patientAssociated with rapid twisting injury with foot plantedPatients may sense a slight “pop” or click.Most times patient can continue to play or complete task (unless associated with ligament injury)
6. Meniscus TearsCan be degenerativeUsually involves the medial meniscusOlder individualsNo real traumatic eventKnee suddenly became painfulMay have some mild associated OA on x-ray
7. Meniscus TearsExam/DiagnosisPainMild knee effusionJoint line tendernessDecreased motionCatching or lockingMcMurray’s testApley compression testXraysMRI
8. Meniscus TearsDiagnosisMRI has become the gold standard imaging for intra-articular injuryAllows for accurate diagnosis (also can reveal associated ligament injuries)Can help reveal prognosis for surgical treatment (bone edema, AVN or chondromalacia)
9. Meniscus TearsTear Patterns Bucket handle tearRadial tearHorizontal cleavageOblique (Parrot beak)Longitudinal tear (peripheral)Complex tear (combined radial and horizontal tear)
10. Meniscus TearsTraumatic tear treatmentTraumatic 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 TearsTraumatic tear treatmentMeniscus tears in the periphery can sometimes be repaired (preserves entire meniscal tissue)Location and configuration of the tear is important in determining successPostop rehabilitation significantly longer for repair
12. Meniscus TearsDegenerative tear treatmentDegenerative tears can initially be treated non-operatively Rest/IceNSAIDSInjectionPhysical therapyVisco supplementationArthroscopy (some insurance companies view surgery as experimental)
13. Meniscus TearsDegenerative tear treatmentMany outcome studies dispute the efficacy of arthroscopy in patients with underlying OAIs the pain from the tear or exacerbation of OA?Associated bone edema, early avascular necrosis (AVN)
14. Meniscus TearsDegenerative tear treatmentThe presence of a tear does not necessarily equate with source of the pain These patients best treated non-operatively, at least initiallySurgery, when necessary, may include arthroscopy with subchondroplastyConsider partial knee arthroplasty if pain persists
15. Meniscus tearsDegenerative tear treatmentSubchondroplasty is a newer procedure to try to treat the bone in addition to the meniscus tearPin is inserted into the subchondral bone under x-ray and calcium/phosphate compound injected
16. Meniscus tearsDegenerative tear treatmentMaterial requires 8-10 minutes to cureRecovery time longer than standard arthroscopy (hurt longer)Can also be used in delayed healing of stress fracturesResults are mixed (limited long term data)
17. Meniscus TearsRehabilitationPhysical therapy for partial menisectomy is generally uncomplicatedRegain of motionQuad and hamstring flexibility/strengthGradual return to activity in 4-6 weeks
18. Meniscus TearsRepair Rehab ProtocolPhysical therapy for meniscal repairs is more complex (isolated repair not associated with ACL)Rehab protocols differ and the data is limitedAll protocols limit flexion and include some degree of early immobilization
19. Meniscus TearsRepair Rehab ProtocolGoals of treatment are acceptedControl pain and swellingInitiate knee motionActivate QuadricepsProtect repair
20. Meniscus Tears Repair Rehab Protocol (0-6 weeks)Postop brace locked in full extensionWBAT in brace with crutchesStart gentle ROM exercises 0-90 degreesQuad setsHeel propsSitting heel slidesAnkle pumpsHip AbductionShort arc quadsStraight leg raise
21. Meniscus TearsRepair Rehab Protocol (6-12 weeks)Progress ROM beyond 90 degreesDiscontinue brace if full extension achievedAvoid pivoting or squattingStationary bicycleWall slidesLunges 0-90 degreesStanding hamstring curlCan use ankle weights to add resistanceSeated leg press 0-90 degrees
22. Meniscus TearsRepair Rehab Protocol (12-16 weeks)Full weight with normal gait patternFull painless ROMFocus on single leg strengthBegin light jogging/runningSport specific drillsHealing time will depend on location of tear (blood supply)Healing better when performed with ACL reconstructionOverall success rate is 80-85%
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