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Questions and Answers
What is the maximum flexion range allowed immediately after meniscal repair?
What is the maximum flexion range allowed immediately after meniscal repair?
What is the recommended timeline for returning to a graded running program after meniscal repair?
What is the recommended timeline for returning to a graded running program after meniscal repair?
Which of the following activities should be avoided for at least 6 months post-meniscal repair?
Which of the following activities should be avoided for at least 6 months post-meniscal repair?
Which technique is NOT mentioned as a method to enhance healing in the avascular region of the meniscus?
Which technique is NOT mentioned as a method to enhance healing in the avascular region of the meniscus?
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What percentage of patients under 19 years did not show signs of clinical failure at follow-up after meniscal repair?
What percentage of patients under 19 years did not show signs of clinical failure at follow-up after meniscal repair?
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What mechanism is a common cause of meniscal injuries?
What mechanism is a common cause of meniscal injuries?
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Which of the following is NOT a sign or symptom of meniscal injury?
Which of the following is NOT a sign or symptom of meniscal injury?
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In what scenario would a meniscal injury be left alone?
In what scenario would a meniscal injury be left alone?
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What is the primary objective in rehabilitation following arthroscopic debridement?
What is the primary objective in rehabilitation following arthroscopic debridement?
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At what stage is it typically acceptable to begin treadmill running post-surgery if quad strength is >70%?
At what stage is it typically acceptable to begin treadmill running post-surgery if quad strength is >70%?
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What is a critical consideration for a successful meniscal repair?
What is a critical consideration for a successful meniscal repair?
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Which postoperative activity is restricted for the first 6 weeks following meniscal repair?
Which postoperative activity is restricted for the first 6 weeks following meniscal repair?
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What is the recommended progression for range of motion following meniscal repair within the first few weeks?
What is the recommended progression for range of motion following meniscal repair within the first few weeks?
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Study Notes
Meniscal Injuries: Mechanisms
- Sudden changes in direction with the foot fixed on the ground (e.g., cutting, pivoting) are common causes
- Hyperflexion (e.g., landing, activities by certain professions like miners, plumbers, wrestlers) can cause injuries
- High-impact compression loads can also lead to injuries
- Injuries can be related to mechanisms involving the MCL or ACL
Meniscal Injuries: Signs and Symptoms
- Severe pain immediately following injury, with swelling (effusion) developing within hours
- Feeling of instability or giving way on the affected knee
- Intermittent pain and swelling (effusion) can occur later
- Locking of the knee joint is a possible symptom
- Tenderness along the joint line is a possible indication
- Positive McMurray or Apley compression tests may indicate a meniscal tear
- Limited range of motion (ROM) and premature end-feel
- Symptoms exacerbated by deep squatting
Decision-making: Leave Alone
- Partial thickness tears of the meniscus, especially short peripheral tears, that don't disrupt joint mechanics might not require treatment
- Stable meniscus in an otherwise unstable knee might be observed
- Degenerative meniscus in a degenerative knee might be observed
Partial Menisectomy
- A procedure to remove a portion of the meniscus is recommended when a meniscal tear disrupts the knee mechanics and the patient is not a surgical candidate for repair
- Debridement involves removing as little of the damaged tissue as possible
Rehabilitation Following Arthroscopic Debridement
- Muscle strengthening and joint mobility exercises, including isometrics, active range of motion (AROM), and posterior chain mobilization (PF mobilization)
- Immediately following surgery, soft tissue manipulation of the portal scars should be done. This is performed when the incisions are healed and ready.
- Progress to progressive resistance exercise (PREs) when tolerated
- Add neuromuscular electrical stimulation (NMES) when appropriate
Rehabilitation Following Arthroscopic Debridement: Ambulation
- Partial Weight Bearing After Surgery (PWBAT) is permitted immediately
- Progress to full weight bearing (FWB) when walking without limping, which usually takes 1 to 2 weeks
Rehabilitation Following Arthroscopic Debridement: Return to Activity
- Return to running on a treadmill around 3-4 weeks if quad strength is over 70% and there is no joint pain or swelling
- Progress to level surface running, sprinting, and agility training as tolerated
- Full activity usually resumes within 6 weeks, with quad strength above 85%
Meniscal Repair
- Repair is considered if the lesion is in an area with good blood supply (vascularization)
- Lesions are at least 1 cm in length
Rehabilitation Following Meniscal Repair: Muscles and Mobility
- Limited range of passive and active range of motion (PROM & AROM) for the first 2-3 weeks (0-90 degrees), gradually progress to full ROM within 6-8 weeks
- Isometric exercises should be started immediately after surgery
- No resisted hamstring or closed chain exercises for the first six weeks
- Progress to more aggressive strengthening exercises (e.g., closed-chain exercises) after 6 weeks. Avoid resisted open-chain hamstring exercises
Rehabilitation Following Meniscal Repair: Ambulation
- Weight-bearing as tolerated (WBAT) with the brace locked in extension for the first 1-2 weeks after surgery.
- When the brace is unlocked, gradually wean off crutches and progress to full weight-bearing (FWB) ambulation.
Rehabilitation Following Meniscal Repair: Return to Activity
- Start a graded running program (begin on a treadmill) after 3-6 months, depending on quad strength, pain, and swelling
- Full activity can be expected after 6 months or more depending on the progress in the running and agility program
- Activity restrictions after surgery and too much early activity may hinder recovery
Meniscal Repair of Avascular, Central Region
- Meniscal repair of avascular, central regions are more common due to increased emphasis on preserving the meniscus
- Modifications to surgical techniques, like fibrin clot development, and rasping of synovial fringes to create vascular access channels improve healing
- Outcomes are encouraging, with high success rates for these procedures.
Meniscal Repair of Avascular, Central Region: Specific Data
- Noyes, et al. (2002) reported successful outcomes with 75% of patients having no symptoms at an average follow-up of 18 to 51 months following repair in individuals under 19 years of age.
- Noyes, et al. (2000) reported 26/30 patients (87%) were symptom-free after 34 months post-surgery in individuals 40 years or older.
Meniscal Repair of Avascular, Central Region: Rehabilitation Protocol (Noyes, 2002)
- Immediate knee motion (0-90 degrees)
- Flexion to 120 degrees by 3-4 weeks
- Flexion to 135 degrees by 5-6 weeks
- Crutches for the first 4 weeks, then progress to touch weight bearing
- Full weight bearing (FWB) by 6 weeks
- No deep squatting, running, jumping, cutting, or twisting for 6 months
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Description
This quiz covers the mechanisms, signs, and symptoms associated with meniscal injuries in the knee. It also discusses decision-making regarding the management of partial thickness tears. Test your knowledge on this important aspect of sports medicine and orthopedic evaluation.
