Are you having knee pain? Did someone tell you you tore your meniscus or are your searching for answers and information as you try to make decisions around caring for your knee? Meniscus injuries can be confusing and with all the new research and change in treatment protocols it can be difficult to know what to do.Like many injuries, there are different types of meniscus injuries that sometimes require surgery and some that do not. By the end of this blog we hope you understand what a meniscus injury is, the different types, symptoms involved with meniscus injuries, how they occur, options after the diagnosis, and what the general rehabilitation process looks like.
So let's get started!
1. Anatomy
The menisci are crescent-shaped fibrocartilaginous structures that are located between the tibiofemoral joint (knee joint). There is the medial meniscus which is located on the inner side of the knee and the lateral menisucs which is located on the outer side of the knee. The medial meniscus is firmly bound to the joint capsule and also has attachments to the deep fibers of the medial collateral ligament (MCL), which causes them to be less mobile than the lateral meniscus. If you have heard of anybody with an ACL and/or a MCL injury, that is the one of the reasons why they tend to also have medial meniscus involvement as well. The primary functions of the menisci are for transfer of load and shock absorption within the knee joint.
In addition to symptoms that are common
2. Mechanism of Injury - How do meniscus injuries occur? We call the the mechanism of injury or MOI. Below are some of the typical things we see:
- Rotational or shear forces applied to the knee joint
- More common when the knee is in a flexed/bent position
- Rapid acceleration or deceleration
- Change of direction
- Cutting
- Direct Trauma
- Degenerative changes due to lack of activity or movement in the knee joint (requires less force to cause tears)
3. Symptoms :
- Pain
- Decreased knee mobility (usually flexion/bending)
- Swelling
- Tenderness at the knee joint line
- Catching sensations
- Knee giving out
4. Meniscectomy vs. Meniscus Repair vs. Rehabilitation Only
The big question after getting diagnosed is, what now? The surgeon will typically consider what type of tear it is (flap, bucket handle, radial, etc), the activity level of the patient, the location of the tear (inner 2/3 vs. peripheral 1/3), and the goals of the patient. So what's the difference between the procedures?
- Meniscectomy - removal or trimming of the meniscus tissue
- Meniscus Repair - suturing and anchoring of the meniscus in place
Based on some of the current research, meniscus repairs tend to have better long term outcomes when it comes to function and pain and also have a higher rate of return to sport, while meniscectomies have a earlier return to sport timeline but increases the risk of accelerated osteoarthritis.
Now that many of the orthopedic surgeons understand the value of conservative treatment and physical therapy prior to surgeries, some patients are able to avoid surgeries entirely. This is why we educate our patients that this diagnosis is not a death sentence. The MRI result does not always determine your level of function and that surgery is not always the only option. In fact, there have been studies that showed no significant differences in symptoms and function between patients who received the meniscectomy versus a placebo surgery. Exercise alone has been clinically proven to improve the symptoms and function of patients with degenerative meniscus tears. In fact, recent research shows that there in fact is no difference in outcomes when comparing a meniscus surgery with conservative rehab. We see this generally in our practice as well. When in doubt, start conservatively first with physical therapy while consulting with the orthopedist for their opinions as well to create a multi-professional game plan.
5. Rehabilitation
Depending on the option you choose above, rehab could look a little different. Post surgical rehab will focus on scar healing and protecting the knee, however all other goals will be generally same.
Here is a breakdown of the stages of care and our goals for each stage:
Early Stage
- Improve range of motion
- Reduce the pain and inflammation
- Build sensory awareness of the musculature that surround the knee
- Continue to train the opposite leg
- Blood flow restriction training if appropriate
*The slight difference in this stage with regards to meniscus repair vs meniscectomy is that most surgeons will recommend a slower progression of knee flexion/bend range of motion and weight-bearing to minimize the stress put on the sutures for meniscus repairs. Current research is moving more towards early mobilization and weight-bearing, but again, will depend on the surgeon.*
Middle Stage
- STRENGTH in various planes of movement
- Power development
- Early plyometrics
- Depending on the patient population, slowly starting to build confidence with low intensity sports specific movements
Late Stage
- Continue to build strength and power
- Athletic patterns - shuffling, cutting, acceleration, sprinting, hip turns
- True agility work involving reactionary drills
- Gradual return to SPORT
- Gradual return to PLAY
At the end of it all, we are here to help you regardless of what you decide to do with your meniscus injury. We'll be here for your prehab work, post surgical rehabilitation, or even for injury risk management to reduce the risk of getting a meniscus injury. With all of the various factors that are involved with these conditions, we want to make it as easy as possible for you.
If you are interested in working with us we work with clients on site and virtually through Telehealth. Click here if you are interested in booking a a session or getting more information! https://www.physicaltherapysanpedro.com/sports
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Much Love <3 ,
The PTSP Docs
Dr. Daisuke, Dr. Brown, Dr. Bay, & Dr. Sandoval