Physical therapy pt and exercises for a meniscus tear rehab. The utilization of the mc in the evaluation and treatment of a 20yearold soccer player with an apparent acute meniscal injury is presented. Rehabilitation guidelines for meniscal repair of root and. Undifferentiated knee pain in the adult, physical examination of the knee, and other specific knee injuries are discussed separately. Any sudden twisting or blunt forces exerted onto the meniscus can result in damage. The meniscus is a cshaped piece of cartilage in the knee that cushions and acts as a shock absorber between your thigh bone femur and shin bone tibia. Apr 24, 2020 a varus force on a flexed knee with the femur externally rotated may lead to a lateral meniscus lesion. 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. See medial collateral ligament injury of the knee and anterior cruciate ligament injury. The lateral meniscus is on the outer side of the knee and is attached to the tibia but not to the corresponding lateral collateral ligament.
This is partly because the medial meniscus is attached to the medial collateral ligament, and partly because tackles are often directed towards the lateral side of the knee, causing external rotation of the tibia. Rehabilitation guidelines for meniscal repair uw health. Use of this image without authorization from primal pictures, ltd. An injury can cause altered biomechanics of the knee joint and pain. The medial and lateral menisci play an important role in absorbing force and assisting in the role of nourishing the knee joint. Figure 4 schematic representation of the meniscal effect on contact pressure in the knee.
Imaging techniques such as magnetic resonance imaging may be warranted but are no substitute for thorough clinical history and examination. You have both an inner medial and outer lateral meniscus that help distribute the forces in the knee when you are weightbearing. Cabaud et al performed transverse medial meniscal lacerations and repair with a single dexon suture on 20 canine and 12 rhesus knee joints. The meniscus are c shaped discs, made of tough cartilage called fibrocartilage. Lie on your back with your legs straight out in front of you. It would be ideal to repair all meniscus tears but failure rate is high. The medial meniscus is a cshaped cartilage structure that is attached to the tibia and acts as a shock absorber for the knee. The symptoms of a meniscus tear depend on the severity of the injury and your age. If the force is sufficient, a meniscus tear may result. For older adults, you might not even remember injuring your knee.
Medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. Acl ruptures 36% were the most common injuries con comitant with articular cartilage injuries. The lateral translates 9 to 11mm in the anterioposterior plane. Physical therapy pt can be useful for a torn meniscus whether or not you have surgery. However, it may also occur in older athletes through gradual degeneration.
Because of this, it is less prone to tears than the medial meniscus just because it is more mobile. The medial meniscus is semicircular in shape and the lateral meniscus is almost a complete circle. Jan 21, 20 epidemiological studies showed that all meniscal lesions, in different sports athletes, involves 24% of medial meniscus, while 8% of lateral meniscus and about 2030% of meniscal lesions are associated with other ligament injuries. If you have a meniscus tear, this movement will cause a clicking sound. Rehabilitation protocol for meniscus repair this protocol is intended to guide clinicians and patients through the postoperative course for a meniscus repair. A torn meniscus is a tear of one of the semicircular cartilage discs in the knee joint. Meniscus tears are among the most common knee injuries. Acute traumatic tears occur most frequently in the athletic population as a result of a twisting injury to. Meniscus, meniscectomy, meniscal tear, meniscal repair. He or she will check for tenderness along the joint line where the meniscus sits. Meniscus rehab exercises the physical therapy advisor.
Behrens, md abstract meniscal injury is a common cause for presentation to the emergency department or primary care physicians office. Meniscal tears can be treated conservatively or surgically. Stand with the foot of your injured leg on a support 3 to 5 inches 8 to centimeters high like a small step or block of wood. Contact area is increased by 50% with addition of menisci. Another variation is to perform this with your toes straight into the air.
You could also add an ankle weight to increase the. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. A medial meniscus tear is more common than a lateral meniscus tear because it firmly attaches to the deep medial collateral ligament and the joint capsule. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much strength and flexibility in your knee as possible. A medial meniscus tear on the inside of the knee is more common. A medial meniscus tear can take place from several factors. Shift your weight onto the injured leg on the support. Like a lot of knee injuries, a meniscus tear can be painful and debilitating. Diagnosis and management of meniscal injury rhode island. Meniscal injuries can be the result of a forceful, twisting event in a young athletes knee or it can insidiously present in the older patient. Causes of meniscal tears injuries to the meniscus are usually called tears and they can happen to anyone. Meniscus tear treatment with 4 exercises to avoid surgery. For example, after a highvelocity sports injury, you might feel a pop and some pain. The management of meniscal injuries has evolved from open total meniscectomy to arthroscopic.
A tear that on inspection of probing is greater than 9 mm in length 2. Still, many athletes keep playing after a meniscus tear if no other damage has been done to the knee. Be sure to rotate your leg outward laterally slightly to gain a better activation of the medial inner side of the quadriceps. Meniscal injuries can be the result of a forceful, twisting event in a young athletes knee or it can insid iously present in the older patient. Figure 5 mri images of an intact and torn meniscal root. Tighten the thigh muscle on your injured side and lift your leg about 8 inches off the floor. If you have questions, contact the referring physician.
Meniscus unstable meniscus definition a tear in which the meniscus or a meniscal fragment is displaced or can be displaced by a probe 1. Racgp meniscal tear presentation, diagnosis and management. Every time we walk, run or jump the medial meniscus and the lateral meniscus help absorb the full pressure exerted across the knee joint. 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. Athletes, particularly those who play contact sports, are at risk for meniscus tears. Straighten your injured leg as the other leg comes off the floor. Meniscal tears are the most common lesions followed by the meniscal cyst.
Diagnosis and management of meniscal injury jacob babu, md, mha. Jul 18, 2014 in the early 1980s animal studies were performed to evaluate the response of the meniscus to injury, and showed that meniscal tissue was capable generating a healing response particularly at its periphery. When the knee is loaded, the meniscus is compressed, synovial fluid is driven into the articular cartilage, thereby decreasing friction and providing joint nutrition. 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. A large radial tear of a radial tear with wide separation at the site of tear 4. There have been multiple studies that have demonstrated the clinical success of meniscal repair. Tibia medial meniscus femur figure 2 medial inside view of the knee. Meniscus tear is a common injury that affects the knee joint. This is because the medial meniscus acts as a secondary stabilizer to restrict the knee from. This page will explore how and what happens when the menisci become injured a tear and or a rupture. One of the main tests for meniscus tears is the mcmurray test. Your doctor will bend your knee, then straighten and rotate it.
First, in the younger population, a sporting injury can cause it. Find out when it helps, what to expect, and how long youll need to do it for. For many years the meniscus was treated with disrespect as an unnecessary appendage that could be sacrificed with the first hint of malfunction. Rehabilitation exercises a meniscus tear is a common knee joint injury. Tears are more common of the medial inside meniscus than the lateral outside meniscus. C 24 patients with acl injury should be referred to an orthopedic surgeon if they have recurrent givingway episodes, a strong desire to resume highintensity activity, or concomitant meniscal or. Meniscus tear causes, symptoms and natural treatments.
This disparity in motion contributes to the frequency in which each meniscus is injured. The lachman test is the most accurate test for detecting acl injury, followed by the anterior drawer test and the pivot shift test. Rehabilitation exercises appendix topic images meniscus tears quad sets straightleg raise to the front straightleg raise to the back hamstring curls heel raises heel dig bridging shallow standing knee bends meniscus tear. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much. All of these structures are surrounded by cartilage and ligaments that support the knee joint and protect it from injury. Meniscal injury is a major cause of functional impairment of the knee. Physical therapy exercises for a knee meniscus tear. According to ricklin, the medial meniscus is attached more firmly than the relatively mobile lateral meniscus, and this may result in a greater incidence of medial meniscus injury. The success of meniscus repair depends on tear pattern recognition and location for the capacity to heal.
Oct 16, 2014 blood supply 1 medial inferior genicular artery supplies peripheral 2030% of medial meniscus 2lateral inferior genicular artery supplies peripheral 1025% of lateral meniscus central 75% receive nutrition through diffusionthis presents a problem when there is an injury to the meniscus, as the avascular areas tend not to heal without the. The medial meniscus is u shaped covering around 60% of the medial. The size and location of the meniscal tear may also affect the rate of postoperative progression. May 30, 2016 the meniscus works like a suction cup in the knee, and when it is torn, it becomes painful and sometimes feels like your knee is going to give out on you. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. The meniscus is the most commonly injured structure in the knee joint.
Pdf medial and lateral knee joint menisci serve to transfer load and absorb shock, aid joint stability and provide lubrication. Medial meniscus tears commonly happen with an acl tear by twisting on a slightly flexed knee. They are positioned on the tibial plateau top surface of the shin bone between the tibia shin bone and the femur thigh bone and are important for distributing load and absorbing shock at the. Meniscal injury is a common cause for presentation to the emergency department or primary care physicians office. Symptoms include pain on the inside of the knee which. Meniscus injury is associated with acl anterior cruciate ligament injury. This injury does not have to occur at speed as the mechanism of twisting while the joint is weight bearing can cause the meniscus to get trapped between the bones and pinched. The medial meniscus is on the inner side and is attached to the tibia and the medial collateral ligament. In fact, a meniscal tear is one of the most frequently occurring cartilage injuries. Keep your leg straight and your thigh muscle tight. Also, the medial meniscus absorbs up to 50% of the shock of the medial compartment, making the medial meniscus susceptible to injury. It is caused by direct impact in contact sports or twisting.
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