The outer onethird of the meniscus has a rich blood supply. Rehabilitation and return to play if the tear is minor and the pain and other symptoms cease, a musclestrengthening program may be recommended. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. The athlete continued to play on his injury for the rest of the game so it is unclear to how severe the tear was from the initial mechanism of injury and if the athlete could have injured the meniscus further during completion of the game. Meniscus tears are among the most common knee injuries. Pdf meniscal injuries represent one of the most frequent lesions in sport practicing and in particular in soccer players and skiers. Meniscus tear repair was applied to the right knee in 15 cases and to the left in 12, medial in 21 77. Small meniscal tears commonly medial tears will often lead to a quicker rehabilitation period than a more complicated tear, especially if the lateral meniscus is injured. Manual stretching for extension with overpressure or recurvatum. Dec 23, 2016 explaining the 4q model today, which i incorporate in my training sessions. After meniscal surgery, rehabilitation with a physical therapist or athletic trainer is needed to restore range of motion, strength, movement control and guide the athletes return to sport. Oct 21, 2010 the rubbery meniscus cushions the knee, but a twist or pivot can tear this cartilage. Control inflammationeffusion allow early healing full passive knee extension gradually increase knee flexion independent quad. Do not do resisted long or short arc quads, to avoid adversely stressing the graft.
Horizontal cleavage meniscus tear treated with allinside. Rehabilitation following meniscus repair memorial hermann. Lowe this rehabilitation protocol was developed for patients who have isolated meniscal repairs. Meniscal tear meniscus injury meniscus injuries your knee has 2 menisci. Common tears include longitudinal, parrotbeak, flap, bucket handle, and mixedcomplex. Acl reconstruction with meniscus repair protocol dr bradley bruner 01012009 guidelines. Intraoperatively, a decision has to be made whether to repair, excise, or leave the tear in the meniscus alone. Behrens, md abstract meniscal injury is a common cause for presentation to the emergency department or primary care physicians office. May be reproduced, as is, for clinical, educational, and. Any activity that causes you to forcefully twist or rotate your knee, especially when.
Pdf isakos classification of meniscal tears illustration. Other knee injuries, most commonly to the anterior cruciate ligament acl andor the medial collateral ligament, may occur at the same time as a meniscus tear. The increasingly used isakos arthroscopic meniscus tear classification. It is designed for rehabilitation following arthroscopic repair of a complex meniscal tear. A torn meniscus is one of the most common knee injuries. Repair of isolated horizontal meniscal tears with all. Follow evaluationcriteriabased guidelines the journal of knee surgery vol. Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet. The rubbery meniscus cushions the knee, but a twist or pivot can tear this cartilage. Diagnosis and management of meniscal injury jacob babu, md, mha.
Young patient non operave treatment not typically recommended. Rehabilitation exercises a meniscus tear is a common knee joint injury. If the force is sufficient, a meniscus tear may result. Peter sabonghy,md assistant professor, ut houston medical school the meniscus tear patterns mri david rubinrobin smithius wash u. Immediate postsurgery days 17 ice, compression, elevation. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear. Most often degenerative tears are surgically removed. Meniscus tear the meniscus is a c shaped pad of cartilage that sits between the heads of your femur thighbone, tibia shinbone, and patella kneecap. The meniscus is a wedge shaped cartilage ring found on both the inside and outside of the knee between the femur thigh bone and tibia shin bone. Sports injury medicine department 9250 sw hall blvd. Root and radial tears can have a profound effect on the health of the articular cartilage of the knee with the potential for meniscal extrusion and accelerated arthritic.
State of the art of rehabilitation protocols related to surgical procedures. As reported by majewski, injuries to the menisci are the second most common injury to the knee, with an incidence of 12% to 14% and a prevalence of 61 cases per 100,000 persons6. When an unstable fragment from a buckethandle tear moves into the intracondlar notch it blocks full extension of the knee joint. Pdf rehabilitation and return to play following meniscal repair. 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. Pain and swelling are the most common signs of an injury to your meniscus. Nov 15, 2019 the meniscus is a cshaped piece of tough, rubbery cartilage that acts as a shock absorber between your shinbone and thighbone. Rehabilitation of a lateral meniscus repair of a usmaps. Rehabilitation guidelines for meniscal repair uw health. It also acts as a bumper and can help prevent abnormal motion in the knee especially if your ligaments are loose or injured.
Vertical tears longitudinal tears are most often traumatic. This is not a complete listing of rehabilitation strategies. Rehabilitation depending on the severity of the damage the rehabilitation process may take from 412 weeks. Meniscal repairs located in the vascular zones of the periphery or outer third of the meniscus are progressed more rapidly than those repairs that are. If you just found out that the pain and swelling in your knee is a torn meniscus, you probably have a decision to make about how to treat it. This blood supply is necessary for a tear or a repair to heal. Be sure to rotate your leg outward laterally slightly to gain a better activation of the medial inner side of the quadriceps. Your knee meniscus is fibrocartilage that separates thigh bone femur from your shin bone tibia. Even if an exercise or activity is listed at a particular time frame, some patients may not be ready to perform it. Athletes, particularly those who play contact sports, are at risk for meniscus tears.
Division of sports medicine, department of orthopaedic surgery, north shore university hospital, and orthopaedic associates of manhasset, manhasset, new york abstract increasing emphasis on the comprehensive reconstruction of the knee and on restoration of knee function after. These files will have pdf in brackets along with the filesize of the download. Outcome measures the lower extremity functional scale and meniscus repair return to sport index will be used throughout. What is rehabilitation and recovery like for a patient with a meniscus. The meniscus is a crescent shaped specialized cartilage that helps cushion the knee and distribute to forces of walking, running, etc. This rubbery pad serves as a shock absorber by providing cushioning and stability to the knee joint. Explaining the 4q model today, which i incorporate in my training sessions. The torn flap of meniscus can cause further damage leading to greater risk of. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Tear pattern of the meniscus or the size of the articular cartilage lesion and clinical signs and symptoms have typically guided the clinical decision making of treatment interventions primarily for the type of surgical intervention. Meniscal repair guideline complex tears sanford health. Meniscus tear common 35% of people over the age of 50 have a meniscus tear.
Interventions are listed by phase of rehabilitation early, early to late phase. Meniscus repair rehab protocol orthopaedic medical group. A large tear produces a flap of meniscus that may interfere with normal joint mechanics. The followup period of all the patients with horizontal meniscus tear repair was mean 29 months range, 2438. Isakos classification of meniscal tears illustration on 2d and 3d isotropic spin echo mr imaging. As we get older the meniscus weakens and tears can occur more easily, even from something as simple as squatting or stepping off a curb onto an uneven surface. Only 27% of the injuries were associated with sports activities, but they were the meniscus tear. If the tear is closer to the middle, there is no blood supply, so healing will not occur. Symptoms knee pain and tenderness along the joint stiffness or swelling. Racgp meniscal tear presentation, diagnosis and management.
The menisci act as shock absorbers in the knee, and provide stability to the joint. The gundersen sports medicine meniscus repair rehabilitation program is an. Meniscus tear treatment and rehabilitation information uw. Pdf most of the documents on the racgp website are in portable document format pdf. In his epidemiological study conducted on 17,397 patients in germany and switzerland, soccer, followed by skiing, are the sport with an increased risk of. For most tears, some simple exercises can help maintain muscle strength in the front of the thigh quadriceps, back of the thigh hamstr. The treatment chosen will depend on the location of the tear, the athletes sport, ligamentous stability of the. Modifications to the protocol may be necessary dependent on location of. Repair of isolated horizontal meniscal tears with allinside. Evidence based management of meniscal tears kenneth g.
Only teach patients exercises appropriate for this time frame if they were able to demonstrate functional criteria listed above. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much strength and flexibility in your knee as possible. Horizontal cleavage meniscus tears are a common orthopedic injury often treated with partial or total meniscectomy versus repair. Patient guide to meniscus injuries what is the meniscus. When the meniscus root is repaired there will be a prolonged. Occasionally a patient may be able to regain function through rehabilitation without surgery progressing to knee arthritis.
Meniscal repair postoperative rehabilitation protocol. 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. Meniscal injuries can be the result of a forceful, twisting event in a young athletes knee or it can insid. Rehabilitation guidelines for knee arthroscopy uw health. Jan 21, 20 he highlights the importance of walking with crutches in a longleg brace for about 6 weeks after meniscal transplant and complex meniscus repairs extending into central onethird region but not routinely after repair of a peripheral meniscus tear. Lots of leg workout in this session using a combination of lunges.
Pdf the outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play rtp. Brace knee immobilizer used for four weeks, ted hose to be worn until ambulation has returned to normal presurgery level or two weeks. Rehabilitation guidelines for meniscal repair of root and. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much. If you do not have it you can download adobe reader free of charge. Symptoms of a degenerative meniscus tear include swelling, pain along the joint line, catching and locking. Tears are more common of the medial inside meniscus than the lateral outside meniscus and the medial meniscus may have better repairing qualities. The preoperative symptom of the patients and examination findings are presented in table 2. To open a pdf file you will need compatible software such as adobe reader. Brian krabak and susanne michaud talk about the injury and their approach to getting patients. Com meniscal cartilage tear top view femur thighbone tibia shinbone medical meniscus front view of knee lateral meniscus torn what are the symptoms. A meniscal tear may settle conservatively without giving many problems.
Occupational cartilage and meniscal injuries of the knee lyndon b. Each knee joint has a medial meniscus and a lateral meniscus. Once a decision has been made to proceed with operative management, further decisions regarding the surgical treatment of the meniscus tear need to be made see images below. Oct 28, 2016 meniscus tear repair was applied to the right knee in 15 cases and to the left in 12, medial in 21 77. It can be torn if you suddenly twist your knee while bearing weight on it. Meniscus repair rehabilitation protocol general guidelines use the cryotherapy cuff continuously for the first 72 hours, then as needed thereafter ensure that the cuff never contacts the skin directly apply to the knee after performing rehabilitation exercises for the first 6 weeks. Meniscus rehab exercises the physical therapy advisor.
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