Knee: Treatment 3 Flashcards
Meniscal injury:
treatment options
- conservative care
- partial or full meniscectomy
- debridement
- repair
- transplant
Meniscal injury: conservative tx
best for
- small tear
- localized to outer ⅓ (red zone)
Meniscal injury: conservative tx
focus on
- control of swelling
- restore PROM
- quad activation
Meniscal injury: conservative tx
avoid these during healing
- squatting
- pivoting
- cutting
- running
Meniscal injury: surgical tx
When would this be the preferred option
when locking or giving way are present
Meniscal injury: surgical tx
If injury in outer ⅓…
repair
Meniscal injury: surgical tx
if inner ⅔…
removed
Meniscal injury: surgical tx
Ideal to preserve…
as much meniscal tissue as possible
Meniscectomy: precautions
none
Meniscectomy: rehab
recovery time
2-6 weeks
Meniscectomy: rehab
focus
- controll swelling
- ROM
- quad activation
Meniscectomy:
occasionally, will use knee immobilizer for a short time to…
- dec WB stress
- limit swelling
Meniscal repair: rehab
monitor
- swelling
- pain
- gait
- knee flex/ext ROM
- patellar mobility
- strength
- flexibility
- motor control
Meniscal repair: rehab
WB
limited at first and progressed over approximately 8 weeks
Meniscal repair: rehab
WB typically begins (position)
in extension with brace donned
Meniscal repair: rehab
avoid flexion past __˚ initially
45˚
Meniscal repair: rehab
Avoid flex past 45˚ for __weeks
4 weeks – progress over next 4 weeks
Meniscal repair: rehab
need to perform this
OKC knee extension
Meniscal repair: rehab
Avoid cutting/pivoting for how long?
4-9 mos depending on tear type
Meniscal transplant:
indications
- prior meniscectomy and pain in the area
- < 40 yo (or < 50 if active)
- minimal OA
- not currently TKA candidate
Meniscal transplant: for best outcomes, need (radiographs)
2 mm joint space visible on 45˚ WB films
Meniscal transplant:
contraindicated
- varus or valgus axial malalignments
- advanced OA
- instability
- arthrofibrosis
- obesity (BMI > 30)
Meniscal transplant: rehab
PWB how long?
4-8 weeks
Meniscal transplant: PROM progression
0-2 weeks
PROM 0-90˚
Meniscal transplant: PROM progression
3-4 weeks
120˚
Meniscal transplant: PROM progression
5-6 weeks
135˚
Meniscal transplant: CKC exercises begin when?
week 3-4
Meniscal transplant: OKC exercises begin when
week 5-6
Meniscal transplant: running delayed by how long
x 1 year
Meniscal transplant: exercises in first 2 weeks
- QS
- SLR
- AAROM ext from 90-0˚
