Knee Unit- Meniscal Tears

Question 1

Which side of the meniscus is more commonly injured?

Answer 1

medial is compared to lateral

Question 2

How does the meniscus get injured?

Answer 2

-May occur when the foot is fixed on the ground and the femur is rotated internally
>Pivoting, getting out of the car, receiving a clipping injury

-ACL injury often accompanies a medial meniscus tear

Question 3

What might tear the lateral meniscus?

Answer 3

Lateral rotation of the femur on a fixed tibia

Question 4

Common impairments involve?

Answer 4

-Can cause an acute locking of the knee and chronic symptoms with intermittent locking
>Knee does not fully extend , springy end feel when passive extension attempted

• Pain occurs along the joint line
• Joint swelling: Slight limit in flexion and extension
• Some degree of quad atrophy

Question 5

The patient might not be able to bear weight when..?

Answer 5

The meniscus tear is acute

Question 6

What often occurs during ambulation causing safety problems?

Answer 6

Unexpected locking or giving way

Question 7

Nonoperative management:

Answer 7

• Unlocking may happen spontaneously or patient can move leg and unlock it
• Treat acute symptoms

Question 8

Nonoperative management: what happens when acute symptoms decrease?

Answer 8

Exercises should be performed in open and closed chain positions to improve strength and endurance in isolated muscle groups and to prepare patient for functional activities

Question 9

Surgical management:

Answer 9

Every effort is made to retain as much of the meniscus as possible to minimize long term degeneration of the articular surfaces of the knee

Question 10

What are the surgical options for meniscus?

Answer 10

-Repair or partial menisectomy
-Total menisectomy
>Almost all tears are evaluated and treated arthroscopically

Question 11

If there is blood supply to the injured tissue then what surgery is done?

Answer 11

Repair (the outer 1/3 of medial or lateral meniscus)

Question 12

If there is no blood supply then what surgery is chosen?

Answer 12

partial menisectomy or total menisectomy

Question 13

Menisucs repair:

Answer 13

-Knee typically immobilized in full extension brace immediately after surgery

Question 14

How long is there controlled motion of 0-90 degrees in a meniscus repair? Why?

Answer 14

4-6 weeks, To avoid excessive motion at suture site

Question 15

How long is WB restricted in a Meniscus repair?

Answer 15

until 6-8 weeks

Question 16

Goals of Maximum protection phase: Repair

IMPORTANT

Answer 16

1. Minimize atrophy and reestablish neuromuscular control of knee
2. Maintain strength in hip musculature
3. Regain mobility

Question 17

Goals of Controlled Mobility Phase

Important

Answer 17

1. Progress ROM
2. Maintain flexibility
3. Increase strength and dynamic control
4. Increase muscular endurance
5. Re-establish balance

Question 18

Goals for return to function phase:

important

Answer 18

1. Progress strengthening
2. Improve cardio respiratory status
3. Restore functional abilities

Question 19

IMPORTANT rehab considerations

Answer 19

• Some limit CKC exercise until 8 weeks

- Full squatting or lunges should be avoided for at least 6 months

Question 20

IMPORTANT rehab considerations: Precautions for repair-

When should twisting, turning and pivoting activities happen?

Answer 20

should be progressed cautiously between 4-9 months to prevent excessive shear forces on the repaired meniscus

Question 21

IMPORTANT rehab considerations: Precautions for repair-

When should return to full activity happen?

Answer 21

Return to full activity varies but generally a minimum of 6 months is required for peripheral repair and 9 months for central repair

Question 22

Menisectomy/partial-

Answer 22

• Tears of the inner 2/3 ( avascular portion) of the medial or lateral menisci
• WB progressed as tolerated

Question 23

Will a Menisectomy/partial be immobilized?

Answer 23

no, postop will have compressive bandage but will not be immobilized

Question 24

Why s there no need for an extended maximum protection phase?

Answer 24

little soft tissue trauma occurs during surgery

Question 25

Controlled Mobility Phase- lasts how long?

Answer 25

3-4 weeks

All exercises and weightbearing activities should be pain free and progressed gradually during the first few post op weeks

Initiate closed chain exercises and stationary bike to regain dynamic control and endurance of knee

Question 26

Return to Function Phase-

Answer 26

3-4 weeks postop

• Should achieve full AROM (Resistance training, Endurance activities, Functional closed chain exercises in full wtb, Balance training)
• Advanced activities in 6-8 weeks

Question 27

What is the main difference between menisectomy and repair rehab?

Answer 27

allowing the surgically repaired meniscus to heal by avoiding (limiting) loads and stresses (ROM) that compromise the repair site

Differences are:

• Delays in wtb
• Full ROM
• Initiation of CKC exercises