Knee Unit- Meniscal Tears Flashcards
Which side of the meniscus is more commonly injured?
medial is compared to lateral
How does the meniscus get injured?
-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
What might tear the lateral meniscus?
Lateral rotation of the femur on a fixed tibia
Common impairments involve?
-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
The patient might not be able to bear weight when..?
The meniscus tear is acute
What often occurs during ambulation causing safety problems?
Unexpected locking or giving way
Nonoperative management:
- Unlocking may happen spontaneously or patient can move leg and unlock it
- Treat acute symptoms
Nonoperative management: what happens when acute symptoms decrease?
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
Surgical management:
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
What are the surgical options for meniscus?
-Repair or partial menisectomy
-Total menisectomy
>Almost all tears are evaluated and treated arthroscopically
If there is blood supply to the injured tissue then what surgery is done?
Repair (the outer 1/3 of medial or lateral meniscus)
If there is no blood supply then what surgery is chosen?
partial menisectomy or total menisectomy
Menisucs repair:
-Knee typically immobilized in full extension brace immediately after surgery
How long is there controlled motion of 0-90 degrees in a meniscus repair? Why?
4-6 weeks, To avoid excessive motion at suture site
How long is WB restricted in a Meniscus repair?
until 6-8 weeks
Goals of Maximum protection phase: Repair
IMPORTANT
- Minimize atrophy and reestablish neuromuscular control of knee
- Maintain strength in hip musculature
- Regain mobility
Goals of Controlled Mobility Phase
Important
- Progress ROM
- Maintain flexibility
- Increase strength and dynamic control
- Increase muscular endurance
- Re-establish balance
Goals for return to function phase:
important
- Progress strengthening
- Improve cardio respiratory status
- Restore functional abilities
IMPORTANT rehab considerations
- Some limit CKC exercise until 8 weeks
- Full squatting or lunges should be avoided for at least 6 months
IMPORTANT rehab considerations: Precautions for repair-
When should twisting, turning and pivoting activities happen?
should be progressed cautiously between 4-9 months to prevent excessive shear forces on the repaired meniscus
IMPORTANT rehab considerations: Precautions for repair-
When should return to full activity happen?
Return to full activity varies but generally a minimum of 6 months is required for peripheral repair and 9 months for central repair
Menisectomy/partial-
- Tears of the inner 2/3 ( avascular portion) of the medial or lateral menisci
- WB progressed as tolerated
Will a Menisectomy/partial be immobilized?
no, postop will have compressive bandage but will not be immobilized
Why s there no need for an extended maximum protection phase?
little soft tissue trauma occurs during surgery
Controlled Mobility Phase- lasts how long?
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
Return to Function Phase-
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
What is the main difference between menisectomy and repair rehab?
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
