Meniscus Injuries Flashcards
The ___________ meniscus is more mobile and gets injured ________.
lateral; less
Only the ______________ __________ meniscus had blood supply
outer 1/3
anatomically, the meniscus is divided into the ____________, __________, and _____________.
anterior horn, posterior horn, body
tears typicallly begin in the ________ horn and progress ________.
posterior,
anteriorly
Medial Meniscus anatomy
semicircular
less mobile (2-5mm)
attached to MCL
increased injury incidence
Lateral Meniscus anatomy
ovoid
more mobile (9-11mm)
less firmly attached
injured less often
meniscus physiology
peripheral 1/3 vascularized over 70% of tears are in posterior horn meniscal motion follows femoral condyles greatest risk at 20-30 degrees flexion functions: load distribution, knee stability, joint lubrication
MOI
non contact stress:
deceleration/acceleration
cutting/change of direction
contact stress:
varus/valgus force with rotaton
hyperextension with rotation
Meniscal injuries clinical findings
joint line tenderness low-level swelling locking antalgic gait pain with twisting and squatting
special tests
joint line tenderness thessaly mcmurray aply ege's
Differential Diagnosis
Meniscal tear is more common than the following. If MRI is negative for meniscus, think about these:
- Discoid meniscus(congential abnormality of lateral meniscus)
- cystic meniscus:infiltration of synovial fluid through a lateral tear
- popliteus tendonitis
- plica syndrome
- osteochondritis dessecans (“joint mice” fragments)
- meniscotibial ligament sprain (requires arthroscopy to differentiate from meniscal tear)
- tibial spine avulsion fx
- fat pad syndrome
most and least likely to heal
more likely>less likely
longitudinal>radial
simple>complex
traumatic>degenerative
acute>chronic
Is it a capsular pattern?
truely, should be NON CAPSULAR
Treatment goals
pain-free gait, functional mobility and ADLS in 18-12 weeks as reported on VAS and/or functional outcome measure
non palpable edema in 4 weeks
full ROM in 4-6 weeks
at least 4/5 MMR in 6-8 weeks
non antalgic, normalized gait with/without assistive device 6 weeks
HEP initially and at 8-12 weeks
Partial Menisectomy
avoid impact initially
avoid anything that can cause re-tear or disruption (ie twisting)
should be back to normal in about 6 weeks
meniscal repair rehab weeks 1-2
immobilization
NWM
0-90 degrees
isometric quads, quad sets, SLR, patellar mobilization
meniscal repair rehab weeks 2-4
immoblized PWB 0-90 degrees isometric quads, quad sets, SLR patellar joint mobilization, PROM to 90 degrees
meniscal repair rehab weeks 5-6
no brace! WBAT 0-120 degrees begin closed chain exercises patellar and joint mobilization, PROM to 120 degrees
hamstring strengthening delayed because don’t want them to pull on meniscus
Meniscus repair rehab weeks 7-8
no trace WBAT full ROM CKC begin hamstring strengthening (stationary bike) patellar and joint moves
meniscus repair rehab weeks 9-16
no brace
WBAT
full ROM
CKC begin hamstring strengthening stationary bike, strair climber
meniscus repair rehab weeks 17-20
no brace
WBAT
Full ROM
strait running
meniscus repair rehab weeks 21-24
no brace
WBAT
full ROM
Cutting
What are the benefits and risks of playing on a torn meniscus?
won’t progress from one type of tear to another
can get locked if pt hyperextends and damage ligaments
cutaneous pain in medial leg with no weakness is what?
saphenous neuropathy
weak ankle everters could be because of what?
peroneal neuropathy
deep pitting edema in calf and positive homan’s sign is what?
DVT!!!
protocol for meniscal transplant?
no protocol. like meniscus repair but more protected. surgeon driven protocol
What’s a precurser of articular cartilage damage?
bone bruise
Articular Cartilage damage rehab
encourage motion
limit WB
limit shear forces
