Rehabilitation Considerations Following Meniscal Injury Flashcards
What is the anatomy of the medial meniscus?
C shaped cresent, covers 60% of articular cartilage, firmly fixed
What is anatomy of lateral meniscus?
O shaped, covers 80% of articular cartilage, very mobile
What is shape and movement patterns of meniscus?
wedge shaped to deepen socket
moves anterior with extension and posterior with flexion
What is blood supply of meniscus?
supplied by lateral and medial geniculate arteries
however only 10-30% of periphery is supplied- A and P horns more vascularized
Does the meniscus receive innervation?
horns more than bodies, may have a proprioception function
What are main roles of meniscus?
load bearing, maintain jt height, converts compressive force to tensile force
What percentage of load is distributed between lateral and medial meniscus?
70% lateral
50% medial
What happens to meniscus ability to weight bear after a meniscectomy?
contact area reduced by 75% and pressure increased by 235%
What are additional roles of meniscus?
joint stability, shock absorption, joint lubrication, proprioception
What are vascular regions of meniscus?
red on red (100%)
red on white (some vas.)
white on white (no vas.)
What type of meniscal tear is common with catching and locking symptoms?
bucket handle
What is criteria for non op meniscus treatment?
stable tear with less then 3 mm displacement, partial thickness tear, degenerative tear
When is a total meniscectomy performed?
done mostly in presence of severe trauma
What is main concern following a partial meniscus repair?
removing torn portion will increase articular load by 65% and will decrease ability to distribute forces
What is rehab considerations for a partial meniscectomy?
nothing really to heal except incision so:
immediate ROM, unrestricted ambulation, full weight bearing, focus on strength
What is timeline for rehab post partial meniscus repair?
work 1-2 weeks
full activity 2-4 weeks
sports 4-6 weeks
What side of the meniscus heals faster?
lateral better than medial
ACL reconstruction in addition will also heal better (more blood supply)
What is the timeline for healing for a meniscal repair?
50% in 3-4 weeks
80% in 8-12 weeks
100% in 14-18 weeks
remind pts of this
What should be avoided in rehab post repair?
knee flexion AROM (HS), deep squats, rotation, pivoting, impact loading
What are goals of rehab post repair weeks 0-4?
Protected weight bearing vs. NWB – Avoid re-tear no squats – ROM 0°-90° – No resistive work
What are goals of rehab post repair week 4-16?
Full ROM by week 6
– Normalize gait
– Improve strength / endurance
What are goals of rehab post repair week 17-24?
improve total limb function, return to sports
What is important to remember about active mobility post repair?
no resisted HS for 8 weeks
Limited hamstring activity early post op due to semimembranosus attachment to medial meniscus and popliteus to lateral meniscus
– AROM 4-6 weeks, resisted knee flex 6-8 weeks
When can active knee flexion begin post repair??
peripheral tears weeks 5-6
complex tears- minimum tears 6 weeks
What is weight bearing status for peripheral tears post repair?
Peripheral Tears
TTWB→PWB 1-2 weeks WBAT 3-4 weeks
What is weight bearing status for complex tears post repair?
TTWB 1-2 weeks PWB 3-4 weeks WBAT 6-8 weeks
What is important to remember about strength post repair?
QUAD strength critical
Glut Med/Hip ER key as well
Which has better outcomes partial meniscectomy or repair?
repair but not 100% conclusive
When can running program begin post repair?
peripheral- 3-4 months
complex- 5-6 months
What is rehab post meniscal transplant?
Immediate motion 0°→90° – Immediate Quad work – Control swelling – Gradual increase motion – WBAT at 6-8 week – Running at 6 months
