Rehabilitation Considerations Following Meniscal Injury

Question 1

What is the anatomy of the medial meniscus?

Answer 1

C shaped cresent, covers 60% of articular cartilage, firmly fixed

Question 2

What is anatomy of lateral meniscus?

Answer 2

O shaped, covers 80% of articular cartilage, very mobile

Question 3

What is shape and movement patterns of meniscus?

Answer 3

wedge shaped to deepen socket

moves anterior with extension and posterior with flexion

Question 4

What is blood supply of meniscus?

Answer 4

supplied by lateral and medial geniculate arteries

however only 10-30% of periphery is supplied- A and P horns more vascularized

Question 5

Does the meniscus receive innervation?

Answer 5

horns more than bodies, may have a proprioception function

Question 6

What are main roles of meniscus?

Answer 6

load bearing, maintain jt height, converts compressive force to tensile force

Question 7

What percentage of load is distributed between lateral and medial meniscus?

Answer 7

70% lateral

50% medial

Question 8

What happens to meniscus ability to weight bear after a meniscectomy?

Answer 8

contact area reduced by 75% and pressure increased by 235%

Question 9

What are additional roles of meniscus?

Answer 9

joint stability, shock absorption, joint lubrication, proprioception

Question 10

What are vascular regions of meniscus?

Answer 10

red on red (100%)
red on white (some vas.)
white on white (no vas.)

Question 11

What type of meniscal tear is common with catching and locking symptoms?

Answer 11

bucket handle

Question 12

What is criteria for non op meniscus treatment?

Answer 12

stable tear with less then 3 mm displacement, partial thickness tear, degenerative tear

Question 13

When is a total meniscectomy performed?

Answer 13

done mostly in presence of severe trauma

Question 14

What is main concern following a partial meniscus repair?

Answer 14

removing torn portion will increase articular load by 65% and will decrease ability to distribute forces

Question 15

What is rehab considerations for a partial meniscectomy?

Answer 15

nothing really to heal except incision so:

immediate ROM, unrestricted ambulation, full weight bearing, focus on strength

Question 16

What is timeline for rehab post partial meniscus repair?

Answer 16

work 1-2 weeks
full activity 2-4 weeks
sports 4-6 weeks

Question 17

What side of the meniscus heals faster?

Answer 17

lateral better than medial

ACL reconstruction in addition will also heal better (more blood supply)

Question 18

What is the timeline for healing for a meniscal repair?

Answer 18

50% in 3-4 weeks
80% in 8-12 weeks
100% in 14-18 weeks

remind pts of this

Question 19

What should be avoided in rehab post repair?

Answer 19

knee flexion AROM (HS), deep squats, rotation, pivoting, impact loading

Question 20

What are goals of rehab post repair weeks 0-4?

Answer 20

Protected weight
bearing vs. NWB – 
Avoid re-tear
 no squats
– ROM 0°-90°
– No resistive work

Question 21

What are goals of rehab post repair week 4-16?

Answer 21

Full ROM by week 6
– Normalize gait
– Improve strength / endurance

Question 22

What are goals of rehab post repair week 17-24?

Answer 22

improve total limb function, return to sports

Question 23

What is important to remember about active mobility post repair?

Answer 23

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

Question 24

When can active knee flexion begin post repair??

Answer 24

peripheral tears weeks 5-6

complex tears- minimum tears 6 weeks

Question 25

What is weight bearing status for peripheral tears post repair?

Answer 25

Peripheral Tears |  TTWB→PWB 1-2 weeks  WBAT 3-4 weeks

Question 26

What is weight bearing status for complex tears post repair?

Answer 26

TTWB 1-2 weeks  PWB 3-4 weeks  WBAT 6-8 weeks

Question 27

What is important to remember about strength post repair?

Answer 27

 QUAD strength critical |  Glut Med/Hip ER key as well

Question 28

Which has better outcomes partial meniscectomy or repair?

Answer 28

repair but not 100% conclusive

Question 29

When can running program begin post repair?

Answer 29

peripheral- 3-4 months complex- 5-6 months

Question 30

What is rehab post meniscal transplant?

Answer 30

``` Immediate motion 0°→90° – Immediate Quad work – Control swelling – Gradual increase motion – WBAT at 6-8 week – Running at 6 months ```