So You Need Meniscus Surgery?
Meniscal Repair Surgery and Post op PT Rehab
WHERE IS THE MENISCUS?
The meniscus is a C-shaped cartilage disc that cushions and helps stabilize the knee. There are two of these discs in each knee between the end of the thigh bone (femur) and lower leg bone (tibia). The one on the inside of the knee is called the medial meniscus while the one on the outer side is called the lateral meniscus.
HOW DO MENISCUS TEARS TYPICALLY OCCUR?
Tears in the menisci are categorized as either acute or degenerative. Acute meniscus tears occur suddenly, usually when the leg is twisted while the foot is planted and the knee is bent. Due to the mechanism of injury, other structures in the knee such as the anterior cruciate ligament (ACL) or medial collateral ligament (MCL) may be injured at the same time. Degenerative tears occur as a result of general wear and tear in the knee joint.
In general the menisci have poor blood supply. Blood is what carries the nutrients and growth factors and carries away damaged cells to help heal an injury. Because the blood supply is poor, when torn, the meniscus is less likely to be able to heal on its own. While not all meniscus tears require surgery, symptoms of catching or locking usually require a surgical evaluation. Similarly, while conservative treatment like physical therapy is often recommended as a first line treatment approach, failure to respond to physical therapy may indicate surgery is necessary.
HOW IS MENISCUS SURGERY PERFORMED?
Currently there are three main methods of surgical management of meniscus tears (Doral et al., 2018). Which surgical approach is used often depends on the severity of tear, the location of the tear, and the type of tear.
Arthroscopic Partial Meniscectomy: During this procedure the damaged part of the meniscus is trimmed away and removed. As an arthroscopic procedure, it is minimally invasive. This is the most common surgical approach to treating meniscus tears as it is quick, has a low rate of morbidity, and good short term results. It is commonly used to treat degenerative tears and radial tears but may not have as good of long term outcomes as a meniscus repair and thus is often not recommended as a first line treatment of choice.
In the past, total meniscectomy, or the removal of the entire meniscus, was sometimes performed. This type of surgical approach is rare these days due to its association with early osteoarthritis and poor long term clinical outcomes.
Meniscus Repair: This approach is intended to preserve the entire meniscus by repairing the tear. This technique can be performed through an arthroscopic approach or an open approach. Not every tear or every patient is a good candidate for this type of surgery but it is preferable when possible to retain as much of the meniscus as possible. At times what is called an augmentation technique (ex. needling) or the addition of a biological product (ex. Platelet-rich plasma or mesenchymal stem cells) will be used to try and improve the rate of healing after the surgical repair.
Meniscus Reconstruction: This is a more complex procedure used to replace a partially or totally resected meniscus in symptomatic patients who have been unresponsive to conservative management. The main goal is to fill the defect and safely place a functional meniscus that is similar anatomically and structurally to the native meniscus. The intent of this procedure is to improve both pain and function of the knee and delay the onset of osteoarthritis.
POST-OP PHYSICAL THERAPY
Physical therapy is recommended following meniscus surgery. Your physical therapist will work with your surgeon to follow their post-surgical physical therapy protocol. The goal of of physical therapy after meniscus surgery is to return to your prior level of function but while you are undergoing treatment you can expect your physical therapy treatments to address several different areas:
Manage pain and swelling: not only are pain and swelling uncomfortable but they limit knee range of motion and can inhibit muscle activation. Your physical therapist can help you manage your knee pain and swelling through things like icing, compression and elevation.
Returning to weight bearing: crutches, or a walker if needed, are typically used for a few weeks to a few months depending on the type of surgery. In physical therapy you will learn how to use your crutches or walker for things like going up and down a curb and guide you through progressively putting more weight on your leg until it is time to wean off them completely.
Restore knee range of motion: restoring full flexion and extension of the knee is an important step to returning to your prior activities. Soft tissue mobilization and myofascial techniques, active and passive range of motion exercises, and stretching can be used to accomplish this goal.
Improve strength and neuromuscular control: strengthening exercises in the muscles around the hip, knee, and ankle are important to help support the knee joint as you return to activity. Similarly, neuromuscular control exercises help the body coordinate the firing of muscles to provide good stability around the knee joint during things like walking, running, and jumping.
Return to sports and athletics: once healing has progressed, your physical therapist will gradually include dynamic exercises specific to the sports and activities you love and want to resume.
While having meniscus surgery may seem daunting, having a good physical therapist in your corner can make the process much easier. The physical therapists at Evolve are experienced in the rehabilitation of meniscus tears and post-op meniscus surgery and would love to guide you through this process and get you back to doing the things you love and need to do.
Click here to find out more information about physical therapy for meniscus tears
About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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