PT After Meniscal Repair Surgery
So You Have a Torn Meniscus…What’s Next?
So you have a torn meniscus. While meniscus tears are one of the most common injuries of the knee, it provides little comfort to those wondering what to do next? If you have been diagnosed with a meniscus tear or think you might have one, this article will help you learn bit more about this condition and how it is typically treated.
WHERE ARE THE MENISCI?
The meniscus (menisci for plural) 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.
WHAT ARE THE SYMPTOMS OF A MENISCUS TEAR?
Symptoms of a meniscus tear can vary somewhat depending on the acuity, location, and severity of the tear. Here are some common symptoms of a meniscus tear:
An audible or felt popping
Pain in the knee joint on the inside (medial), outside (lateral), or back of the knee
Swelling
Catching or locking of the knee joint
Pain with walking
Inability to fully bend or straighten the knee
Pain when twisting the knee
Feelings of the knee giving out
HOW DO MENISCUS TEARS TYPICALLY OCCUR?
Tears in the menisci are categorized as either acute or degenerative. Acute meniscus tears occur suddenly, as an injury, 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 less blood supply than other structures in the body. Blood is what carries the nutrients and growth factors and carries away damaged cells to help heal an injury. Because the blood supply is reduced, when torn, the meniscus is less likely to be able to heal on its own.
ARE THERE DIFFERENT TYPES OF MENISCUS TEARS?
Meniscus tears are categorized by type and location of tear. The type and location of the tear often guides the treatment approach that is most appropriate.
Radial tear: The tear occurs along the inside of the meniscus where blood supply is limited. This is the most common type of tear
Flap: In this type of tear a flap of cartilage peels partly away. It can cause symptoms of catching and locking as it can flip in and out of position.
Horizontal: The tear occurs parallel to the flat surface of the tibia and divides the meniscus into an upper and lower part, though it may not project all the way through the meniscus from one end to the other.
Vertical:. The tear occurs along the C-curve of the meniscus but is perpendicular to the flat surface of the tibia. If they get large enough the inner edge of the meniscus can tear away and develop into a bucket handle tear.
Bucket Handle: Appearing like the handle of a bucket, the inner edge of the meniscus separates from the rest of the cartilage. Because of their placement the bucket handle tear can sometimes cause the knee to lock which requires an urgent surgical evaluation.
Intrasubstance/Incomplete tear: These tears are usually asymptomatic and look normal during surgery but might be picked up on imaging. They signal early degenerative changes in the meniscus tissue but don’t require surgery
HOW ARE MENISCUS TEARS TREATED?
The recommended treatment approach for a meniscus tear depends on many factors. A small tear that is not restricting any range of motion is a good candidate for conservative management such as physical therapy. Conservative management is also considered the first line approach for degenerative tears as research has shown that in many cases trying to repair the frayed tissue has not added benefit over the effects of conservative treatment.
If the tear is large and is causing locking of the knee or is inhibiting full extension or flexion of the knee, surgical intervention may be the best option to restore normal motion to the knee. A tear that occurs in the inner edge, furthest away from the meniscus’ blood supply, is less likely to heal on its own and may be a good candidate for surgical intervention. Finally, someone who has tried conservative care without success or who has a tear that continues to worsen and is otherwise a good candidate for surgical intervention, may ultimately choose to have surgery.
THERE ARE THREE MAIN SURGICAL OPTIONS FOR MENISCUS TEARS
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.
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.
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.
WHAT IS PHYSICAL THERAPY’S ROLE?
If conservative management is selected to treat your meniscus tear then treatments will be focused on managing symptoms of pain and swelling, restoring normal strength and motion in and around the knee joint, and facilitating return to your prior level of activity.
After assessing your symptoms and evaluating your range of motion, strength, ability to walk and bear weight in the knee, and observing for swelling or inflammation, your PT will prescribe a personalized treatment program to address these symptoms. Early on in your recovery your PT may advise you on how to modify weight bearing by using a device such as crutches or a cane. They may utilize modalities such as ice, electrical stimulation, or even hands-on treatments like massage or soft tissue mobilization to manage pain and swelling.
As your healing continues you may perform gentle stretching and begin strengthening exercises to prevent muscle atrophy and restore joint range of motion. As you begin to tolerate more weight through your knee your exercises will continue to advance to help achieve normal strength, power and agility so that you can resume as many of your previous activities as possible. Throughout your rehab program your PT will also assess you for any underlying biomechanical or musculoskeletal impairments that may have contributed to the tear in the first place so they can also be addressed during rehabilitation to decrease the likelihood of reinjury.
If you have undergone surgery to treat your meniscus tear then physical therapy is typically recommended post-operatively. In this case the surgeon often provides you with a post-operative rehab protocol that will guide you and your physical therapist through a progression of exercises. As you heal, you will begin to bear more weight through your leg and be allowed to do more intensive exercises. As with nonsurgical management of meniscus tears, the goal will be to restore normal movement, strength and coordination of the knee to allow you to return to as many of your previous activities as possible.
If you are trying to heal from a meniscus tear, our therapists at Evolve PT would love to share our expertise and experience to help with your recovery. An individualized plan is always best to help meet your goals and we are looking forward to working with you.
Find out more about physical therapy for torn meniscus
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