Meniscus Tear Rehabilitation or Surgery ?
Introduction
The meniscus is a C-shaped tissue between your femur (thigh bone) and your tibia (shin bone). Each knee has a medial (inner side) meniscus and a lateral (outer side) meniscus. The meniscus is composed of water, collagen, proteins and other cellular elements.
𝐖𝐡𝐚𝐭 𝐢𝐬 𝐭𝐡𝐞 𝐟𝐮𝐧𝐜𝐭𝐢𝐨𝐧 𝐨𝐟 𝐚 𝐦𝐞𝐧𝐢𝐬𝐜𝐮𝐬?
The meniscus is a shock absorber that helps optimize force transmission across the knee and protects the cartilage on the end of our femur and tibia. The medial meniscus is also a secondary stabilizer to the ACL as it can prevent anterior translation (forward shifting) of the tibia.
What are the different types of Meniscus Tears?
The meniscus can become frayed or torn.
Occasionally, wear and tear from degenerative conditions like arthritis can cause a meniscus tear in your knee.
When this happens, pain in your knee may result. Your knee joint may also become swollen, and it may catch or lock when moving in certain positions.
This can cause significant loss of mobility.
𝐃𝐨𝐞𝐬 𝐭𝐡𝐞 𝐦𝐞𝐧𝐢𝐬𝐜𝐮𝐬 𝐡𝐚𝐯𝐞 𝐠𝐨𝐨𝐝 𝐡𝐞𝐚𝐥𝐢𝐧𝐠 𝐚𝐛𝐢𝐥𝐢𝐭𝐲?
Tears in the outer 1/3 of the meniscus have healing potential because there is blood flow to that area. However, tears in the inner 2/3 generally do not heal well as a result of poor circulation.
𝐃𝐨 𝐚𝐥𝐥 𝐦𝐞𝐧𝐢𝐬𝐜𝐮𝐬 𝐭𝐞𝐚𝐫𝐬 𝐧𝐞𝐞𝐝 𝐬𝐮𝐫𝐠𝐞𝐫𝐲? .
No.
All meniscus tears do not require surgery. Surgery is indicated if you have mechanical symptoms such as locking. Otherwise, you should try conservative management first. This includes physical therapy.
Recent research indicates that a course of physical therapy can yield the same outcome as surgery for a torn meniscus in your knee.
If you fail conservative therapy and do not have arthritis, you may then be a candidate for surgery.
𝐖𝐡𝐢𝐜𝐡 𝐞𝐱𝐞𝐫𝐜𝐢𝐬𝐞𝐬 𝐬𝐡𝐨𝐮𝐥𝐝 𝐈 𝐝𝐨?
Exercises that encourage knee mobility, motor control and strength can help to reduce pain and improve function.
Below I will show you some of the exercises you can do at the beginning of the rehabilitation after a meniscus injury.
1. QUADRICEPS SETS AND STRAIGHT LEG RAISES
It is very important for the knee to lock in full extension ( knee straight completely).
You can’t walk well on a bent knee, reason why this exercise is my first option when dealing with knee injuries in general and meniscus tears in particular. It may be painful at 1st but little by little you should be able to lock the knee.
First try to handle the weight of your leg and then add ankle weights to reinforce the contraction of the quadriceps.
Recommended 2-3 sets of 5-10 repetitions.
2 . STRAIGHT LEG RAISES ON THE SIDE
Another important exercise is the same straight-leg raise but this time lying on your side. Same concept, lock the knee and lift it on the side to strengthen the quad and gluteal muscles.
First try to handle the weight of your leg and then add ankle weights to reinforce the contraction of the quadriceps.
3 . HEEL SLIDES
This exercise is also very important to restore the full knee flexion that is necessary for sitting and climbing stairs.
At 1st slide the leg in the angles you are comfortable doing, it may be painful at the end of the movement or on the way back. As you get better try to force the knee to get to the end of the range and even hold it there for a few seconds.
Last drill is the one shown in this video where you do 5-10 repetitions and on the last repetition you force the knee to bend more in 3 steps each of them deeper and deeper.
Recommended 2-3 sets of 10 repetitions.
4 . SUPPORTED SQUATS
As you get better in the range of movement of the knee and the pain gets better you can add weight bearing exercises.
In this video I show an easy way to squat holding, to be able to bend the knee and put weight through the injured knee which makes it more comfortable than the regular squat.
You’ll descend as tolerated. Sometimes you may need to limit the descending because it hurts, so don’t worry , work in the angle tolerated and as the days go by you should be able to descend even more.
Recommended 2-3 sets of 5-8 repetitions.
Always be aware of any more pain you may develop after the squats, a little bit of pain it’s ok but if doing squats irritates your pain work on the previous exercises and retry the squat in a couple of days.
5 . SINGLE LEG SQUATS
The ultimate goal of the rehabilitation process is for you to be able to do a single leg squat and this video shows a good entry-level Single leg squat.
Same as with the squats you may need to limit the descending because it hurts at 1st and then ,go to full range.
Recommended 2-3 sets of 5-8 repetitions.
Always be aware of any more pain you may develop after the squats, a little bit of pain it’s ok but if doing squats irritates your pain work on the previous exercises and retry the squat in a couple of days.
Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages Finally we would like to invite you to follow us at our: Facebook Page Google Plus Page Instagram Page where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport. Lionel Pannunzio Physical Therapist Board-Certified Sports Specialist Owner of White Bay Physical Therapy