Discoid Meniscus

with Rehab

ExitCare ImageThe meniscus is a piece of cartilage in the knee joint, between the shinbone (tibia) and the thigh bone (femur). Each knee joint has two menisci: inner and outer. The purpose of the meniscus is to allow the shinbone and thigh bone to fit together better. The meniscus also acts as a shock absorber, decreasing the forces placed on the body, It also helps provide nutrients to the cartilage on the ends of the shinbone and thigh bone.

A discoid meniscus is a defect present at birth (congenital), in which the meniscus is shaped like an oval instead of like a crescent. A discoid meniscus may also have a normal shape, but have an abnormal attachment to the surrounding structures. Discoid meniscus most often occurs on the outer meniscus. Discoid meniscus may cause symptoms with or without injury.

SYMPTOMS

  • Often, no symptoms at all.

  • Snapping or clunking felt in the knee, with motion.

  • Pain, especially with standing on the affected leg.

  • Tenderness at the joint line.

  • Swelling of the affected knee, seen 1 to 2 days after injury, although it may occur right after the injury.

  • Locking of the knee (cannot straighten the knee completely).

  • Giving way or buckling of the knee.

CAUSES

The cause of discoid meniscus is unknown. Discoid menisci develop before birth. They occur in both knees in up to 10% of people with the condition.

RISK INCREASES WITH:

  • Contact sports (football). Sports in which cleats are involved with pivoting (soccer). Sports in which good shoe grip and sudden change in direction are required (racquetball, basketball).

  • Previous knee injury.

  • Associated knee injury, particularly ligament injuries.

  • Poor strength and flexibility.

  • Asian individuals have up five times higher prevalence (25%) than Caucasians (5%).

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Cardiovascular fitness.

  • Knee strength.

  • Flexibility and endurance.

  • If you participate in jumping (basketball, volleyball) or contact sports, protect the knee joint with supportive devices (wrapped elastic bandages, tape, braces).

  • Wear properly fitted and padded protective equipment.

PROGNOSIS

  • Some meniscus injuries can heal on their own (spontaneously). However, some do not heal but may not cause any symptoms.

  • The only definitive treatment for discoid meniscus is surgery. Surgery may provide complete healing in 6 weeks.

  • If there are no symptoms, leaving the meniscus alone is the best treatment (no surgery).

RELATED COMPLICATIONS

  • Frequently recurring symptoms, resulting in a chronic problem. Properly addressing the problem the first time decreases frequency of recurrence.

  • Repeated knee injury, especially if sports are resumed too soon after injury or surgery.

  • Tear of the meniscus, if untreated.

  • Arthritis of the knee in later years (with removal of tear or without surgery).

  • Complications of surgery: infection, bleeding, injury to nerves (numbness, weakness, paralysis), continued pain, giving way, locking, need for further surgery, and knee stiffness (loss of motion).

TREATMENT

Discoid menisci that are found without symptoms are left alone. If an injury occurs, ice and medicine should be used to reduce pain and inflammation. It may be advised that you walk with crutches until you are able to walk without a limp. Strengthening and stretching exercises may be needed to maintain strength and a full range of motion. These exercises may be performed at home or with a therapist. The only definitive treatment for discoid meniscus is surgery, to repair the malformed meniscus. After surgery, the joint is usually restrained. This is followed by a rehabilitation program consisting of strengthening and stretching exercises.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Discoid Meniscus

These exercises may help you when beginning to rehabilitate after your surgery. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Knee Flexion, Supine

  • Lie on the floor, with your right / left heel and foot lightly touching the wall. (Place both feet on the wall, if you are not using a door frame).

  • Without using any effort, allow gravity to slide your foot down the wall slowly, until you feel a gentle stretch in the front of your right / left knee.

  • Hold this stretch for __________ seconds. Then return the leg to the starting position, using your healthy leg for help, if needed.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Hamstrings, Supine

  • Lie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Knee Extension, Prone

  • Lie on your stomach on a firm surface, such as a bed or countertop. Place your right / left knee and leg just beyond the edge of the surface. You may wish to place a towel under the far end of your right / left thigh for comfort.

  • Relax your leg muscles and allow gravity to straighten your knee. Your caregiver may advise you to add an ankle weight, if more resistance is helpful for you.

  • You should feel a stretch in the back of your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this __________ times per day.

STRENGTHENING EXERCISES - Discoid Meniscus

These exercises may help you when beginning to rehabilitate after your surgery, restraint, or onset of your symptoms. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make sure you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

ExitCare Image STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor, mat, or bed on which you are lying.

  • Hold the muscle as tight as you can, without increasing your pain, for __________ seconds.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Short Arcs

  • Lie on your back. Place a __________ inch towel roll under your knee so that the knee bends slightly.

  • Raise only your lower leg, by tightening the muscles in the front of your thigh. Do not allow your thigh to rise.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

OPTIONAL ANKLE WEIGHTS: Begin with ____________________, but DO NOT exceed ____________________. Increase in 1 lb/0.5 kg increments.

ExitCare Image STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working, to make sure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lie on your back, with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even shake a bit.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.