Meniscus Tear

with Phase I Rehab

ExitCare ImageThe meniscus is a C-shaped cartilage structure, located in the knee joint between the thigh bone (femur) and the shinbone (tibia). Two menisci are located in each knee joint: the inner and outer meniscus. The meniscus acts as an adapter between the thigh bone and shinbone, allowing them to fit properly together. It also functions as a shock absorber, to reduce the stress placed on the knee joint and to help supply nutrients to the knee joint cartilage. As people age, the meniscus begins to harden and become more vulnerable to injury. Meniscus tears are a common injury, especially in older athletes. Inner meniscus tears are more common than outer meniscus tears.

SYMPTOMS

  • Pain in the knee, especially with standing or squatting with the affected leg.

  • Tenderness along the joint line.

  • Swelling in the knee joint (effusion), usually starting 1 to 2 days after injury.

  • Locking or catching of the knee joint, causing inability to straighten the knee completely.

  • Giving way or buckling of the knee.

CAUSES

A meniscus tear occurs when a force is placed on the meniscus that is greater than it can handle. Common causes of injury include:

  • Direct hit (trauma) to the knee.

  • Twisting, pivoting, or cutting (rapidly changing direction while running), kneeling or squatting.

  • Without injury, due to aging.

RISK INCREASES WITH:

  • Contact sports (football, rugby).

  • Sports in which cleats are used with pivoting (soccer, lacrosse) or sports in which good shoe grip and sudden change in direction are required (racquetball, basketball, squash).

  • Previous knee injury.

  • Associated knee injury, particularly ligament injuries.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Protect the knee with a brace or elastic bandage.

  • Wear properly fitted protective equipment (proper cleats for the surface).

PROGNOSIS

Sometimes, meniscus tears heal on their own. However, definitive treatment requires surgery, followed by at least 6 weeks of recovery.

RELATED COMPLICATIONS

  • Recurring symptoms that result in a chronic problem.

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

  • Progression of the tear (the tear gets larger), if untreated.

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

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

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. You may find using crutches to walk more comfortable. However, it is okay to bear weight on the injured knee, if the pain will allow it. Surgery is often advised as a definitive treatment. Surgery is performed through an incision near the joint (arthroscopically). The torn piece of the meniscus is removed, and if possible the joint cartilage is repaired. After surgery, the joint must be restrained. After restraint, it is important to perform strengthening and stretching exercises to help regain strength and a full range of motion. These exercises may be completed at home or with a therapist.

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 - Meniscus Tear, Non-operative, Phase I

These are some of the initial exercises with which you may start your rehabilitation program, until you see your caregiver again or until your symptoms are resolved. Remember:

  • These initial exercises are intended to be gentle. They will help you restore motion without increasing any swelling.

  • Completing these exercises allows less painful movement and prepares you for the more aggressive strengthening exercises in Phase II.

  • 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 RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your healthy knee, placing your foot flat on the floor.)

  • Slowly slide your heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

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

ExitCare Image RANGE OF MOTION - Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending) : Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening) : Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

Repeat __________ times. Complete __________ times per day.

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 do not use 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 - Knee Extension Sitting

  • Sit with your right / left leg/heel propped on another chair, coffee table, or foot stool.

  • Allow your leg muscles to relax, letting gravity straighten out your knee.*

  • You should feel a stretch behind your right / left knee. Hold this position for __________ seconds.

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

*Your physician, physical therapist or athletic trainer may instruct you place a __________ weight on your thigh, just above your kneecap, to deepen the stretch.

STRENGTHENING EXERCISES - Meniscus Tear, Non-operative, Phase I

These exercises may help you when beginning to rehabilitate your injury. 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. Progress the resistance and repetitions only as guided.

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 right / left 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 pound/0.5 kilogram increments.

ExitCare Image STRENGTH - Quadriceps, Straight Leg Raises

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

  • Lay 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 in between each repetition.

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

ExitCare Image STRENGTH - Hamstring, Curls

  • Lay on your stomach with your legs extended. (If you lay on a bed, your feet may hang over the edge.)

  • Tighten the muscles in the back of your thigh to bend your right / left knee up to 90 degrees. Keep your hips flat on the bed.

  • Hold this position for __________ seconds.

  • Slowly lower your leg back to the starting position.

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

ExitCare Image STRENGTH – Quadriceps, Squats

  • Stand in a door frame so that your feet and knees are in line with the frame.

  • Use your hands for balance, not support, on the frame.

  • Slowly lower your weight, bending at the hips and knees. Keep your lower legs upright so that they are parallel with the door frame. Squat only within the range that does not increase your knee pain. Never let your hips drop below your knees.

  • Slowly return upright, pushing with your legs, not pulling with your hands.

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

ExitCare Image STRENGTH - Quad/VMO, Isometric

  • Sit in a chair with your right / left knee slightly bent. With your fingertips, feel the VMO muscle just above the inside of your knee. The VMO is important in controlling the position of your kneecap.

  • Keeping your fingertips on this muscle. Without actually moving your leg, attempt to drive your knee down as if straightening your leg. You should feel your VMO tense. If you have a difficult time, you may wish to try the same exercise on your healthy knee first.

  • Tense this muscle as hard as you can without increasing any knee pain.

  • Hold for __________ seconds. Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete exercise __________ times per day.