Meniscus Tear

with Phase II 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 II

After your physician, physical therapist or athletic trainer feels your knee has made progress significant enough to begin more advanced exercises, he or she may recommend some of the exercises that follow. He or she may also advise you to continue with the exercises which you completed in Phase I of your rehabilitation. 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 - Quadriceps, Prone

  • Lie on your stomach on a firm surface, such as a bed or padded floor.

  • Bend your right / left knee and grasp your ankle. If you are unable to reach your ankle or pant leg, use a belt around your foot to lengthen your reach.

  • Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.

  • 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 - Meniscus Tear Phase II

These are some of the exercises you may progress to in your rehabilitation program. It is critical that you follow the instructions of your caregiver. Based on your individual needs, your caregiver may choose a more or less aggressive approach than the exercises presented. Remember:

  • Strong muscles with good endurance tolerate stress better.

  • Do the exercises as initially prescribed by your caregiver. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used under his or her guidance.

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, Step-Ups

  • Use a thick book, step or step stool that is __________ inches tall.

  • Hold a wall or counter for balance only, not support.

  • Slowly step up with your right / left foot, keeping your knee in line with your hip and foot. Do not allow your knee to bend so far that you cannot see your toes.

  • Slowly unlock your knee and lower yourself to the starting position. Your muscles, not gravity, should lower you.

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

ExitCare Image STRENGTH - Quadriceps, Wall Slides

Follow guidelines for form closely. Increased knee pain often results from poorly placed feet or knees.

  • Lean against a smooth wall or door and walk your feet out 18-24 inches. Place your feet hip width apart.

  • Slowly slide down the wall or door until your knees bend __________ degrees.* Keep your knees over your heels, not your toes, and in line with your hips, not falling to either side.

  • Hold for __________ seconds. Stand up to rest for __________ seconds in between each repetition.

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

* Your physician, physical therapist or athletic trainer will alter this angle based on your symptoms and progress.

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.

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