Surgery for Meniscus Tear

with Phase I Rehab

INDICATIONS - (WHO NEEDS SURGERY, WHEN, WHY, AND GOALS)

  • Surgery is advised for people with meniscus tears who experience locking, recurring swelling, and/or giving way of the knee.

  • Surgery is advised if non-surgical treatment has failed.

  • Sometimes, surgery is advised for people with pain or tenderness along the joint line.

  • Surgery is advised for people with displaced tears that prevent full knee range of motion ("locked knee"), or if there is a sign of a "bucket handle" tear (meniscus tears and flips to the center of the knee).

  • Surgery to repair a meniscus tear is elective (the patient chooses to have surgery). There is no evidence that the timing of surgery has an affect on the outcome of surgery.

  • Menisci have poor blood supply and little ability to heal. For this reason, less than 20% of all meniscus tears are repairable by sewing (suturing) them together. The rest are treated by removal of all or part of the meniscus (meniscectomy).

  • If a meniscectomy is performed, the meniscus does not reform.

  • If the meniscus tear occurs without an anterior cruciate ligament (ACL) tear, the success rate of surgery is approximately 80%. However, if an ACL tear is present, the success rate is about 40%. If the meniscus tear is repairable, most surgeons also recommend reconstructing the ACL.

  • One function of the meniscus is to reduce forces in the knee. Because of this, the loss of meniscus cartilage is linked with the early development of arthritis of the knee joint. The goal of meniscus surgery is to remove as little of the meniscus as possible.

  • Removing all or part of a torn meniscus allows for shaping of the cartilage and removal of torn edges, which prevents:

  • Progression of the tear (making a tear larger).

  • Displacement of the tear, causing recurring symptoms of locking, giving way, and swelling.

  • If a meniscus tear does not cause problems, it may be left alone. However, torn meniscus cartilage does not function, and the development of arthritis or symptoms such as locking, swelling, and giving way may still occur. Further, tears may progress to become larger, if left untreated.

CONTRAINDICATIONS - (REASONS NOT TO OPERATE)

  • Infection of the knee.

  • Inability or unwillingness to complete a rehabilitation program.

  • Pain or symptoms not related to the meniscus.

  • Arthritis of the knee, which causes the (symptomatic) meniscus tear.

RISKS AND COMPLICATIONS

  • Infection.

  • Bleeding.

  • Injury to nerves (numbness, weakness, paralysis).

  • Recurring symptoms (giving way, locking, swelling), including tearing the remaining meniscus if removal of the affected meniscus (meniscectomy) is performed, and re-tear or nonhealing of the meniscus repair.

  • Knee stiffness (loss of knee motion).

  • Continued pain.

  • Weakness of the thigh (quadriceps) muscles.

  • Do not eat or drink anything before surgery. Solid food makes general anesthesia more hazardous.

PROCEDURE

Meniscus tear surgery is performed through an incision near the joint (arthroscopically), and you go home the same day as surgery (outpatient basis). The procedure may be completed with general anesthesia, spinal anesthesia, or local anesthesia. The procedure involves using small power tools to remove the torn portion of the meniscus. If the tear is repairable, the edges of the tear are freshened. Then, sewing (sutures), anchors, or tacks are used to hold the torn edges together, while the meniscus heals.

AFTER THE PROCEDURE

  • Keep the wound clean and dry after the surgery (usually two weeks).

  • Keep the foot and ankle elevated above heart level whenever possible, for the first 1 to 2 weeks after surgery.

  • You will be given pain medicines by your caregiver.

  • Ice the knee to reduce inflammation.

  • You may put as much weight on the operated leg as possible, although you will often be given crutches after surgery, until you can walk without a limp.

  • If the tear is repaired (sewn back together), you may be given a brace, and possibly be allowed to bear full weight on the operated leg while you are wearing the brace, for varying periods (depends on your caregiver).

  • After surgery, rehabilitation and exercises are important to regain motion, and then strength.

RETURN TO SPORTS

  • Return to sports depends on many factors including:

  • Type of procedure (meniscus repair or removal).

  • Type of sport.

  • Position played.

  • It may take 6 weeks before sports can be resumed after meniscus removal (although it may be as early as 1 to 2 weeks), or 6 to 9 months after a meniscus repair.

  • Full knee motion and strength are needed, before sports can be resumed.

SEEK MEDICAL CARE IF:

  • You experience pain, numbness, or coldness in the foot.

  • Any of the following signs of infection occur after surgery: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

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

EXERCISES

PHASE I EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES- Meniscus Tear, Surgery For 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.

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.

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.

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 health leg for help, if needed.

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

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, Surgery For 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. Increase the resistance and repetitions only as guided by your caregiver.

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 in between each repetition.

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

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.

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.

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.

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.

STRENGTH- Isometric Quad/VMO

  • Sit in a chair with your knee bent 75 to 90 degrees.

  • With your fingertips, feel the muscle just above the kneecap on the inside half of your thigh. This is the VMO.

  • Push your foot and leg into the floor to cause the thigh muscles to tighten.

  • Concentrate on feeling the VMO tighten. This muscle is important because it helps control the position of your kneecap.

  • Tighten and hold for __________ seconds.

  • Repeat exercise __________ times, __________ times per day.

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 between each repetition.

Repeat __________ times. Complete exercise __________ times per day.