Surgery for Meniscus Tear

with Phase II 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 II EXERCISES

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

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.

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 Surgery For 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.

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, 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.

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 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.

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.