Treatments Classes

Meniscal Injury

The meniscus is the cartilage inside the knee comprising of a medial and lateral portion. Meniscal tears are common sporting injuries and it is far more common to sustain an injury to the medial meniscus. Additionally meniscal tears can be common with osteoarthritis due to weakness and breakdown of the meniscus. They are commonly associated with ligamentous injuries within the knee. The most common mechanism of acute injury is when the knee is twisted while semi flexed and weight bearing, while chronic/ degenerative tears tend to occur spontaneously in the absence of trauma. Tears can be different shapes and directions but typically have the same healing rate. Tears can also be partial or a complete rupture.

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Symptoms

1. A feeling of instability in the knee
2. Pain and tenderness around the joint line
3. Painful clicking within the knee that can be replicated with special tests on assessment
4. Bending and loading the knee i.e. during a squat can increase symptoms
5. Degenerative meniscal tears present with the same symptoms but may also have patella pain

Treatments

While surgery can be indicated following a meniscal tear, it is not always necessary especially if the symptoms are well controlled initially. Conservative physiotherapy treatment can effectively manage the condition [1].
Immediate management of the injury includes rest, ice, elevation and compression to reduce the pain and swelling in the area [2]. After the initial inflammatory response has settled, it is important to begin strengthening the leg muscles before they weaken. Exercises typically begin as static strengthening so as not to aggravate the injury [3][4]. Often non weight bearing exercises are used to begin with [5] and as the irritability decreases and strength increases your physiotherapist will increase the difficulty of your exercise programme to include static cycling, leg press, wall squats, lunges and step ups.
It is important to maintain flexibility in the leg muscles, particularly knee extension [3][4]. Flexibility stretches can be passive or active and applied by your physiotherapist or given as home exercises. It is important to maintain full movement of the knee, especially extension [3][4][6]. Balance, agility and proprioceptive exercises are another crucial aspect to rehabilitating your knee fully, your physiotherapist will be able to introduce them at the right time for you depending on your symptoms [6], usually this is after you are able to jog with no pain or symptoms.
If conservative treatment does not resolve the injury or if the tear is severe, a knee arthroscopy may be required however starting a strengthening programme before surgery can make recovery far easier. Your post-operative physiotherapy will follow a similar structure but be guided by your consultants recommendations [3][5][6].

References

1.https://link.springer.com/article/10.1007/s00167-013-2494-z Rathleff, C.R., Cavallius, C., Jensen, H.P., Simonsen, O.H., Rasmussen, S., Kaalund, S. and Østgaard, S.E., 2015. Successful conservative treatment of patients with MRI-verified meniscal lesions. Knee Surgery, Sports Traumatology, Arthroscopy, 23(1), pp.178-183.
2. https://europepmc.org/abstract/med/12483953 Perryman, J.R. and Hershman, E.B., 2002. The acute management of soft tissue injuries of the knee. The Orthopedic clinics of North America, 33(3), pp.575-585.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666539/ Frizziero, A., Ferrari, R., Giannotti, E., Ferroni, C., Poli, P. and Masiero, S., 2012. The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures. Muscles, ligaments and tendons journal, 2(4), p.295.
4. https://acad.ro/sectii2002/proceedingsChemistry/doc2018-2/Art04DaiaArticle.pdf DAIA, C., ONOSE, G., BICA, F. and BADEA, R., 2018. New Team, Rehabilitation and Orthopedic, Approaches of Patients with Meniscal Lesions.
5.https://bmjopensem.bmj.com/content/4/1/e000212?itm_campaign=bmjosem&itm_content=consumer&itm_medium=cpc&itm_source=trendmd&itm_term=0-A Spang III, R.C., Nasr, M.C., Mohamadi, A., DeAngelis, J.P., Nazarian, A. and Ramappa, A.J., 2018. Rehabilitation following meniscal repair: a systematic review. BMJ open sport & exercise medicine, 4(1), p.e000212.
6. https://www.sciencedirect.com/science/article/pii/S1060187217300400 Lennon, O.M. and Totlis, T., 2017. Rehabilitation and Return to Play Following Meniscal Repair. Operative Techniques in Sports Medicine, 25(3), pp.194-207.
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