17) Meniscal Injuries

What is the 2nd most common injury to the knee?

Meniscal tears

What is the MOI for meniscal injury?

• Acute → twisting injury of knee

• Chronic → people >50 may not have MOI

What is the patient presentation of meniscal injury?

• Pain worse with movement (squat/twist)

• May have collateral or cruciate ligament injury

• May complain of locking

• Joint line tenderness

What are the menisci made out of?

Fibrocartilage

What are the 4 functions of the menisci?

• Reduce compressive forces at joint

• Joint lubrication/decrease friction

• Increase stability

• Provide proprioception

What are the roots of the menisci?

Attachment zone of menisci to tibia

Which part of the menisci have the highest concentration of mechanoreceptors?

Horns

Which parts of the menisci are highly innervated and vascular?

Horns & roots

What is the red-red zone?

• Outer 1/3 of meniscus

• Has good potential to heal

• Highest concentration of innervation

What is the red-white zone?

• Middle 1/3 of meniscus

• May have healing potential

• Transitional zone

What is the white-white zone?

• Inner 1/3 of meniscus

• No blood supply

• Will NOT heal

Which meniscal tears can be managed conservatively or surgically?

Body or Horn tears

Which type of meniscal tear needs to be surgically managed?

Root tears

What makes up conservative care for meniscal tears?

• Temporary change in activity

• NSAIDs

• PT

What makes up surgical care for meniscal tears?

• Partial meniscectomy → cut out & smooth surfaces

• Complete meniscectomy → remove entire meniscus

• Repair

What factors indicate a good prognosis?

• Younger patient (<35)

• Peripheral damage in red-red zone

• Longitudinal tear

• Acute injury with blood effusion

• Stable knee

What factors indicate a poor prognosis?

• Older patient

• Central damage in white-white zone

• Complete tear

• Bucket handle tear

• Chronic injury

• Unstable knee

What does meniscectomy rehab look like during phase 1 (0-2 weeks)?

• Pt education

• WBAT

• Normalize gait pattern

• ROM: 0-115°

• Strength: bike or total gym

What does meniscectomy rehab look like during phase 2 (2-8 weeks)?

• WBAT → gait without AD → unloaded jogging

• ROM: full ROM

• Strength: kinetic chain; avoid CKC squats >90° until 6 weeks

• Balance & proprioception

What does meniscectomy rehab look like during phase 3 (8+ weeks)?

• WB: normalize jogging/running/function

• Strength: address kinetic chain

• Balance/proprioception

What happens to the knee with a root tear?

• Disrupt hoop stress function of menisci

• Increase compressive forces in knee

Root tears are equivalent to what?

Complete medial or lateral meniscectomy

What conditions are meniscus repairs performed on?

• Root tears

• Horn tears

• Body tears

What are the indications for meniscus repair?

• Traumatic lesion within vascular zone or root

• Meniscal tear without fragmentation

What does meniscus repair rehab look like during phase 1 (0-6 weeks)?

• Pt education

• WB: NWB with hinged brace for 4-6 weeks

• ROM: 90° flexion at 2-4 weeks & 120° flexion at 6 weeks

• Strength: quad sets, seated hip flexion, hip abduction/clam

• AVOID ACTIVE HS

What does meniscus repair rehab look like during phase 2 (6-10 weeks)?

• WBAT & normalize gait pattern with AD

• ROM: 0-120°+

• Strength: quad sets, SLR, heel raises, total gym

• Balance/proprioception

What does meniscus repair rehab look like during phase 3 (10 weeks - 12 months)?

• FWB

• Full AROM

• Strength: progress to single leg

• Balance/proprioception → single leg & dynamic stability

• Gait: unloaded jogging/running at 16-20 weeks