Knee/Meniscus/Cartilage Injuries

what happens if the meniscus is not there to reduce friction

will have more catching and cause irritation

arthrokinematics of femur during knee flexion

posterior roll and anterior glide (past 30 degrees)

menisci movement during flexion

distort posteriorly

why is there a high incidence of meniscal tears occurring with ACL injuries

more movement in the joint leads to more loading of the menisci

types of meniscal tears

traumatic and degenerative

meniscal injury repair in older adults

menisectomy

risk factors of meniscal injury

cutting and pivoting sports, age, damaged ACL, female, higher BMI

diagnosis of meniscal injury

MOI was twisting knee, delayed effusion, catching/locking, pain along joint line, decreased ROM, difficulty WB

why do pts opt for menisectomies despite weaker healing

faster return to play

diagnosis of cartilage injury

acute trauma with hemarthrosis in 0-2 hours, insidious onset aggravated by repetitive impact, intermittent pain and swelling, catching/locking, joint pain tenderness

tests for meniscal injury

reproduction of pain with forced hyperextension or max knee flexion, mcmurray’s, thessaly’s

non-operative approach to acute meniscal tears

LE strengthening, balance, core strengthening (rare to not get surgery)

preferred rehab for degenerative meniscal tears

non-operative management

recommendations of rehab after meniscus repair

depends on type of tear

healing time frame of menisectomy

4-12 weeks

healing time frame of meniscal reconstruction

at least 9 months

precautions after meniscal repairs

no loaded knee flexion past 45 degrees for 4 weeks and past 90 for 8 weeks, avoid end range flexion

why should resisted hamstring exercises be avoided after a meniscal repair

it pulls the tibia back and causes shear

best intervention strategies following meniscal repairs

early progressive knee motion, WB, return to activity

type of therapeutic exercise done after meniscal repairs

quad and hamstring strength training

healing time frame of meniscal repair

12-14 weeks

cause of majority of articular cartilage lesions

traumatic non-contact mechanisms

most frequent location of articular cartilage lesions

medial femoral condyle and patella

risk factors of cartilage lesion

meniscal tears, ACL injury

cartilage surgical techniques

restorative and reparative transfers and transplantations

healing phases of cartilage

protection and activation (cotton), loading and functional restoration (dough), activity restoration (rubber)

what could effusion mean in cartilage rehab

too much WB activity, not enough motion

how long is it normal to swell up after cartilage repair

6 weeks

WB guidelines after femoral cartilage repair

touch-down loading for 2 weeks and full WB at 4-6 weeks

neuromuscular control during protection and activation phase of cartilage rehab

recruitment of quads and hamstrings (isos), activation of gluteal hip muscles

consequence of co-contraction of quads and hamstrings during gait

increases compression forces on the tibiofemoral joint → OA

relationship between quad strength and knee OA

increase in strength helps prevent development of OA

importance of quads during gait

eccentric contraction during weight acceptance reduces impact shock and joint loading

criteria to go from phase 1 to 2 of cartilage repair rehab

full passive ROM, minimal pain, minimal effusion, recovery of muscular activation and gait

activities of loading and functional restoration phase of cartilage repair rehab

fix LE alignment, biofeedback or visual feedback (mirroring) of functional and dynamic tasks

criteria to go from phase 2 to phase 3 of cartilage repair rehab

max peak torque difference of less than 20%, hop performance less than 10% difference, self-reported outcomes greater than 90%

goals of protection and activation phase of cartilage repair rehab

WB control, ROM, muscular activation, gait

goals of loading and functional restoration phase of cartilage repair rehab

low impact load, muscle strength training, LE alignment

goals of activity restoration phase of cartilage repair rehab

mod-high impact load, muscle strength training