Rehabilitation after Meniscal injury

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Rehabilitation after Meniscal injury

• Dr. Ali Abd El-Monsif Thabet

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Anatomical considerations

• The medial meniscus is C shaped and thicker
  posteriorly. It occupies 50 of the articular
  contact area of the medial compartment. The
  lateral meniscus is O shaped and of equal
  thickness throughout. It covers 70 of the
  lateral tibial plateau.

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• The peripheral portion obtains its nutrition
  through blood vessels but the central portion
  must rely on the diffusion of synovial fluid.
  The process of fluid diffusion to support
  nutrition requires intermittent loading of the
  meniscus by either weight-bearing or muscular
  contractions

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Functions

• 1- Joint lubrication
• 2- Increase joint congruency
• 3- Act as a shock absorber
• 4- Distribute weight-bearing forces

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Injury mechanism

• Mechanical elements in meniscal injury include
  force moments of knee joint flexion, compression,
  and rotation

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Injury mechanism

• A valgus force sufficient to cause disruption of
  the MCL also might produce an ACL tear as well as
  a meniscus tear unhappy triad

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Pathomechanics

• Medial meniscus (90) (Less mobile than lateral
  meniscus )
• Lateral meniscus (10)

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Diagnosis

• Injury followed by pain in area of medial or
  lateral joint lines
• Most patients describe pain especially when the
  knee is straightened.
• Effusion develops gradually over 48 to 72 hours,
  although a tear at the periphery might produce a
  more acute hemarthrosis.

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• 1. Apley's Compression test a combination of
  tibiofemoral compression and rotation forces that
  are used to check for the presence of a meniscal
  tear

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Fig. 2 . The McMurray test for meniscal tears.
flexed, internally and externally the
knee. rotate the tibia on the femur.
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the test is considered positive for a
torn medial meniscus, usually in the
posterior position.
With the leg externally rotated and in valgus,
slowly extend the knee. If click is palpable or
audible, With the leg externally rotated, place a
valgus stress on the knee.
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• Bragard sign
• This test may be used if anterior joint-line
  point tenderness is present.
• Bounce home test
• The patient is supine with his heel cupped in the
  examiner's hand.

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• Payr sign
• With the patient sitting cross-legged, the
  examiner exerts downward pressure along the
  medial aspect of the knee.
• Medial knee pain indicates a posterior horn
  lesion of the medial meniscus

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• First Steinmann sign
• With the patient supine and the knee and hip
  flexed at 90, the examiner forcefully and
  quickly rotates the tibia internally and
  externally.
• Pain in the lateral compartment with forced
  internal rotation indicates a lateral meniscus
  lesion. Medial compartment pain during forced
  external rotation indicates a lesion of the
  medial meniscus.

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• Second Steinmann sign
• This test is indicated when point tenderness is
  located along the anterior joint line.
• When the examiner moves the knee from extension
  into flexion, the meniscus is displaced
  posteriorly, along with its lesions. The point of
  tenderness also shifts posteriorly toward the
  collateral ligament.

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Operative management

• The overall treatment goal is to preserve as much
  meniscal tissue as possible.
• Meniscal tears in the outer third or vascular
  zone will heal and therefore a meniscal repair is
  recommended.
• Meniscal tears that extend beyond the outer third
  or vascular zone will not heal and therefore a
  partial meniscectomy is recommended.
• A complete meniscectomy may be performed
  especially with significant degenerative tears to
  the meniscus.

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POSTOPERATIVE REHABILITATION

• Goals
• 1- Control of pain and edema
• 2- Obtaining and maintaining full ROM
• 3- Regaining proper quadriceps
  strength.
• 4- Immediate weight bearing as
  tolerated
• 5- Return to activity

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Criteria for Return

• The athlete may return to activity when
• (1) Swelling does not occur with activity.
• (2) Full ROM has been regained,
• (3) There is equal bilateral strength in knee
  flexion and extension,
• (4) The athlete can successfully complete
  functional performance tests.

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Thank you