Meniscal Tear
Treatment
Non-surgical treatment of meniscal tears is indicated in less severe cases. Grade 1 or 2 tears can usually be treated with conservative measures including rest, ice, non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation, physical therapy. Conservative treatment is usually tried in many cases before surgery is indicated unless there are obvious signs of a more severe meniscal tear. Physical therapy treatment includes:
Surgery may be indicated in more severe cases of meniscal tears. If so, the most common surgical treatment for a torn or worn meniscus is an arthroscopic partial meniscectomy.6 During this procedure, the damaged part of the meniscus is removed from the knee joint. Northmore et al. have shown that patients who received arthroscopic partial meniscectomy procedures showed considerably better post-surgical results in areas of symptoms, functionality, and return to sport, as compared to those who received either an open partial meniscectomy or a total meniscectomy.7 Other surgical treatments of meniscal tears include meniscal repair via suturing and meniscal transplantation both of which are less commonly used.
Physical therapy following a meniscus repair is typically more intensive. Patients who have undergone a partial meniscectomy may begin to perform some partial weight-bearing activities on the 1st postoperative day along with other non-weightbearing exercises. A home or supervised rehabilitation protocol will likely be given. Physical therapy interventions for post-operative meniscectomy patients includes the following:
- Minimizing swelling
- Pain-free ROM exercises
- Strengthening exercises of the lower extremities to prevent muscular atrophy
- Balance/proprioception exercises
- Gait training
- Cardiovascular endurance
Surgery may be indicated in more severe cases of meniscal tears. If so, the most common surgical treatment for a torn or worn meniscus is an arthroscopic partial meniscectomy.6 During this procedure, the damaged part of the meniscus is removed from the knee joint. Northmore et al. have shown that patients who received arthroscopic partial meniscectomy procedures showed considerably better post-surgical results in areas of symptoms, functionality, and return to sport, as compared to those who received either an open partial meniscectomy or a total meniscectomy.7 Other surgical treatments of meniscal tears include meniscal repair via suturing and meniscal transplantation both of which are less commonly used.
Physical therapy following a meniscus repair is typically more intensive. Patients who have undergone a partial meniscectomy may begin to perform some partial weight-bearing activities on the 1st postoperative day along with other non-weightbearing exercises. A home or supervised rehabilitation protocol will likely be given. Physical therapy interventions for post-operative meniscectomy patients includes the following:
- ROM exercises to attain pain-free ROM in the knee
- Lower-extremity strengthening with an emphasis on quadriceps strengthening to avoid muscle atrophy
- Stretching/ mobilization techniques
- Modalities like ice, heat packs, electrical stimulation, and hydrotherapy may be used to help control pain and swelling
- Gait training to help normalize gait pattern following surgery
- Specific return to sport/activity functional activities.
- Patient education
Prevention
Many cases of meniscal tears may not be preventable since they usually are caused by a traumatic event or due to degenerative changes. In general, strengthening and stretching the lower extremity muscles can help reduce lower extremity injuries especially the hamstrings, quadriceps, and calf muscles. Wearing the appropriate footwear for the sport/activity and playing surface can also help to reduce knee injuries. Any abrupt increase in activity/exercise intensity can increase the chance that an injury will occur. A gradual increase in activity/exercise intensity should be implemented to avoid injury.
Education
The patient should be taught about any weight-bearing precautions associated with their post-operative status. Patients who undergo a supervised rehabilitation program following a meniscectomy have the advantage of being taught how to properly perform exercises, adhere to weight-bearing guidelines, and return to a normal gait pattern. Also, patients should be taught by their physical therapist how to avoid any potential risk factors for further injury during sport or activity.
References
- Seitz H, Marlovits S, Wielke T, Vecsei V. [Meniscus lesions after isolated anterior cruciate ligament rupture]. Wien Klin Wochenschr. 1996;108(22):727-730.
- Tandogan RN, Taser O, Kayaalp A, et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc. 2004;12(4):262-270. Epub 2003 Sep 2020.
- Lee JJ, Choi YJ, Shin KY, Choi CH. Medial meniscal tears in anterior cruciate ligament-deficient knees: effects of posterior tibial slope on medial meniscal tear. Knee Surg Relat Res. 2011;23(4):227-230. Epub 2011 Nov 2030.
- Crues JV, 3rd, Mink J, Levy TL, Lotysch M, Stoller DW. Meniscal tears of the knee: accuracy of MR imaging. Radiology. 1987;164(2):445-448.
- Dandy DJ. The arthroscopic anatomy of symptomatic meniscal lesions. J Bone Joint Surg Br. 1990;72(4):628-633.
- Yan R, Wang H, Yang Z, Ji ZH, Guo YM. Predicted probability of meniscus tears: comparing history and physical examination with MRI. Swiss Med Wkly. 2011;141:w13314.(doi):10.4414/smw.2011.13314.
- Fabricant PD, Jokl P. Surgical outcomes after arthroscopic partial meniscectomy. J Am Acad Orthop Surg. 2007;15(11):647-653.
- Northmore-Ball MD, Dandy DJ, Jackson RW. Arthroscopic, open partial, and total meniscectomy. A comparative study. J Bone Joint Surg Br. 1983;65(4):400-404.