The meniscus is a C-shaped cartilage disc that cushions and helps stabilize the knee

1. MENISCAL REPAIR SURGERY AND POST OP PT REHAB
WH ERE IS TH E MEN IS CU S ?
The meniscus is a C-shaped cartilage disc
that cushions and helps stabilize the
knee. There are two of these discs in
each knee between the end of the thigh
bone (femur) and lower leg bone (tibia).
The one on the inside of the knee is
called the medial meniscus while the one
on the outer side is called the lateral
meniscus.
H OW DO MEN IS CU S TEARS
TYPICALLY OCCU R?
Tears in the menisci are categorized as
either acute or degenerative. Acute
meniscus tears occur suddenly, usually
when the leg is twisted while the foot is
planted and the knee is bent. Due to the
mechanism of injury, other structures in the knee such as the anterior cruciate ligament
(ACL) or medial collateral ligament (MCL) may be injured at the same time.
Degenerative tears occur as a result of general wear and tear in the knee joint.
In general the menisci have poor blood supply. Blood is what carries the nutrients and
growth factors and carries away damaged cells to help heal an injury. Because the
blood supply is poor, when torn, the meniscus is less likely to be able to heal on its
own. While not all meniscus tears require surgery, symptoms of catching or locking
usually require a surgical evaluation. Similarly, while conservative treatment like
physical therapy is often recommended as a first line treatment approach, failure to
respond to physical therapy may indicate surgery is necessary.
H OW IS MEN IS CU S S U RGERY PERFORMED?
Currently there are three main methods of surgical management of meniscus tears
(Doral et al., 2018). Which surgical approach is used often depends on the severity of
tear, the location of the tear, and the type of tear.
Arthroscopic Partial Meniscectomy: During this procedure the damaged part of the
meniscus is trimmed away and removed. As an arthroscopic procedure, it is minimally
invasive. This is the most common surgical approach to treating meniscus tears as it is
quick, has a low rate of morbidity, and good short term results. It is commonly used to
treat degenerative tears and radial tears but may not have as good of long term
outcomes as a meniscus repair and thus is often not recommended as a first line
treatment of choice.
In the past, total meniscectomy, or the removal of the entire meniscus, was
sometimes performed. This type of surgical approach is rare these days due to its
association with early osteoarthritis and poor long term clinical outcomes.
Meniscus Repair: This approach is intended to preserve the entire meniscus by
repairing the tear. This technique can be performed through an arthroscopic approach
or an open approach. Not every tear or every patient is a good candidate for this type of
surgery but it is preferable when possible to retain as much of the meniscus as
possible. At times what is called an augmentation technique (ex. needling) or the
NOVEMBER 21, 2022
SO YOU NEED MENISCUS SURGERY?
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addition of a biological product (ex. Platelet-rich plasma or mesenchymal stem cells) will
be used to try and improve the rate of healing after the surgical repair.
Meniscus Reconstruction: This is a more complex procedure used to replace a partially
or totally resected meniscus in symptomatic patients who have been unresponsive to
conservative management. The main goal is to fill the defect and safely place a
functional meniscus that is similar anatomically and structurally to the native meniscus.
The intent of this procedure is to improve both pain and function of the knee and delay
the onset of osteoarthritis.
POS T-OP PH YS ICAL TH ERAPY
Physical therapy is recommended following meniscus surgery. Your physical therapist
will work with your surgeon to follow their post-surgical physical therapy protocol. The
goal of of physical therapy after meniscus surgery is to return to your prior level of
function but while you are undergoing treatment you can expect your physical therapy
treatments to address several different areas:
• Manage pain and swelling: not only are pain and swelling uncomfortable but they
limit knee range of motion and can inhibit muscle activation. Your physical
therapist can help you manage your knee pain and swelling through things like
icing, compression and elevation.
• Returning to weight bearing: crutches, or a walker if needed, are typically used for
a few weeks to a few months depending on the type of surgery. In physical
therapy you will learn how to use your crutches or walker for things like going up
and down a curb and guide you through progressively putting more weight on
your leg until it is time to wean off them completely.
• Restore knee range of motion: restoring full flexion and extension of the knee is
an important step to returning to your prior activities. Soft tissue mobilization and
myofascial techniques, active and passive range of motion exercises, and
stretching can be used to accomplish this goal.
• Improve strength and neuromuscular control: strengthening exercises in the
muscles around the hip, knee, and ankle are important to help support the knee
joint as you return to activity. Similarly, neuromuscular control exercises help the
body coordinate the firing of muscles to provide good stability around the knee
joint during things like walking, running, and jumping.
• Return to sports and athletics: once healing has progressed, your physical
therapist will gradually include dynamic exercises specific to the sports and
activities you love and want to resume.
While having meniscus surgery may seem daunting, having a good physical therapist in
your corner can make the process much easier. The physical therapists at Evolve are
experienced in the rehabilitation of meniscus tears and post-op meniscus surgery and
would love to guide you through this process and get you back to doing the things you
love and need to do.
Click here to find out more information about physical therapy for meniscus tears
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