Meniscus Surgery Rehabilitation: What does it look like?
What is the meniscus?
The meniscus acts to reduce stress on the knee joint by increasing the contact area between the femur and tibia. The menisci act as a “buffer against axial, rotational and shearing forces about the knee during motion”. The meniscus is a cushioning structure in the knee with little vasculature (blood supply). Structures that have a high level of blood flow have an improved ability to repair and structurally heal on their own, compared to areas with little or no vasculature.
Why are meniscal tears being diagnosed more often now?
We have seen an increase in the incidence of meniscal injury diagnosis. “The incidence of meniscal injuries is on the rise and can be partly attributed to increased participation in sports as well as the recent advances and easy availability of imaging technology such as MRI”. It is important to note that many individuals have asymptomatic tears. It is key to understand that tissue injury does not always correlate with pain levels. However, if your tear is symptomatic, it is key to get a detailed evaluation to help one improve their strength, range of motion, control, and return to prior functional level.
One thing we often hear is: Do I need surgery? What’s the difference between a“Meniscectomy” and a Meniscal Repair?
A meniscectomy is a procedure in which a portion of the meniscus is removed from the knee completely. In a meniscus repair, the meniscus is salvaged and surgically repaired. Arthroscopic partial meniscectomy is currently the most commonly performed orthopedic procedure. However, some recent studies have conclusively shown that outcomes after an APM are no better than the outcomes after a sham/placebo surgery. This is one reason why meniscal repairs are becoming more popular. Due to the drastic difference in procedures, the rehabilitation timelines and protocols look quite different. The meniscus repair rehab will require a conservative timeline with more specific restrictions early on. Meniscal repair aims to achieve meniscal healing while completely avoiding the adverse effects of partial meniscectomy, such as joint arthrosis.
Meniscal Repair Rehabilitation: What to expect!
When one receives a surgical protocol, they have time frames on them. The early stages often look pretty similar and their time frames are more rigid due to tissue healing timelines. However, after the tissue has healed, it is important to not only use timelines but also specific criteria for advancement. This ensures that someone does not progress in a protocol to more advanced movements and exercises before achieving critical movement milestones. Different surgeon’s protocols look different, but here are some general guidelines that highlight what a rehab program may look like.
Early rehab looks to:
Emphasis on full passive extension
Control post-operative pain / swelling
Begin early range of motion exercises (Surgeon’s have their own guidelines)
Range of Motion ( 90° flexion or as per surgeon’s prescription
Regain quadriceps control
Middle stages look to:
Unlock the brace and discharge the brace
Regain normal gait function and mechanics, and begin working on functional movements such as stairs.
End-stages look to:
Returning to a higher level of functioning
The goal is to try to “normalize the left leg compared to the right”
No rehab process is the same. It is crucial to know that. Each individuals’ experience is different. It is important to understand that just because you have a meniscus “tear”, it does not mean that you automatically need to have surgery. There are many people in the world that have meniscus tears that have been confirmed via MRI, that are still functioning to their fullest ability without feeling any pain or symptoms. Physical therapy has great results for individuals that have a meniscus tear, however, in certain instances due to the nature/location of the tear and not achieving the results that you wanted via Physical Therapy, surgery may be warranted. Have any questions? Are you dealing with a meniscus tear and want to speak to one of our highly trained Doctors of Physical Therapy? Reach out to us and schedule your free 15 minute discovery call with us to see how we can best help you get back to the activities that you love to do most!
Resources
Bhan K. (2020). Meniscal Tears: Current Understanding, Diagnosis, and Management. Cureus, 12(6), e8590. https://doi.org/10.7759/cureus.8590
Spang Iii, R. C., Nasr, M. C., Mohamadi, A., DeAngelis, J. P., Nazarian, A., & Ramappa, A. J. (2018). Rehabilitation following meniscal repair: a systematic review. BMJ open sport & exercise medicine, 4(1), e000212. https://doi.org/10.1136/bmjsem-2016-000212
