Rehabilitation after Meniscus Injury
Meniscal tears involve injury or degenerative changes to the C-shaped piece of cartilage of the knee. The meniscus acts as a shock absorber and distributes weight equally to promote balance and stability and control movements at the knee. In athletic populations, meniscus tears are frequently the result of traumatic injuries and can occur during high-risk sports including soccer, tennis, and basketball. Mechanism of injury typically involves the knee twisting or rotating during pivoting, kneeling, or squatting.
The location of the tear has a significant impact on the ability of the tear to heal and the corresponding treatment. Though some meniscal tears can be treated non-operatively, others warrant surgical repair depending on the extent of the injury and interference with normal knee motion. Those who elect to not have surgery often undergo a course of physical therapy aimed at restoring joint range of motion, reducing swelling, and correcting any imbalances in muscle strength or flexibility between the injured and non-injured limb.
Rehabilitation guidelines after surgery are based on whether a patient had the meniscus repaired or just “cleaned” or smoothed out called a meniscectomy. With a meniscectomy, patients can expect to progress through rehab fairly quickly. There are minimal restrictions, and physical therapy will initially focus on reducing pain/swelling, restoring range of motion, and light strengthening. Once this is achieved, rehab will emphasize strengthening, balance, control of the surgical limb, and return to activity.
Meniscal repairs, however, involve more restrictions. Depending on the location of the tear and subsequent repair, patients will initially not be able to put weight through their limb and will not be able to bend their knee past 90 degrees for up to 6 weeks. This ensures that the repair heals properly and that a meniscus tear does not occur. Physical therapy in the early phases will involve many table-based exercises to improve range of motion and strengthen the hip and knee. Examples of exercises include heel slides, squeezing the thigh muscle, weight shifting, straight leg raises, and hip extension.
Whether treated conservatively or surgically, physical therapy in the later phases of rehab works to restore function so a patient can get back to the activities they desire. The rehab program will be individually tailored towards improving basic strength, flexibility, and balance, progressing towards sports-specific activities such as running, cutting, pivoting, and jumping.
By Danielle Morency, PT, DPT, CSCS
Physical Therapist, Certified Strength and Conditioning Specialist
Midwest Orthopaedics at Rush