Physical Therapy for Meniscus Tear Injuries
What is the meniscus?
The meniscus is a piece of cartilage located in the knee joint, positioned between the thigh bone (femur) and the shinbone (tibia).
The meniscus has a crescent shape and is made of tough, rubbery cartilage. It is divided into two main parts: the medial meniscus, located on the inner side of the knee, and the lateral meniscus, positioned on the outer side of the knee. Each meniscus is further divided into regions based on blood supply and anatomy: the inner portion, known as the avascular zone, lacks a direct blood supply, while the outer portion, called the vascular zone, has a blood supply that facilitates healing.
What do the menisci do?
The menisci It serves several important functions in the knee, including:
Shock Absorption: The meniscus acts as a shock absorber, cushioning the impact between the femur and tibia during movements such as walking, running, and jumping.
Load Distribution: By distributing weight evenly across the knee joint, the meniscus helps prevent excessive stress and wear on the articular cartilage, which covers the ends of the bones.
Stability: The meniscus helps stabilize the knee joint by enhancing its congruence and preventing excessive movement or instability.
How does a meniscus tear occur?
A meniscus tear usually happens during activities that forcefully twist or rotate the knee joint while bearing weight. This commonly occurs during sports activities like basketball, soccer, or skiing, where sudden stops and changes in direction can put stress on the knee. It can also occur due to degenerative changes in the knee joint over time, making the meniscus more prone to tearing with less force.
Meniscus Mechanism of Injury
What are the different types of meniscus tears?
Meniscus tears can be classified into several types based on their location, shape, and severity:
Radial Tear: These tears occur perpendicular to the long axis of the meniscus and can be further classified into vertical, horizontal, or oblique tears.
Bucket Handle Tear: This type of tear is characterized by a large longitudinal tear that resembles a bucket handle, causing the meniscus to displace into the joint space.
Flap Tear: Flap tears involve a portion of the meniscus folding over on itself, creating a flap-like structure.
Horizontal Tear: These tears occur parallel to the tibial plateau and are often associated with degenerative changes.
Complex Tear: This term is used when there are multiple types of tears present in the meniscus.
Different Types of Meniscus Tears
The medial meniscus, located on the inner side of the knee, is more commonly torn than the lateral meniscus, which is on the outer side. This is primarily due to its anatomical attachment to the medial collateral ligament and the greater forces it experiences during weight-bearing activities and twisting motions of the knee.
Should you have surgery after a meniscus tear?
Whether or not to have surgery after a meniscus tear depends on various factors, including the severity of the tear, the individual's symptoms, their activity level, and their overall health. Here are some considerations:
Symptoms: If the tear is causing persistent pain, swelling, locking, or instability in the knee, surgery may be considered to address these symptoms.
Tear Type and Location: The type and location of the tear can influence treatment decisions. For example, larger tears, bucket handle tears, or tears that cause mechanical symptoms like locking may benefit more from surgical intervention.
Activity Level: Individuals who are highly active and participate in sports or activities that require pivoting, cutting, or sudden changes in direction may opt for surgery to restore knee stability and function.
Age and Health Status: Younger, healthy individuals may be more inclined to undergo surgery to preserve knee function and prevent long-term complications, while older adults or those with pre-existing health conditions may explore non-surgical options first.
Non-Surgical Options: In some cases, especially for small tears or tears in specific locations, conservative treatments such as physical therapy, activity modification, pain management, and corticosteroid injections may be effective in managing symptoms without the need for surgery.
Recent research has challenged the notion that surgery is always superior to non-surgical treatment for meniscus tears, particularly degenerative tears. This study by Katz et al. (2013) found that there was no significant difference in outcomes between surgery and conservative treatment, such as physical therapy, for degenerative meniscal tears.
What are the long term risks of having a meniscectomy?
The long-term risks of undergoing a meniscectomy include:
Increased Risk of Knee Osteoarthritis (OA): Removal of a portion of the meniscus alters the biomechanics of the knee joint, leading to increased stress on the articular cartilage. Over time, this can accelerate the degenerative process and increase the risk of developing knee osteoarthritis. This study demonstrated an association between meniscectomy and the development or progression of knee OA later in life.
Cartilage Damage: Meniscectomy can result in increased contact pressures and shear forces within the knee joint, which may contribute to cartilage damage and chondral lesions over time. Cartilage degeneration can further exacerbate symptoms and functional impairment and increase the risk of developing OA.
Progression of Meniscal Pathology: In some cases, meniscectomy may fail to address underlying meniscal pathology or lead to the progression of degenerative changes within the remaining meniscal tissue. This can result in ongoing symptoms and the need for additional interventions, such as revision surgery.
Is it better to have a meniscus repair versus a meniscectomy?
Whether it's better to have a meniscus repair versus a meniscectomy depends on several factors, including the type and location of the meniscal tear, the patient's age, activity level, and overall knee health. We strongly encourage our clients to have this conversation with their orthopedic surgeon. Here's a comparison of meniscus repair vs. meniscectomy:
Meniscus Repair:
Purpose: Meniscus repair aims to preserve the integrity and function of the meniscus by suturing the torn edges back together.
Suitability: Meniscus repair is typically suitable for younger patients with tears located in the peripheral vascular zone, where there is sufficient blood supply for healing. It is often preferred for longitudinal tears, radial tears near the periphery, and tears in the red-red or red-white zones of the meniscus.
Benefits: By preserving the meniscus, repair surgery may help maintain knee stability, distribute load forces more evenly across the joint, and reduce the risk of developing knee osteoarthritis later in life, as noted in this study.
Considerations: Meniscus repair requires a longer recovery period and may involve restrictions on weight-bearing, range of motion, and physical activity during the initial healing phase. Success rates can vary depending on various factors, including tear characteristics, surgical technique, and patient compliance with rehab protocols.
Meniscectomy:
Purpose: Meniscectomy involves the partial or complete removal of the torn portion of the meniscus.
Suitability: Meniscectomy may be considered for patients with complex tears, degenerative tears, or tears in the avascular zone of the meniscus (white-white zone), where repair may not be feasible or effective. It is often chosen for older patients or those with tears that are unlikely to heal with repair.
Benefits: Meniscectomy can provide symptomatic relief by eliminating mechanical symptoms such as locking or catching and reducing pain and swelling in the knee. It is generally associated with shorter recovery times and fewer postoperative restrictions compared to repair surgery.
Considerations: While meniscectomy can provide short-term symptomatic relief, it may increase the risk of developing knee osteoarthritis over time, as previously stated, especially in younger patients. It also involves the removal of meniscal tissue, which can compromise knee stability and increase the likelihood of future knee injuries.
A comprehensive discussion between the patient and their healthcare providers is essential to determine the most appropriate treatment option for the individual's specific circumstances.
How can physical therapy treatment help if you’ve had a meniscus tear?
Physical therapy after a meniscus tear can help to reduce pain, improve strength and flexibility, restore normal function to the knee joint, and facilitate return to functional activities and sport.
Here's are some of the treatment techniques our physical therapists use in the rehab process:
Manual Therapy: Physical therapists can use manual therapy techniques such as soft tissue massage and joint mobilizations to help reduce pain and inflammation, and improve range of motion in the knee.
Range of Motion Exercises: Gentle range of motion exercises are prescribed to improve the range of motion in the knee joint, preventing stiffness and promoting healing.
Strength Training: Strengthening exercises focus on the muscles surrounding the knee, particularly the quadriceps, hamstrings, and calf muscles to provide better support and stability for the knee.
Balance and Proprioception Training: Meniscus tears can affect balance and proprioception (awareness of the position and movement of the body). Physical therapists can implement exercises to improve these aspects, reducing the risk of falls or further injury.
Functional and Sports-Specific Training: Exercises are tailored to mimic activities of daily living or specific sports movements, helping patients regain functional abilities and return to their regular activities or sports safely.
What are the best exercises to do if you have a meniscus tear?
We begin by focusing on restoring your range of motion. Patients with meniscus injuries will lack range of motion into both flexion and extension (with extension usually being more limited). As you improve and your range of motion is restored, our therapists begin to focus on strengthening the hip and knee. Then your therapist will begin to include more sport specific movement patterns that involve changes in direction and change of speed. Every client presents differently, so it’s important to be properly evaluated by a specialist before you begin an exercise protocol.
How long does it take to heal from a meniscus tear?
The duration for healing from a meniscus tear varies depending on several factors, including the severity of the tear, the individual's age and overall health, and adherence to the prescribed treatment plan. Minor tears might heal within a few weeks with proper rest and rehabilitation, while more severe tears or those requiring surgical intervention might take several months for full recovery. It's crucial to follow the guidance of your healthcare provider and physical therapist for the best outcome.
Closing Remarks
If you’re dealing with knee pain from a meniscus injury and want to consult us in the rehab process, click the button below to speak with one of our Doctors of Physical Therapy.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioner. Please consult with a trusted provider.
Dr. Paul Nasri PT, DPT, OCS, COMT
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy