Meniscus Tears
Meniscus tears are common injuries in the knee and occur in all age groups.
Symptoms of meniscus tears include;
- Pain
- Swelling
-
- Reduced range of motion- both bending and straightening
- Locking- when the meniscus flips into the joint and physically stops the knee from straightening
- Clicking
There are 2 types of meniscal tears, traumatic and atraumatic. Traumatic meniscal tears tend to occur when the knee is slightly bent, loaded and a twisting motion or change in direction occurs. These meniscal tears can occur in isolation or in combination with ligament tears.
Atraumatic or degenerative meniscal tears don’t tend to have a discrete episode leading to injury but are a result of repetitive stress (microtears) on the meniscus with age. As the meniscus tissue becomes worn out and stiff, tears can occur at any time. These tears occur in multiple directions and are often not repairable. Most often, degenerate tears are initially treated without surgery.
Based on the patient age, the type of tear and blood supply to the fragment some meniscus tears are repairable while others are not. Dr. Cohen tends to favor repair over meniscectomy (removal of damaged meniscus) whenever possible. Complete removal of the meniscus predisposes the knee to arthritis. When tears are not repaired, the minimal amount of meniscal tissue is removed.
Meniscal Root Tears
A variant of the meniscal tear is called a meniscal root tear. This involves partial or complete detachment of the meniscus at one of its anchor points at the front or back of the knee.
Complete tears of the meniscal root behave like the meniscus is deficient or entirely removed because most of the tension is lost and it cannot function properly.
Complete meniscal root tears in patients with intact cartilage should be repaired to avoid early arthritis.
| Stage | Goals | Weight Bearing | ROM/Cardio | Exercises |
| Stage 1
Weeks 0-6 Recovery and Non -Weight Bearing Phase |
(rest, ice, compression and elevation)
|
TTWB
ROM Brace locked in extension when mobilizing and sleeping |
Rom Brace as per prescribed post-op orders
Passive and active assisted Heel Slides Patella Mobilizations |
Multi Plane SLR
Multi Plane Hip Range IRQ Static quads, hamstrings, calf pumps |
| Stage 2
Weeks 6-8 Early Weight Bearing and Strength Training |
|
PWB then progress to WBAT
ROM brace 0-90 when mobilizing ROM brace not required for exercises or at rest |
Stationary Bike, no resistance to begin
Treadmill Walking Re-establish ROM No deep weight bearing < 90° |
**Body Weight Strengthening only
Half squats, Ball squats Wall slides Bridges Forward lunges to 60° |
| Stage 3
Weeks 8-16 Strengthening |
|
WBAT | Full ROM
Start Treadmill Walking week 8 Start Elliptical Week 10 Start inline Jogging week 12 – if quads index >80% contralateral limb No cutting or pivoting until week 16 |
Quads, hamstrings, calf strengthening
Hip abductor and adductor strengthening Squats (to chair if appropriate) Step downs- front, back and lateral Lateral Lunges Romanian Deadlift unloaded from week 8, loaded week 10 From Week 12 Single leg squats to 90° Loaded Squats and Deadlift from week 12 Single limb balance and proprioception |
| Stage 4
Week 16+ Return to Sport |
|
WBAT | Multi-plane plyometrics
Multi-plane Agility Cutting and Pivoting Exercises Ladder Drills Landing Mechanics |
Return to Sport Criteria
Single Leg hop Quads index > 95% Hamstrings index >95% Pain and swelling free post exercise
|
General info
- NWB for 6 weeks after Meniscal Root Repair
- Posterior Root Repairs will require limited flexion for 4-6 weeks (<90°)
- Anterior Root Repairs will have extension limited for 2-4 weeks (>10°)
- No deep flexion weight bearing for 8 weeks
- Inline running from 12 weeks
- Pivoting and Cutting from 16 weeks
| Stage | Goals | Weight Bearing | ROM Exercises/Cardio | Strengthening |
| Stage 1-
0-2 Weeks Recovery from Surgery |
(rest, ice, compression, and elevation)
|
As tolerated using Crutches | Patella Mobilization
Heel slides Prone Hangs and Heel Props Gastrocnemius and Hamstrings Stretch Start Exercise Bike when ROM Allows |
IRQ
Static contraction and co-contractions Calf Raises SLR Hip Abductors-clamshell and Therabands |
| Stage 2-
Weeks 2-4 ROM and provisional strengthening |
|
As tolerated
Wean Crutches as quads control improves |
Exercise Bike
Patella Mobilizations Prone and Standing Quads Stretch Hip Flexor Stretch |
Hamstring Curls
Step-up Half Squats, Ball squats Wall Slides Bridges on and off ball Start Leg Press Flexed Single limb balance |
| Stage 3- Weeks 4-8
Strengthening and cardiovascular training |
|
WBAT | Elliptical from week 4
Stair Climber from week 4 Pool Jogging from week 6 Inline jogging from week 8
|
Quads, hamstrings, calf strengthening
Hip abductor and adductor strengthening Squats (to chair if appropriate) Single leg squats Step downs- front, back and lateral Lateral Lunges Single leg deadlift where appropriate Single limb balance and proprioception |
| Stage 4-
Weeks 9-12 Return to Sport |
|
WBAT | Multi-plane plyometrics
Multi-plane Agility Cutting and Pivoting Exercises |
Return to Sport Criteria
Single Leg hop Quads index > 95% Hamstrings index >95% Pain and swelling free post exercise
|
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