Wednesday, December 16, 2009

Treatment for Medial Meniscus Tear

A great summary from the Sports Injury Clinic...

What is a medial meniscus injury?
The medial meniscus is more prone to injury than the lateral meniscus as it is connected to the medial collateral ligament and the joint capsule and so is less mobile. Hence, any forces impacting from the outer surface of the knee, such as a rugby tackle, can severly damage the medial meniscus. In addition, medial meniscal injuries are often also associted with injuries to the anterior cruciate ligament. Other mechanisms of injury may be twisting of the knee or degenerative changes that are associated with age. Any of these circumstances may lead to tearing of the medial meniscus, which in serious cases may require surgical intervention.

Symptoms of medial meniscus tear
A history of trauma or twisting of the knee
Pain on the inner surface of the knee joint
Swelling of the knee within 24-48 hours of injury
Inability to bend knee fully- this may be associated with pain or a clicking noise
A positive sign (pain and/or clicking noise) during a "McMurrays test"
Pain when rotating and pressing down on the knee in prone position (video).
"Locking" of the knee
Inability to weight bear on the affected side

Types of meniscal injuries:
Degenerative Changes: This may lead to edges of the menisci becoming frayed and jagged
Longitudical Tears: This is a tear that occurs along the length of the meniscus
Bucket- Handle Tears: This is an exaggerated form of a longitudical tear where a portion of the meniscus becomes detached from the tibia forming a flap that looks like a bucket handle

Treatment of medial cartilage meniscus injury

What can the athlete do:

Apply RICE to the injured knee.
Wear a heat retainer or support.
Gentle exercises to maintain quadriceps strength, although care should be taken not to aggravate the symptoms.
Take a glucosamine / joint healing supplement.
Consult a
Sports Injury Specialist.

A Sports Injury Clinician May:

The first aim of the sports injury specialist will be to correctly diagnose the injury. He/she may do this by utilizing specific tests for meniscal tears such as a "McMurrays" test. Once diagnised the practitioner may consider two different modes of treatment depending on the extent of the injury.

Conservative Treatment
This may be indicated in the case of a small tear or a degenerative meniscus and may involve:

Ice, compression and recommendation of NSAIDs e.g. Ibuprofen.
Electrotherapy i.e ultasound,
laser therapy and TENS.
Manual therapy
Once pain has subsided, exercises to increase range of movement, balance and maintain quadriceps strength may be prescribed. These may include: squating, single calf raises and wobble-board techniques.

2. Surgical Intervention
In the event of more severe meniscal tears such as a bucket handle tear, arthroscopic surgical procedures may be necessary to repair the lesion. The aim of surgery is to preserve as much of the meniscus cartilage as possible. The procedure itself will normally invlove stitching of the torn cartilage. The success of the surgery depends not only on the severity of the tear but also on the age and physical condition of the patient. Younger and fitter patients are known to have better outcomes.

Following surgery a rehabilitive exercise program will be outlined for the patient which may include strenghtening and balance training. Full co-operation with the rehabilitive technique will be necessary to maximise recovery.

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