Lecture 10 MENISCAL’S TEARS of knee.pdf

Meniscal tears of knee and their cure

1. MENISCAL TEARS:NONOPERATIVE
MANAGEMENT

2. Mechanisms of Injury
•The medial meniscus is injured more frequently than the lateral
meniscus.
•Insult may occur when the foot is fixed on the ground and the femur
is rotated internally, as when pivoting, getting out of a car, or
receiving a clipping injury.
•An ACL injury often accompanies a medial meniscus tear. Lateral
rotation of the femur on a fixed tibia may tear the lateral meniscus.
Simple squatting or trauma may also cause a tear.

4. Functional Limitations/Disabilities
•A meniscus tear can cause acute locking of the knee or chronic
symptoms with intermittent catching/locking.
•Pain during forced hyperextension or maximum flexion
•When there is joint catching/locking, the knee does not fully extend,
and there is a springy end feel when passive extension is attempted.
•If the joint is swollen, there is usually slight limitation of flexion or
extension.
•The McMurray test or Apley’scompression/distraction test may be
positive.
•When the meniscus tear is acute, the patient may be unable to bear
weight on the involved side. Unexpected locking or giving way during
ambulation often occurs, causing safety problems.

5. Management
•Often the patient can actively move the leg to “unlock” the knee, or
the unlocking happens spontaneously.
•Passive manipulative reduction of the medial meniscus may unlock
the knee.
Internally and externally rotate the tibia as you
flex the hip and knee,thenlaterally rotate the
tibia and apply a valgus stress
at the knee as you extend it. The meniscus may
click into place

6. Surgical and Postoperative Management
•Primary surgical options are partial
meniscectomyand meniscal repair, both of which
are considered preferable to total meniscectomy.
•The location and nature of the tear influences
the selection of a procedure, as does the
patient’s age and level of activity.
•Tears of the outer area of a meniscus, which has
a rich vascular supply, heal well, whereas tears
extending into the central portion, where the
vascular supply is considerably less, have
marginal healing properties.

7. Meniscus Repair
Indications for Surgery
•A lesion in the vascular outer third of the medial or lateral meniscus
•A tear extending into the central, relatively avascular third of the
meniscus of a young (younger than age 40 to 50) or physically active
older (older than age 50) individual

8. Procedure
•Prior to the operative procedure, a comprehensive arthroscopic
examination of the joint is performed to determine if a meniscus tear is
suitable for repair and to identify any concomitant injuries, such as ACL
damage.
•The meniscus repair itself typically is performed using an arthroscopically
assisted open approach or a fully arthroscopic approach.
•There are several surgical procedures—referred to as
Inside-out
Outside-in
All-inside Technique

10. •The inside-outand outside-intechniques are arthroscopically
assisted, with a portion of the procedure being performed through an
incision at the posteromedial or posterolateral aspectof the knee
The all-inside technique is fully arthroscopic.

11. Postoperative Management
IMMOBILIZATION AND PROTECTIVE BRACING
•The knee is held in full extension, first in the postoperative
immobilizer and then in a long-leg brace when the bulky compression
dressing is removed a few days after surgery.
WEIGHT BEARING
•If quadriceps control is sufficient, full weight bearing may be
permitted by 4 weeks after a peripheral repair and by 6 to 8 weeks
after a central repair or transplantation.

12. Exercises Maximum Protection Phase
•Maximum Protection Phase
•Moderate Protection/Controlled Motion Phase

14. PARTIAL MENISCECTOMY
INDICATIONS FOR SURGERY
■A symptomatic (pain and locking), displaced tear of the meniscus
sustained by an older, inactive individual associated with pain and
locking of the knee
■A tear extending into the central, less vascular third of the meniscus
if not determined repairable when arthroscopically visualized and
probed
■A tear localized to the inner, avascular third of the meniscus

15. PROCEDURE
•Arthroscopic meniscectomytypically is performed on an outpatient
basis under local anesthesia.
•The torn portion of the meniscus is identified, grasped, and divided
endoscopicallyby knife or scissors and removed by vacuum.
•Intra-articular debris or loose bodies also are removed. After the knee
is irrigated and drained, skin incisions at the portal sites are closed,
and a compression dressing is applied to the knee.

16. Postoperative Management
Immobilization and Weight Bearing
A compression dressing is placed on the knee, but it is not necessary to
immobilize the knee postoperatively with a splint or motion-controlling
orthosis. For the first few postoperative days, cryotherapy,
compression, and elevation of the operated leg are used to control
edemaand pain. Weight bearing is progressed as tolerated.

17. Exercises
•Maximum and Moderate Protection Phases
•Minimum Protection/Return to Function Phase

18. Special Test
Apley’sTest
Patient Position:The patient lies in the prone position with the knee
flexed to 90°. The patient’s thigh is then anchored to the examining
table with the examiner’s knee
Therapist Position:
•The examiner medially and laterally rotates the tibia, combined first
with distraction, while noting any restriction, excessive movement, or
discomfort. Then the process is repeated using compression instead
of distraction. If rotation plus distraction is more painful or shows
increased rotation relative to the normal side, the lesion is probably
ligamentous.

19. •If the rotation plus compression is more painful or shows decreased
rotation relative to the normal side, the lesion is probably a meniscus
injury.
https://www.youtube.com/watch?v=6Z_9lfX_Pc8

20. McMurray Test
Patient Position:The patient lies in the supine position with the knee
completely flexed (the heel to the buttock).
Therapist Position:The examiner then medially rotates the tibia and
extends the knee .
•If there is a loose fragment of the lateral meniscus, this action causes
a snap or click that is often accompanied by pain.
https://www.youtube.com/watch?v=lwDFPAyGGgI

21. THANK YOU