Running head: Meniscus Tears

Meniscus Tears
Kaitlyn Hutchins
Liberty University

Meniscus Tears
Description of Injury The meniscus is separated into two separate menisci. A medial, more crescent shaped menisci, and a lateral, more circular one. The meniscus is responsible for lubricating and nourishing the knee joint and assisting with joint biomechanics by mainly providing shock absorption during weight bearing. Injuries to a healthy meniscus are usually produced by a compressive force coupled with transverse-plane tibiofemoral rotation as the knee moves from flexion to extension during rapid cutting or pivoting (Brindle, 2001, 160). Meniscus tears can be considered acute or chronic depending on the mechanism of injury and the participants injury history. The patient may even be able to continue participation in activities but will notice a significant loss of the range of motion in the knee joint and a feeling that the knee is “giving out”. In many cases, it is the medial meniscus that is more commonly injured due to the fact that it is much less stable because of its crescent shape, and because it is also attached to the medial collateral ligament.
Mechanisms of Injury The possible mechanisms of injury for meniscus tears varies from rapid cutting or changing of directions while running, to extreme compressive force to the lower leg region causing unnatural stress on the menisci. There are three different types of tears to the menisci which include a “bucket handle” tear, “parrot beak”, and a horizontal tear. “Bucket handle” tears occur when the femur and tibia trap the meniscus when the knee turns medially or laterally (Micheli, 2011). This can be triggered by swift cutting or rapid deceleration in sports such as football or soccer. The second type of tear is known as the “parrot beak” and this occurs when the meniscus splits in two as a result of repetitive stress activities such as running (Micheli, 2011). The third and least likely tear to occur is a horizontal tear down the middle of the menisci. This is a result of degeneration over time and starts at the inner edge and works its way back along the middle of the menisci (Micheli, 2011).
Signs, Symptoms and Diagnostic Testing Athletes with meniscal tears commonly describe feeling a pop or snapping sensation while performing a sudden movement during activity. In most cases, the athlete will still be able to walk or run on their knee without any pain following the injury. However, after activity ceases, for several days the athlete may experience stiffness and swelling along with tenderness at the joint line (Micheli, 2011). A comprehensive examination of this injury should include a thorough injury history regional palpation, and select special tests (Brindle, 2001). X-rays can eliminate to possibility of a fracture to the surrounding bones, but magnetic resonance imaging, known as MRIs, are the preferred method of diagnosis of meniscal tears.
Immediate Treatment Initial treatment of meniscal tear follows the RICE formula which is rest, ice, compression and elevation. This combined with nonsteroidal anti-inflammatory drugs for pain should help reduce the immediate onset of symptoms that will occur (Micheli, 2011). If the athlete’s knee is stable and does not lock, this conservative treatment may be all that is needed due to the fact that the tear may be small enough for the blood vessels surrounding the outer edge of the meniscus to heal the small tear on its own provided that athlete gives it the rest that it requires (Micheli, 2011).
Extended Treatment and Rehabilitation The main goal following a meniscal injury is to control the pain and inflammation associated with maintaining range of motion and general conditioning to strengthen the knee joint during the rehabilitation process. Immediate progressive range of motion and neuromuscular reeducation and strengthening are warranted (Brindle, 2001, 168). The use of cryotherapy and nonsteroidal anti-inflammatories will also aid in the control of pain and inflammation. Nonsurgical rehabilitation will typically last six to twelve weeks depending on severity and each individual’s healing process. Exercises will be those that focus on strengthening the muscles around the knee, avoiding high impact activities, and the possible use of a brace to stabilize the knee during the healing process (Micheli, 2011). The patient is allowed to return to full activity when there is no more signs of swelling in the knee, the pain subsides, and the patient has gained complete strength and range of motion within the knee joint (Micheli, 2011).
Surgical Repair/Reconstruction and Post-op Rehabilitation Surgery may be needed is the meniscus does not heal on its own or the knee becomes locked. Arthroscopic surgeries are most frequently used to perform this type of surgery. Following the surgery, the patient will wear a brace or cast to immobilize the knee. He or she must complete a course of rehabilitation exercises before gradually returning to normal activities (Micheli, 2011). Most patients will take part in a formal physical therapy program to return their knee to full strength and range of motion as the meniscus heals. Non weight bearing exercises are recommended for the first 4-6 weeks of recovery to ensure adequate tissue regeneration and repair (McLaughlin, 1994). Several factors must be taken into account when administering a rehabilitation program following meniscal surgery including anatomical, surgical and healing factors (McLaughlin, 1994). Anatomical factors including the location of the tear, surgical factors including the stability of the repair and soft tissue, and healing factors including the individual differences in rate of recovery (McLaughlin, 1994). Since each person’s healing process differs, it is important to closely monitor range of motion and strength progress as well as pain and any other side effects of surgery that may extend recovery time.
Injury Prevention Various strength exercises can be performed in order to strengthen and stabilize the knee joint to prevent meniscus injuries. Exercises such as squats and straight leg raises focus on building the strength of the muscles surrounding the knee joint so as to stabilize the joint through the full range of motion. In sports that require excessive cutting actions and rapid deceleration such as soccer or football, the use of a knee brace or support may be necessary in order to ensure the knee joint is kept stable while performing movements that will stress the joint too much. Instilling proper technique and ample practice will ensure that the patient’s body is well adapted to the stresses and movements required of them while participating in high-risk sports.

References
Brindle, T., Nyland, J., & Johnson, D. (2001). The Meniscus: Review of Basic Principles With Application to Surgery and Rehabilitation. Journal of Athletic Training, 36(2), 160-169. Retrieved March 30, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC155528/?tool=pmcentrez
McLaughlin, J. (1994). Rehabilitation After Meniscus Repair. Orthopedics, 17(5), 463-471. Retrieved March 30, 2015, from http://search.proquest.com/docview/962450402?pq-origsite=summon
Micheli, L. (2011). Meniscus Injuries. Encyclopedia of Sports Medicine, 3, 857-860. Retrieved March 30, 2015, from http://rx9vh3hy4r.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:book&rft.genre=book item&rft.title=Encyclopedia of Sports Medicine&rft.atitl