Case Study presentation given to UCLA Sports Medicine Internship Program; Co-Presenters: Josh Honrado and Jennifer Ho

1. Case Studies of the Knee:
Meniscus Tears
and Osteochondral Fractures
Jennifer Ho (Injury A)
Joshua Honrado (Injury
B)
Claire DeBolt (Injury C)

2. Knee aNATOMY

3. KNEE ANATOMY

4. Injury a
• 20 year old male track athlete
• 5k and 10k distance events
• 3 years prior, consistent
discomfort and pain along
L medial joint line
• 4 weeks prior, escalated to
extreme pain
• Spoke with ATC and consulted physicians
• Preoperative exam and MRI revealed a medial
meniscus tear
• Did not respond well to conservative treatments
• Surgery on Jan 21, 2011

5. Injury B
• 20 year old male track athlete
• High jump, triple jump
• Athlete c/o pain x1wk and swelling in R
knee after playing basketball, unable to
run/ jump w/o pain (pain similar to initial
surgery)
• Spoke with ATC and consulted physicians
• Preoperative exam and MRI revealed
possible medial meniscus tear
• Did not respond well to conservative
treatment and Celebrex
• Surgery on October 21, 2010

6. INJURY C
• Previous knee injuries
• Pain and effusion in the right
knee; no specific mechanism
• MRI results:
anterolateralmeniscal
abnormality
• Pain over the lateral joint line;
negative for special tests
• Diagnosis: Lateral meniscal
tear
• Arthroscopic menisectomy

7. MenisCectomy

8. MENISCECTOMY
IMAGING

9. Surgery a, boUTCOMEs
• Partial meniscectomy of the L medial meniscus
• Arthroscopy revealed complex degenerative tear of the
posterior horn of the medial meniscus in the white-white zone
• Horizontal and vertical tears
• Partial meniscectomy of R medial meniscus
• Arthroscopy revealed mild superficial fraying of posterior horn
of medial meniscus in the white-white zone
• Same area where original meniscectomy was performed
• Originally resected only the torn unstable parts of the medial
meniscus

10. SURGERY A, B

11. cHONDRALFRACTUREs

12. Screw Fixation and
Microfracture Basis

13. CHONDRAL FRACTURES

14. General rehabilitation plan
• Decrease Pain and Reduce Swelling; RICE
• Knee Joint Mobilizations
• Reduces arthrofibrosis
• Flexibility/ ROM
• Muscular Strength
• Quads, hamstrings, abd, add, gastroc
• Neuromuscular Control; Proprioception
• Cardiorespiratory Fitness
• Non-weight bearing
• Functional Progression
• Sport-specific skills

15. Rehab a
• Week 1-2: Control pain and swelling, core, ankle and hip passive ROM and
strength, balance
• Modalities: russian stim, micromassage, cryopress, soft tissue massage
• Gentle stretching, clamshells, calf raises, SL airex balance
• Week 3-8: strengthening and balance, cardiovascular fitness, effusion reduction
• Cycling, swimEx, elliptical,  decreased activity due to persistent effusion
• Prone hangs (knee extension), 4 way ankle TB exercises, DL squats, russian twists, monster
walks, forward/backward walks
• Jump rope, DL/SL squats, lunges, increased time on cardio workouts
• Modalities: graston, microflush, soft tissue massage
• Week 9-11: reduce posterior capsule tightness, proprioceptive + dynamic
stability, cardiovascular fitness
• DL/SL squats, airex lunge, tennis balance, step-ups, walking supermans, knee grabs, ABC
skips, slide board, AlterG progression
• Modalities: graston
• Week 12-Present: functional progression, return-to-sport
• FMS (21), cleared to begin running
• Currently running on the track every other day, slowly adding mileage

16. REHAB B
• Rehabilitation was a lot faster than initial surgery
• Swelling reduced and full ROM by 5th week
• Winter break slowed progression
• Focused on proprioception (SL balance), box
jumps, progression of short step approaches
• 4 months after surgery cleared PT eval with FMS
screening for in-door high jump
• Later cleared for outdoor long-jump

17. REHAB C
• Weeks 1-3: Decreasing pain and swelling, achieving full
extension, slowly increasing ROM, increasing quad control and
VMO tone, maintaining glute, hip
• Modalities (Russian, microcurrent); Soft tissue mobilization;
Cryotherapy
• Ankle pumps; Quad and HS sets; Adductor sets, supine hip
flexion, prone glute activation; Bike (ROM)
• Week 3: PWB (50%), ROM 0-30; Goals: effusion control, maintain
extension, gait activity
• Extension exercises
• Week 4-7: Passive ROM 1-110; Goals: effusion control, soft tissue
and joint mobilization, maintain full extension, FOCUS: VMO
• Wall slides
• Heel slides, Double leg bridges with squeeze, weight shifts, calf
raises, balance

18. REHAB C
• Week 7; X-Ray 2: Screw and fragment intact; FWB
permitted
• Swim-Ex
• Balance Exercises
• SL exercises
• Week 8; X- Ray 3:No evidence of hardware complication;
etc. No pain, little swelling observed.
• Weeks 9-12: Maintained rehab program
• 3-way hip, clamsheels (TB), DL bridged (med ball), SL
bridges, SLR, TB side steps, calf raises
• Swim Ex: 4 way hip, flutter and bike kicks, jogging

19. REHAB c
• SURGERY 2: Hardware removal
• Lower extremity strengthening; proprioception
• 3 way hip, clam shells, squatting, side stepping, wall
sits, bridging, calf raises, balance exercises
• Lunges, bridge walk-outs, power-ups, monster
walks, slide-board, squatting

20. aTHLETE a:
cURRENT STATUS
• As of 11.5 week post-op he was discharged from PT and
began to slowly increase mileage
• Currently progressed to 3 miles every other day
• Occasionally feels discomfort from the site of partial
meniscectomy when speeding up

21. Athlete b:
current status
• Full participation in outdoor track and field
• Does high-jump, long jump, but no longer does triple
jump
• Recently had a case of shin-splints
• Occasionally feels pain
discomfort from site of
meniscectomy

22. Athlete C:
Current Status
• ~5 weeks post surgery
• Progressing smoothly
• Alter G: 50% 60%
• Expected to return to full
play by summer ball

23. THE END