2. ObjectivesObjectives
You will be able to identify the two menisci in the kneeYou will be able to identify the two menisci in the knee
You will know the most common mechanisms ofYou will know the most common mechanisms of
meniscal tearsmeniscal tears
You will be able to recognize and evaluate a meniscalYou will be able to recognize and evaluate a meniscal
teartear
You will know the proper treatments and rehabilitation forYou will know the proper treatments and rehabilitation for
a meniscal teara meniscal tear
You will understand the requirements for an athlete toYou will understand the requirements for an athlete to
return to playreturn to play
You will learn various stretches and strengtheningYou will learn various stretches and strengthening
techniques for preventiontechniques for prevention
3. The Knee JointThe Knee Joint
The knee joint has twoThe knee joint has two
menisci, a lateral andmenisci, a lateral and
medialmedial
They are fibrous cartilageThey are fibrous cartilage
They rest on top of theThey rest on top of the
tibia in shallowtibia in shallow
indentationsindentations
The lateral meniscus is onThe lateral meniscus is on
the outside of your kneethe outside of your knee
and the medial the insideand the medial the inside
4. Functions of the menisciFunctions of the menisci
Aid in lubrication andAid in lubrication and
nutrition of the jointnutrition of the joint
Act as shockAct as shock
absorbersabsorbers
Evenly distributeEvenly distribute
weight throughout theweight throughout the
kneeknee
Allows for smootherAllows for smoother
motions between themotions between the
femur and tibiafemur and tibia
5. The inner 2/3 of theThe inner 2/3 of the
menisci are avascularmenisci are avascular
(without blood supply)(without blood supply)
The remaining outer 1/3The remaining outer 1/3
is vascular (with bloodis vascular (with blood
supply)supply)
6. Mechanisms of injuryMechanisms of injury
An acute twisting injury fromAn acute twisting injury from
impact during a sportimpact during a sport
Usually the foot stays fixed on theUsually the foot stays fixed on the
ground and the rest of bodyground and the rest of body
rotatesrotates
Getting up from a squatting orGetting up from a squatting or
crouching positioncrouching position
Loading the knee from a fixedLoading the knee from a fixed
positionposition
7. Injuring the meniscusInjuring the meniscus
There are several types of tearsThere are several types of tears
VerticalVertical
RadialRadial
HorizontalHorizontal
DegenerateDegenerate
ComplexComplex
HornHorn
A loss of any part of the meniscus causesA loss of any part of the meniscus causes
uneven weight distribution and can lead to earlyuneven weight distribution and can lead to early
wear of the kneewear of the knee
The lateral meniscus is not attached as firmly toThe lateral meniscus is not attached as firmly to
the tibia as the medial meniscus, making it lessthe tibia as the medial meniscus, making it less
likely to become injuredlikely to become injured
8. Meniscal injury statsMeniscal injury stats
Meniscal injuries occur in 15% of ACL injuriesMeniscal injuries occur in 15% of ACL injuries
80% of patients with a history of ACL tears will80% of patients with a history of ACL tears will
likely tear their meniscus with incidences oflikely tear their meniscus with incidences of
instability of the kneeinstability of the knee
70.7% of meniscal injuries are to the medial70.7% of meniscal injuries are to the medial
meniscusmeniscus
Almost all meniscal injuries ages 20 and underAlmost all meniscal injuries ages 20 and under
are sports related 11 out of 12 casesare sports related 11 out of 12 cases
Ages 20-29, 64.5% were sports relatedAges 20-29, 64.5% were sports related
Ages 30-39, 30.6% were sports relatedAges 30-39, 30.6% were sports related
Ages 40-49 and 50-59 only 19.6% and 14.3%Ages 40-49 and 50-59 only 19.6% and 14.3%
were sports relatedwere sports related
9. What to look for?What to look for?
Not all meniscal tears are symptomaticNot all meniscal tears are symptomatic
If there are symptoms you could look for:If there are symptoms you could look for:
SwellingSwelling
Pain along the joint line (tenderness)Pain along the joint line (tenderness)
Pain when squatting, kneeling or pivotingPain when squatting, kneeling or pivoting
Locking of the kneeLocking of the knee
Loss of full knee extensionLoss of full knee extension
10. How can the coach help?How can the coach help?
If there is a possible meniscal tear 80-90% of theIf there is a possible meniscal tear 80-90% of the
time an athlete will remember the mechanism oftime an athlete will remember the mechanism of
the injury and may report a “pop” or a “snap”the injury and may report a “pop” or a “snap”
You could ask the athlete if there is pain whenYou could ask the athlete if there is pain when
weight bearing, or bending of the kneeweight bearing, or bending of the knee
You could also ask the athlete if they are havingYou could also ask the athlete if they are having
any locking in their knee or trouble extending theany locking in their knee or trouble extending the
knee all the wayknee all the way
11. When there is a meniscal injuryWhen there is a meniscal injury
As a coach in the event of a meniscalAs a coach in the event of a meniscal
injury you shouldinjury you should
Ice the area in painIce the area in pain
Limit movement of the knee joint (rest)Limit movement of the knee joint (rest)
Keep weight bearing limited to a tolerableKeep weight bearing limited to a tolerable
level of pain for the injured kneelevel of pain for the injured knee
Sometimes a splint can be applied for comfortSometimes a splint can be applied for comfort
12. Rehabilitation optionsRehabilitation options
There are two common ways that a meniscal tearThere are two common ways that a meniscal tear
can be repaired surgicallycan be repaired surgically
There is also a non surgical option because theThere is also a non surgical option because the
menisci are partially vascular they have themenisci are partially vascular they have the
ability to heal themselvesability to heal themselves
13. Why choose surgery?Why choose surgery?
Surgery is usually advised for a fewSurgery is usually advised for a few
different reasonsdifferent reasons
The location of the tear, if the tear is in aThe location of the tear, if the tear is in a
avascular zone it will most likely not heal itselfavascular zone it will most likely not heal itself
If the tear is longer than 5-8mmIf the tear is longer than 5-8mm
If the pain limits activities of daily livingIf the pain limits activities of daily living
Or if the individual is not happy with their levelOr if the individual is not happy with their level
of functionof function
14. Surgical techniquesSurgical techniques
The more common technique is arthroscopicThe more common technique is arthroscopic
partial menisectomy, which consists of removingpartial menisectomy, which consists of removing
the torn fragment of the meniscusthe torn fragment of the meniscus
This reduces irritation, but can effect the weightThis reduces irritation, but can effect the weight
distribution in the kneedistribution in the knee
The other option is an arthroscopic repair, whichThe other option is an arthroscopic repair, which
requires suturing the meniscus back togetherrequires suturing the meniscus back together
This option attempts to conserve the meniscus inThis option attempts to conserve the meniscus in
hopes of preventing the early onset of arthritishopes of preventing the early onset of arthritis
15. Road to recoveryRoad to recovery
Whether you choose the surgical orWhether you choose the surgical or
conservative approach, the rehabilitation isconservative approach, the rehabilitation is
similarsimilar
The rehabilitation time frames can varyThe rehabilitation time frames can vary
depending on the individual and the severity ofdepending on the individual and the severity of
the tearthe tear
The protocols may vary depending on theThe protocols may vary depending on the
surgical approach and physician. A commonsurgical approach and physician. A common
protocol may include the followingprotocol may include the following
16. Steps to recoverySteps to recovery
The patient may be full weight bearing right afterThe patient may be full weight bearing right after
the surgery with or without crutchesthe surgery with or without crutches
Initial symptoms can be reduced using certainInitial symptoms can be reduced using certain
modalities and manual techniquesmodalities and manual techniques
Stretching/ flexibility exercises focusing onStretching/ flexibility exercises focusing on
hamstrings, quadriceps, hip flexors, hiphamstrings, quadriceps, hip flexors, hip
adductors and calf musclesadductors and calf muscles
StrengtheningStrengthening
Balance trainingBalance training
Dynamic exercises/plyometricsDynamic exercises/plyometrics
17. Initial physical therapyInitial physical therapy
The first few sessions of physical therapy mayThe first few sessions of physical therapy may
consist more of modalities and some manualconsist more of modalities and some manual
techniques to address inflammation, pain andtechniques to address inflammation, pain and
ROM such as:ROM such as:
Heat/iceHeat/ice
UltrasoundUltrasound
Electrical stimulationElectrical stimulation
Manual stretchingManual stretching
Scar and patella mobilizationsScar and patella mobilizations
Passive range of motion for full knee flexion andPassive range of motion for full knee flexion and
extensionextension
Retrograde massage to decrease swellingRetrograde massage to decrease swelling
18. Once pain and swelling are reduced theOnce pain and swelling are reduced the
sessions mainly focus on increasing thesessions mainly focus on increasing the
strength and flexibility of the lowerstrength and flexibility of the lower
extremity as toleratedextremity as tolerated
The progression will vary depending onThe progression will vary depending on
the individualthe individual
Some examples of stretching andSome examples of stretching and
strengthening exercises are illustrated instrengthening exercises are illustrated in
the following slidesthe following slides
21. StrengtheningStrengthening
Focusing on strengthening the muscles aroundFocusing on strengthening the muscles around
the knee is essential in rehabilitationthe knee is essential in rehabilitation
Quad sets Straight leg raises (in all planes)Quad sets Straight leg raises (in all planes)
Heel raises Leg CurlHeel raises Leg Curl
Leg extensionLeg extension
22. BalanceBalance
Balance canBalance can
sometimes besometimes be
compromised after ancompromised after an
injury or surgeryinjury or surgery
Here are someHere are some
balance exercisesbalance exercises
that can helpthat can help
23. Dynamic exercises/plyometricsDynamic exercises/plyometrics
Progression to moreProgression to more
dynamic sportsdynamic sports
specific exercisesspecific exercises
helps with thehelps with the
transition back intotransition back into
sportssports
24. Return to playReturn to play
This can vary widely from athlete toThis can vary widely from athlete to
athleteathlete
When the athlete can participate in sportWhen the athlete can participate in sport
specific exercises without pain orspecific exercises without pain or
weaknessweakness
Full ROM is apparent in the injured kneeFull ROM is apparent in the injured knee
Collaborate decision between athlete,Collaborate decision between athlete,
physical therapist and physicianphysical therapist and physician
25. PreventionPrevention
The prevention of meniscal tears is veryThe prevention of meniscal tears is very
similar to the rehabilitationsimilar to the rehabilitation
Research has shown that more flexibleResearch has shown that more flexible
and stronger joints are less likely to getand stronger joints are less likely to get
injuredinjured
The athlete would continue stretching andThe athlete would continue stretching and
strengthening the lower extremitiesstrengthening the lower extremities
26. BibliographyBibliography
Learmonth, DJA. “Aspects of the knee: meniscal injury and surgery.” Trauma. 2000. Vol. 2Learmonth, DJA. “Aspects of the knee: meniscal injury and surgery.” Trauma. 2000. Vol. 2
p. 223-230p. 223-230
Gilbert, Rob. Ashwood, Neil. “Meniscal repair and replacement: a review of efficacy.”Gilbert, Rob. Ashwood, Neil. “Meniscal repair and replacement: a review of efficacy.”
Trauma. 2007. Vol. 9 p. 189-194Trauma. 2007. Vol. 9 p. 189-194
Lento, Paul. Akuthota, Venu. “Meniscal injuries: A critical review.” Journal of Back andLento, Paul. Akuthota, Venu. “Meniscal injuries: A critical review.” Journal of Back and
Musculoskeletal Rehabilitation. 2000. Vol. 15 p. 55-62Musculoskeletal Rehabilitation. 2000. Vol. 15 p. 55-62
Boyd, Kevin. Myers, Peter. “Meniscus preservation; rationale, repair techniques and results.”Boyd, Kevin. Myers, Peter. “Meniscus preservation; rationale, repair techniques and results.”
The Knee. March 2003. Vol. 10 Iss. 1 p. 1-11The Knee. March 2003. Vol. 10 Iss. 1 p. 1-11
Brindle, Timothy. Nyland, John. Johnson, Darren. “The Meniscus: Review of BasicBrindle, Timothy. Nyland, John. Johnson, Darren. “The Meniscus: Review of Basic
Principles With Application of Surgery and Rehabilitation.” Journal of Athletic Training.Principles With Application of Surgery and Rehabilitation.” Journal of Athletic Training.
Apr-Jun. 2001. Vol. 36 p. 160-169Apr-Jun. 2001. Vol. 36 p. 160-169
Drosos, G.I. Pozo, J.L. “The causes and mechanisms of meniscal injuries in the sporting andDrosos, G.I. Pozo, J.L. “The causes and mechanisms of meniscal injuries in the sporting and
non-sporting environment in an unselected population.” The Knee. April 2004. Vol. 11non-sporting environment in an unselected population.” The Knee. April 2004. Vol. 11
Iss. 2 p. 143-149Iss. 2 p. 143-149
Magee, David. “Orthopedic Physical Assessment 2Magee, David. “Orthopedic Physical Assessment 2ndnd
edition.” Philadelphia: W.B. Saundersedition.” Philadelphia: W.B. Saunders
Company, 1992Company, 1992
