Spoits Neuicine Centei

281 Lincoln St.

Woicestei, NA u16uS
Aithiitis anu }oint Centei
119 Belmont St.
Woicestei, NA u16uS
NENISCAL REPAIR
The meniscus is a ciescent shapeu caitilage that acts as a shock absoibei between
the femui (thigh bone) anu tibia (shin bone). Each knee has two menisci: meuial
(innei) anu lateial (outei). Theie is an auuitional type of caitilage in the knee joint
calleu aiticulai caitilage. This is a smooth, white glistening suiface that coveis the
enus of the bones. The aiticulai caitilage pioviues lubiication anu as a iesult, theie
is veiy little fiiction when the joint moves. Eithei by viitue of iegulai weai anu teai
on youi knee joint, oi an acute injuiy these caitilages can become toin anu cause
pain. These teais aie often accompanieu by swelling, anu can occasionally be
accompanieu by sensations of popping, giinuing, buckling oi having the knee lock in
place.
The mainstay of tieatment foi a meniscus teai is
non-opeiative. A shoit couise of activity
mouification (iefiaining fiom spoits oi
activities that huit the knee), ice, anti-
inflammatoiy meuication anu elevation will
usually ielieve the acute symptoms. Physical
theiapy anu exeicises aimeu at stiengthening
the muscles aiounu the knee joint (the
hamstiings anu quauiiceps) can often be
helpful. The majoiity of patients with meniscal
teais oi caitilage injuiies uo not iequiie
suigeiy. Bowevei, theie aie a small peicentage
of patients who continue to have symptoms
uespite a couise of conseivative tieatment.
Some poition of the pain may be fiom osteoaithiitis, wheieby the caitilage lining
the knee joint has simply woin away. This may be uue to an injuiy eailiei in life, oi
theie may be a genetic component as well. Pain fiom aithiitis may be uue to
inflammation in the lining of the knee joint (calleu synovitis), small fiactuies of the
bone unuei the caitilage (calleu subchonuial bone), stietching of neive fibeis ovei
bone spuis that foim (calleu osteophytes), anu loose bone chips in the joint.
Anothei poition of the pain may be mechanical in natuie, wheieby the toin piece of
meniscus oi aiticulai caitilage gets tiappeu in the joint anu causes shaip episoues of
pain, which can take a few uays to iesolve. Peisons who have pain of this natuie can
often have iepeateu episoues of having the meniscus oi caitilage piece become
tiappeu.
The meniscus gets its bloou supply fiom the outsiue
of the knee towaiu the insiue of the knee. If theie is
a teai of the meniscus in a iegion with goou bloou
supply (towaiu the outsiue of the knee), anu the teai
is of an appiopiiate size anu theie is not too much
auvanceu aithiitis the meniscus can be iepaiieu
iathei than iemoveu.
Foi those patients that fail to impiove with non-opeiative tieatment theie aie
suigical options available to tiy anu alleviate some of theii symptoms. Aithioscopy
is a suigical pioceuuie that oithopeuic suigeons use to visualize, uiagnose anu tieat
pioblems insiue of a joint. In an aithioscopic examination, Bi. Piice makes a small
incision in the patient's skin anu inseits pencil-sizeu instiuments that contain a
small lens anu lighting system to magnify anu illuminate the stiuctuies insiue the
joint. We can then ueteimine the amount anu type of injuiy, anu then iepaii oi
coiiect the pioblem, if it is necessaiy.
The pioceuuie to iepaii the meniscus involves sutuiing the toin enus of meniscus
back togethei with sutuies that aie left insiue youi knee joint. The benefit of
iepaiiing the meniscus is that you aie left with an intact shock absoibei insiue youi
knee that will iueally help piotect against the uevelopment of latei aithiitis.
The iisks of meniscus iepaii suigeiy incluue but aie not limiteu to:

Infection

Bleeuing

Excessive swelling

Bloou clots

}oint stiffness

Pain, postopeiative anuoi peisistent

Neniscus iepaii may fail as often as 2u% of the time, leauing to the neeu to
peifoim auuitional suigeiy to iemove the sutuies anu the meniscus
REBABILITATI0N AFTER NENISCAL REPAIR
Rehabilitation anu piotection of the meniscal iepaii aie ciucial aftei youi suigeiy.
0ne majoi ieason foi failuie of a mensical iepaii is failuie on the pait of the patient
to auheie to postopeiative instiuctions anu iestiictions.
Remembei, though, that people who have aithioscopy can have many uiffeient
uiagnoses anu pieexisting conuitions, so each patient's aithioscopic suigeiy is
unique to that peison. Recoveiy time will ieflect that inuiviuuality. It is veiy iaie
that youi iecoveiy will be the same as that of a fiienu oi family membei who also
hau "aithioscopic suigeiy."
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You will wake up in the opeiating ioom with an ice pack in place. You will also have
white compiession stockings on both legs. These aie to help pievent bloou clots anu
shoulu be woin foi the fiist two weeks following suigeiy.
You will be sent home with a piesciiption foi pain meuication. In auuition to the
pain meuication you shoulu take one auult stiength aspiiin eveiy uay foi 14 uays, in
oiuei to help pievent bloou clots. The pain meuication can make you constipateu. If
this is the case, take an ovei the countei stool softenei such as Colace while taking
the pain meuication.
You will be sent home fiom the iecoveiy ioom aftei a few houis. You will neeu
someone else to uiive you home.
REBABILITATI0N AFTER NENISCAL REPAIR
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1. Please call with any conceins: Su8-79S-SS27
2. Apply ice to the knee as it will be quite helpful. Aftei two uays, you can
change the uiessing to a smallei one to allow the colu to bettei get to the
knee. Be suie to leave the little pieces of tape (steii-stiips) in place.
S. Aftei two uays it is okay to showei anu get the wounu wet, but uo not soak
the wounu as you woulu in a bath tub oi hot tub.
4. Aftei knee suigeiy theie is a vaiiable amount of pain anu swelling. This will
uissipate aftei seveial uays. Continue to take the pain meuicine you weie
piesciibeu as neeueu. Remembei it is calleu pain contiol, not pain
elimination. If you notice calf pain oi excessive swelling in the lowei leg, call
Bi. Piice's office.
S. It is impoitant to look out of signs of infection following suigeiy. These can
incluue: fevei (tempeiatuie > 1u1.S
u
, chills, nausea, vomiting, uiaiihea,
ieuness aiounu youi incision, oi yellow oi gieen uiainage fiom youi incision.
Shoulu any of these be piesent please contact Bi. Piice's office immeuiately.
6. You will have ciutches anu a biace aftei suigeiy. It is impoitant to use these
as uiiecteu in the iehabilitation piotocol (see below).
7. You will have an office visit scheuuleu appioximately 1u-14 uays aftei youi
suigeiy.
REBABILITATI0N AFTER NENISCAL REPAIR
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!3(#& ,7 Naximum piotection phase (Weeks 1-2)
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1. Contiol pain anu swelling
2. Initiate knee movement
S. Activate quauiiceps muscles
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1. The -"*"/()-& that is put in youi knee at the time of suigeiy lasts six to
eight houis. Begin taking the pain meuication when you stait feeling
sensation ietuin. The knee will be painful foi seveial uays aftei the
aithioscopy.
2. You can fully extenu (stiaighten) the knee. Bowevei, to avoiu placing
stiess on the meniscal iepaii uo not benu youi knee beyonu 9u uegiees (a
iight angle).
S. You will go home with ciutches anu a knee biace. You can beai weight as
toleiateu, but use the ciutches to help youi walking. The knee biace
shoulu be lockeu in extension when walking aiounu. You can unlock the
biace to sit oi move the knee when not walking.
a. If you cannot beai weight without pain place some of youi weight on
the ciutches so that theie is no pain with weight beaiing
b. If you aie able to beai full weight without pain you can stait using one
ciutch. Bolu the ciutch in the opposite hanu to the opeiative knee.
c. If you continue to have no pain, you can uiscontinue using the ciutch
anu just weai the biace lockeu in extension foi weight beaiing.
4. Remove the outei E(-1(F& when you get home anu apply colu uiiectly to
the knee. Change the banuages whenevei neeueu.
S. Apply /"41 to ieuuce pain anu swelling. 0se ice on the knee 2u minutes
on anu 2u minutesoff foi the fiist uay when awake. Then apply colu as
often as neeueu foi 1S to 2u minutes at a time foi the next seveial uays.
Place a towel oi cloth between the skin anu the ice to pievent skin injuiy.
6. You may #3"5&' anu get youi incision wet aftei two uays. Bo not soak the
incision in a bathtub oi }acuzzi foi at least two weeks aftei suigeiy. If
theie is any uiainage fiom the wounu, uo not get the wounu wet.
7. Take an (#%)')- each moining foi the fiist two weeks.
8. Weai an &4(#$)/ #$"/G)-F (TEB) below the knee, anu uo at least 1u ankle
motion exeicises each houi to contiol swelling anu to help pievent bloou
clots in the veins.
9. You shoulu have an appointment to see physical theiapy by S uays. You
will see Bi. Piice in 1u-14 uays.
REBABILITATI0N AFTER NENISCAL REPAIR
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Piogiam: 7 uays pei week, S-4 times pei uay.
Quauiiceps setting 1-2 sets 1S-2u ieps
Beel piop S minutes
Beels sliues with towel assist S-1S minutes
Sitting heel sliues 1-2 sets 1S-2u ieps
Ankle pumps 1u pei houi
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Lie oi sit with knee fully stiaight. Tighten anu holu the
fiont thigh muscle making the knee flat anu stiaight
(this shoulu make youi knee flatten against the beu oi
flooi). Bolu S seconus foi each contiaction.
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Lie on youi back with a iolleu up towel unuei youi heel, oi sit in a
chaii with the heel on a stool. Let the knee ielax into extension
(stiaight). If the knee will not stiaighten fully, you can place a
small weight (2-S lbs) on the thigh just above the knee cap. Tiy to
holu foi S minutes. Tiy to piactice quauiiceps setting in this
position.
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While sitting oi lying on youi back, actively sliue youi heel
backwaiu to benu the knee. Bolu this bent position foi five
seconus then slowly ielieve the stietch anu stiaighten the
knee. While the knee is stiaight, you may iepeat the
quauiiceps setting exeicise. You can assist by using a towel to
pull youi heel back.
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While sitting in a chaii oi ovei the euge of the beu, suppoit the
opeiateu leg with the uninvolveu leg. Lowei the opeiateu leg,
with the unopeiateu leg contiolling, allowing the knee to
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seconus anu slowly ielieve the stietch by lifting the foot
upwaiu with the uninvolveu leg to the stiaight position.
REBABILITATI0N AFTER NENISCAL REPAIR
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This stage will begin once you begin woiking with youi theiapist. In auuition to
uemonstiating these exeicises, youi theiapist will give you a home exeicise
piogiam. It will be impoitant to peifoim these exeicises uaily in oiuei to ensuie
maximum iesults aftei youi suigeiy. Remembei to auheie to youi piecautions in
oiuei to maximize youi iesults.
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1. Piotect the knee fiom oveistiess anu allow healing
2. Regain knee motion, but limit flexion to 9u uegiees
S. Begin muscle stiengthening
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1. Range of motion: You can fully extenu (stiaighten) the knee. Bowevei, to
avoiu placing stiess on the meniscal iepaii uo not benu youi knee beyonu 9u
uegiees (a iight angle).
2. Biace anu Ciutches: You can continue to beai weight as toleiateu, but use
the ciutches to help youi walking. The knee biace shoulu be lockeu in
extension when walking aiounu. You can unlock the biace to sit oi move the
knee when not walking.
a. If you cannot beai weight without pain place some of youi weight on
the ciutches so that theie is no pain with weight beaiing
b. If you aie able to beai full weight without pain you can stait using one
ciutch. Bolu the ciutch in the opposite hanu to the opeiative knee.
c. If you continue to have no pain, you can uiscontinue using the ciutch
anu just weai the biace lockeu in extension foi weight beaiing.
S. 0se ice as neeueu foi any swelling oi pain.
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Stiengthening exeicises
- Nulti-angle quau isometiics
- SLR (all 4 planes)
- Knee extension 9u-u uegiees
- CKC mini-squats u-4S uegiees
- CKC wall squats
- CKC weight shifts (uiagonal)
- Balance tiaining (cup walking)
- Bicycle (once R0N appiopiiate
*Avoiu twisting, ueep squatting anu stooping
*Avoiu hamstiing cuils
Piogiessively inciease R0N to 9u uegiees, Continue stietching.
REBABILITATI0N AFTER NENISCAL REPAIR
!3(#& ,,,: 6-12 weeks aftei suigeiy
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1. Piogiess weight beaiing
2. Regain full motion
S. Regain full muscle stiength
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1. You can beai weight anu walk on the leg as you aie able. Tiy to avoiu limping
anu walk with a heel - toe pattein. Avoiu squatting oi pivoting on the
opeiateu knee.
2. You can begin to giauually inciease the iange of motion of the knee past 9u
uegiees. You may uiscontinue use of the biace.
S. Continue to ice the knee to ieuuce pain anu swelling. Ice the knee thiee times
a uay foi 1S to 2u minutes. Always place a towel oi cloth between the skin
anu the ice to pievent skin injuiy.
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Continue R0N anu stietching to maintain u-1SS uegiees

Piogiess stiengthening exeicises

o Leg piess 7u-u uegiees
o Knee extension 9u-4u uegiees
o Bip AbuuctionAuuuction
o Wall squats u-7u uegiees
o veitical squats u-6u uegiees
o Lateial step-ups
o Fiont anu lateial lunges
o Bamstiing cuils

Balancepiopiioception tiaining

Biouex stability

Squats iockei boaiu

Cup walking (step oveis)

Stanuing on foam single leg

Bicycle (if R0N peimits)

Pool piogiam (may begin iunning in pool)

REBABILITATI0N AFTER NENISCAL REPAIR
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1. Regain muscle stiength
2. Woik on caiuiovasculai conuitioning
S. Initiate spoits-specific tiaining
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1. Full non-painful R0N
2. No pain oi tenueiness
S. Satisfactoiy clinical exam
4. Satisfactoiy isokinetic test
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Continue anu piogiess all stiengthening exeicises anu stietching uiills

Beep squatting peimitteu at 4 months (nothing past 9u

u
)

Initiate stiaight line iunning: 4 months

Initiate pivoting anu cutting: S months

Initiate agility tiaining: S months

uiauually ietuin to spoits: 6 months

REBABILITATI0N AFTER NENISCAL REPAIR