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1st Jul

2013

Risk Factors for Meniscal Tears and Physical Therapy Rehabilitation

Meniscal tears in the knee are common in sports, and in the general population as we age. In acute injuries, such tears often occur with twisting motions while the knee is semi-bent, and the foot is planted. Wear and tear, or degenerative meniscal tears which tend to occur as we get older, may develop with minor forces and seemingly normal daily activities.

Large studies have looked at risk factors which correlate with meniscal tears. Such risk factors for degenerative tears include being older than 60 years of age, being a male, having engaged in work related kneeling and squatting, and climbing stairs regularly. Prolonged walking and standing, carrying heavy weights, and being overweight are additional risk factors for such meniscal tears.

Acute meniscal tears have been found especially in soccer and rugby players, and presumably in similar sports, typically from weightbearing trauma, but even swimming has been found to be associated with such injuries, but not running. People who have had ACL tears and have gone at least 12 months without having had reconstructive surgery also are more likely to develop medial meniscal tears (inside of the knee) but not lateral meniscal tears (outside of the knee).

After meniscal injury, certain treatment guidelines can be suggested: Initially it is important to rest and apply ice off and on, to avoid squatting and kneeling, and any activities that including twisting and pivoting as well as stair climbing, and even swimming using the frog or whip kick.

Inappropriate exercises would include using equipment that requires deep knee bends against resistance such as leg presses, stair stepper, rowing machine and even stationary bicycle. Better tolerated activities and exercises would include walking, swimming using a limited crawl kick, water aerobics and cross-country ski glide-type machine, as long as these exercises do not cause increased pain or swelling.

With degenerative tears, it is common to also have some degree of osteoarthritis in the knee which may be the primary cause of pain rather than the meniscal tear. For these people, low tension stationary bicycle exercise can be one of the most effective forms of rehabilitation, to lubricate the knee joint. Other effective exercises for these people may include high repetition, low to moderate resistance knee movements without weightbearing (e.g. sitting) or with partial weightbearing, and at all times avoiding increase in pain or swelling during or after the exercise.

It is generally agreed upon by the medical community that conservative treatment options should typically be exhausted before considering surgery. An effective rehabilitation program should also attempt to restore normal flexibility, coordination, and muscular endurance and strength, in order to improve mechanics of the knee and build support around it.

However, other times surgery will be required, in particular after severe twisting injuries which cause complex meniscal tears, persistent knee swelling, severe pain and difficulty putting weight on the leg, markedly limited knee mobility, and an additional ACL tear exists, and if there is little progress after three weeks of good conservative care.

Typically people do very well after arthroscopic surgery for meniscal tears that are not degenerative, whereas after meniscectomy for degenerative tears, studies have shown good results in only a relatively small percentage of people at six years follow-up after the surgery.

Factors which would suggest that conservative therapy will be successful include symptoms that develop over 24-48 hours after the acute injury versus immediately after, weightbearing can be tolerated, there is only mild swelling, and there is near full knee range of motion and pain only at end of knee bending.

Best wishes for an enjoyable summer and good health,

Gunnar

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