The Front Row, with Ed!

Welcome to the Front Row: an ongoing series of blogs and videos designed to educate and empower you to take control of your health and life. Today’s topic: What’s my meniscus and I think I tore it

The weather’s finally coming around and you’re out playing softball. You hit a sharp single, but you think you can stretch it out to a double (because you were fast in high school, 25 years ago).  Anyway you round first with visions of grandeur, but your knee twists awkwardly and you feel a pop followed by a deep burning sensation in your knee.  Your first thought is “can I still get to second, may have to slide, but that’s OK, more dramatic and makes for a better story during wings and beers after the game”.  However, your knee has other ideas as the pain now makes you stop in your tracks.  The game stops as you are clearly injured (and out, by the way) and you limp off the field.  Your moment of grandeur is on temporary hold.

You start the medical carousal and end up with the diagnosis of a meniscus tear. To simplify the function of the meniscus, they serve as the shock absorbing structures between the femur and the tibia (you should know what bones I’m talking about and if you don’t, you should be embarrassed) and are also essential in the overall joint stability and lubrication.  Bottom line: you want as much of your meniscus as you can keep.  In the past, the torn part was cut out and back to life you went.  However, better surgery techniques and improved sutures have made repairs much more feasible and desirable to prevent early degenerative changes of the knee.    Below I have outlined a sample protocol after a meniscal repair to help you understand the phases of rehab and to give you a timetable of return to functional activities. Please remember, if you do have surgery, your physician should give you very detailed instructions and timelines based on your particular tear and magnitude.

Phase 1: post op weeks 1-4

1.       Early protection phase, limited ROM from 0-90 degrees as to not stress the meniscus repair

2.       Control inflammation, swelling, and mobilize the patella to minimize tracking issues.

3.       Ambulation with crutches and the knee in a brace locked in full extension. You can slowly wean yourself from the crutches to full weight bearing.

4.       Exercises include but are not limited to straight leg raises, heel slides, isometric quad and hamstring sets and upper extremity cardiovascular exercises.

5.       Exercises are usually performed 2-3 times per day.

6.       Early single leg balance activities with the brace locked in full extension.

Phase 2: Post op weeks 5-9

1.       Working towards resuming normal “activities of daily living” by normalizing gait pattern, regaining full ROM, increasing strength and stability, and increased endurance.

2.       Exercises include but are not limited to partial squats to 60 degrees if pain free, strength training on a stationary bike and continued higher level balance activities.

Phase 3: post op weeks 10-16

1.       Should have full ROM without pain, start interval jogging program without pain or compensation

2.       Start entry level sports specific exercises to go along with higher level strength, balance, and coordination exercises.

Phase 4: post op 16 weeks and beyond

1.       Should be able to start cutting and pivoting on grass surfaces if strength of involved leg is at 90% or greater of the uninvolved leg.

2.       Higher level sports specific agility exercises in a controlled environment

3.       Phase back in to sports if all goals have been met in respect to strength, balance, and ROM.

Advances in surgical techniques have made return from meniscal repair very successful if precautions are taken early in the rehab process to protect the repair and minimize stress on the meniscus.  As always, your comments and any questions are always welcome:   and please keep the sharp single a single!