Meniscus Part II

Meniscus Part II

Surgical Interventions

Historically, meniscectomy was the treatment of choice for surgical repair of a damaged meniscus.  Recent research suggests the meniscus is an integral part of knee function and stability and the removal of part or all of the meniscus is associated with poor outcomes. This resulted in meniscectomy beginning to fall out of favor.  Meniscal repairs have now been determined to have greater results when careful patient selection is performed based upon favorable factors.

 

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A patients age, type and activity requirements are all taken into consideration when determining the surgical procedure.  More importantly, the timing of the injury (surgeries within 8 weeks of injury have better outcomes), the stability of the ACL and the location of the tear (vascular vs nonvascular) are critical in determining the best surgical procedure. 

Indications include but are not limited to:

 -Full thickness tears
  -Longitudinal tears of at least 10 cm in the vascular region
  -Typically, patient is under the age of 50

Rehabilitation Considerations

 -Variable notion and weight bearing restrictions
 -Suture fixation
 -Location of tear
 -Multi ligament instability?
 -Limited to 90 degrees up to 3 weeks post-repair

-Avoid flexion angle greater than 60 degrees (increases stress on meniscus)

  -Focus on early neuromuscular control in multiple angles
  -Avoid pivoting up to 6 months

 

Meniscectomy

Goal of the surgeon is to preserve as much of the functional meniscus as possible with preservation of the entire meniscus being the goal whenever possible.  Indications for a meniscectomy include:

-complicated, radial, degenerative tears
-Tears within the nonvascular areas of the meniscus

Rehabilitation considerations

 -Type, size and location
 -Full versus partial
  -Weight-bearing status
 --Flexion angles greater than 60 degrees
 -Hamstring attachment to medial meniscus (medial meniscus is most often torn secondary to having less mobility)
-Less healing time and quicker return to function