Meniscal Lesions: Difference between revisions

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An examination of the knee and possible arthroscopy provides a clear classification of meniscus injuries. The size and severity of the meniscus rupture are often indicative for the recovery after surgery&nbsp; and for eventual later degenerative phenomena in the knee joint.<br>Different kinds of meniscus ruptures:<br>- Radial rupture<br>- Oblique rupture<br>- Longitudinal rupture<br>- Bucket handle<br>- Horizontal rupture<br>- Complex rupture  
An examination of the knee and possible arthroscopy provides a clear classification of meniscus injuries. The size and severity of the meniscus rupture are often indicative for the recovery after surgery&nbsp; and for eventual later degenerative phenomena in the knee joint.<br>Different kinds of meniscus ruptures:<br>- Radial rupture<br>- Oblique rupture<br>- Longitudinal rupture<br>- Bucket handle<br>- Horizontal rupture<br>- Complex rupture  


Arthroscopy is a small surgery. They look through a thin tube into the knee joint. The procedure can be performed to obtain information of the knee joint. In many cases, there can during the arthroscopy immediate a treatment be given. It’s possible that a larger operation is necessary<ref name="3">CHIRURG EN OPERATIE, http://www.chirurgenoperatie.nl/pagina/traumatologie/arthroscopie_knie.php, geraadpleegd op 24 november 2011 ( level of evidence: 2)</ref>. You can find more information about arthroscopy at the page [[Arthroscopic_Meniscectomy|Arthroscopic Meniscectomy]]<span style="font-size: 11px;">.</span>
Arthroscopy is a small surgery. They look through a thin tube into the knee joint. The procedure can be performed to obtain information of the knee joint. In many cases, there can during the arthroscopy immediate a treatment be given. It’s possible that a larger operation is necessary<ref name="3">CHIRURG EN OPERATIE, http://www.chirurgenoperatie.nl/pagina/traumatologie/arthroscopie_knie.php, geraadpleegd op 24 november 2011 ( level of evidence: 2)</ref>. You can find more information about arthroscopy at the page [[Arthroscopic Meniscectomy|Arthroscopic Meniscectomy]]<span style="font-size: 11px;">.</span>  


Certain meniscal tears like the bucket –handle rupture require operative treatment to prevent worsening of the rupture, to minimize additional damage to the torn portion of the meniscus and to optimize healing. <br>There are different kinds of operative treatment for meniscal tears as repair and partial resection.<br>If a rupture can’t be treated and it involves a large portion of the meniscus, or when repair failed, a significant portion of the meniscus must sometimes be removed. To avoid secondary osteoarthritis, meniscal transplantation may be the best solution. <br>  
Certain meniscal tears like the bucket –handle rupture require operative treatment to prevent worsening of the rupture, to minimize additional damage to the torn portion of the meniscus and to optimize healing. <br>There are different kinds of operative treatment for meniscal tears as repair and partial resection.<br>If a rupture can’t be treated and it involves a large portion of the meniscus, or when repair failed, a significant portion of the meniscus must sometimes be removed. To avoid secondary osteoarthritis, meniscal transplantation may be the best solution. <br>  
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== Physical Therapy Management <br>  ==
== Physical Therapy Management <br>  ==


The physical therapy consists mainly of [[RICE|RICE]]<sup>&nbsp;</sup>( Rest, Ice, Compression, Elevation) when surgery isn’t necessary. <br>RICE is very important in the first 24 hours after an acute soft tissue injury. Especially when there are damaged blood vessels. It helps to reduce pain and swelling.<ref name="10">THE STRETCHING INSTITUTE, http://www.thestretchinghandbook.com/archives/meniscus-tear.php, geraadpleegd op 20 november 2011 (level of evidence: 2)</ref>&nbsp;
The physical therapy consists mainly of [[RICE|RICE]]<sup>&nbsp;</sup>( Rest, Ice, Compression, Elevation) when surgery isn’t necessary. <br>RICE is very important in the first 24 hours after an acute soft tissue injury. Especially when there are damaged blood vessels. It helps to reduce pain and swelling.<ref name="10">THE STRETCHING INSTITUTE, http://www.thestretchinghandbook.com/archives/meniscus-tear.php, geraadpleegd op 20 november 2011 (level of evidence: 2)</ref>&nbsp;  


Cryotherapy, also known as ice application, is a method in which the body is contacted with a medium with a lower temperature. Applying a cold source would decrease the temperature of the tissues. It causes superficial vasoconstriction and a decrease of the local blood flow.<ref name="1">HOUGLUM P.A., ‘Therapeutic Exercise for Musculoskeletal Injuries’ 2005 (level of evidence: 1)</ref>&nbsp;<br>  
Cryotherapy, also known as ice application, is a method in which the body is contacted with a medium with a lower temperature. Applying a cold source would decrease the temperature of the tissues. It causes superficial vasoconstriction and a decrease of the local blood flow.<ref name="1">HOUGLUM P.A., ‘Therapeutic Exercise for Musculoskeletal Injuries’ 2005 (level of evidence: 1)</ref>&nbsp;<br>  
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== Resources <br>  ==
== Resources <br>  ==


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== Clinical Bottom Line  ==
== Clinical Bottom Line  ==
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[[Category:Condition]] [[Category:Sports_injuries]] [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] [[Category:Knee]]
[[Category:Condition]] [[Category:Sports_injuries]] [[Category:Musculoskeletal/Orthopaedics|Orthopaedics]] [[Category:Knee]][[Category:Knee_Conditions]]

Revision as of 11:23, 26 January 2015

Definition/Description[edit | edit source]

A meniscus rupture is an injury that occurs when pieces of the meniscal cartilage are ruptured and when those pieces were injured by specific movements that rotate the knee with a lot of force, while the foot doesn’t rotate and is firmly planted on the floor. There are partial or total ruptures of a lateral or medial meniscus.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

Clinically Relevant Anatomy[edit | edit source]

The clinical relevant anatomy is already described in Arthroscopic Meniscectomy and meniscus lesions.

Epidemiology /Etiology[edit | edit source]

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Characteristics/Clinical Presentation[edit | edit source]

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Differential Diagnosis[edit | edit source]

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Diagnostic Procedures[edit | edit source]

A meniscus injury is generally caused by a torsional movement between the femur and the tibia under load without contact, or making an abrupt movement like a squat. Anything which allows the femur to slip too much forward or backward in relation to the tibia may cause some of the forces to be transmitted to the meniscus and result in a meniscus rupture.
During clinical trials, it’s important to pay attention to some specific data:
- Swelling, hydrops at the level of the knee
- Muscle atrophy
- Painful palpation zones, especially at the level of the joint space
- Limited mobility
- Positive McMurray – test

When a meniscus rupture is suspected, a magnetic resonance imaging (MRI) is considered as the best medical imaging modality to confirm a meniscus rupture. This is necessary when the clinical trial and the anamnese aren’t specific enough.



Outcome Measures[edit | edit source]

See Outcome Measures Database

Examination[edit | edit source]

add text here related to physical examination and assessment

Medical Management
[edit | edit source]

Nonoperative treatment is rarely recommended for meniscal injuries. Sometimes it’s possible when there is a peripheral tear in the red-red junction. Then is healing possible without surgery because of the adequate vascularisation.
The nonoperative treatment consist of rest, ice, compression, elevation, nonsteroidal anti –inflammatory drugs, stretching and strengthening and various physical therapy modalities.

Operative:

An examination of the knee and possible arthroscopy provides a clear classification of meniscus injuries. The size and severity of the meniscus rupture are often indicative for the recovery after surgery  and for eventual later degenerative phenomena in the knee joint.
Different kinds of meniscus ruptures:
- Radial rupture
- Oblique rupture
- Longitudinal rupture
- Bucket handle
- Horizontal rupture
- Complex rupture

Arthroscopy is a small surgery. They look through a thin tube into the knee joint. The procedure can be performed to obtain information of the knee joint. In many cases, there can during the arthroscopy immediate a treatment be given. It’s possible that a larger operation is necessaryCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. You can find more information about arthroscopy at the page Arthroscopic Meniscectomy.

Certain meniscal tears like the bucket –handle rupture require operative treatment to prevent worsening of the rupture, to minimize additional damage to the torn portion of the meniscus and to optimize healing.
There are different kinds of operative treatment for meniscal tears as repair and partial resection.
If a rupture can’t be treated and it involves a large portion of the meniscus, or when repair failed, a significant portion of the meniscus must sometimes be removed. To avoid secondary osteoarthritis, meniscal transplantation may be the best solution.

Physical Therapy Management
[edit | edit source]

The physical therapy consists mainly of RICE ( Rest, Ice, Compression, Elevation) when surgery isn’t necessary.
RICE is very important in the first 24 hours after an acute soft tissue injury. Especially when there are damaged blood vessels. It helps to reduce pain and swelling.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 

Cryotherapy, also known as ice application, is a method in which the body is contacted with a medium with a lower temperature. Applying a cold source would decrease the temperature of the tissues. It causes superficial vasoconstriction and a decrease of the local blood flow.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 

Strengthening and stretch exercises for quadriceps and hamstrings are also important when surgery isn’t necessary.

The rehabilitation of a meniscus rupture after surgery depends on the size of the operation.
Each operation is different.
Therefore it’s so important that the physiotherapist makes every time a complete rehabilitation program.

1. The method of advancing strength depends on the timing of the rehabilitation program but also on          the patient response, availability of equipment and the rehabilitation clinician’s preference.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title  
     - Strength exercises:

Isometric exercises for strengthening the quadriceps:
             • Quad set: With patient supine, uninvolved knee flexed and involved knee straight. The patient tries to push the 

               knee down on the table

             • Straight-leg raise


Isometric exercises for strengthening the hamstrings:
             • Hamstrings sets: The patient supine, uninvolved knee straight and involved knee in partial flexion. The patient

               tries to push the heel into the table.


Non-weight-bearing isotonic exercises:
            • Short-arc quad exercise: also called terminal knee extensions.
            • Full-arc quad exercise
            • Hamstring curls


Weight-bearing resistive exercises: When the patient is able to carry weight on the injured knee.
            • Reciprocal training:  training on a stationary bike. 
            • Platform leg press, wall squats, plié, lunge, step-up, step-down, lateral step-up,…


2. Balance and agility exercises begin with double-support weight-bearing activities and progress to single-limb static balancing on a stable surface.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title

3. Flexibility exercises and joint mobilization are techniques who improve the range of motion and the flexibility.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title 

   - Flexibility exercises:
These exercises can be active or passive. The techniques who are used, depend on the type of tissue.
Prolonged extension stretch is used to increase knee extension. This exercise can be performed in two positions, prone or long sitting. Prolonged flexion stretch is an exercise for increasing flexion in the knee. The position used for this exercise depends on how the flexion movement is present.
Active stretches for quadriceps and hamstrings are also important.


   - Joint mobilization:
Reduced joint mobility could be the result of injury, edema, surgery and immobilization. If this develops it can refer pain to the knee and even effect ankle mobility.
Joint mobilization is important for following joints:
          • Superior Tibiofibular joint
          • Patellofemoral joint. Patellar mobility is necessary for full flexion- extension motion for the knee.
          • Tibiofemoral joint. It’s the most often mobilized joint to improve range of motion in the knee.

Key Research[edit | edit source]

add links and reviews of high quality evidence here (case studies should be added on new pages using the case study template)

Resources
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Clinical Bottom Line[edit | edit source]

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Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]