An example of a lateral meniscus tear rehabilitation programs for patients who have had a complete or partial meniscus removed, patients who have had a cartilage meniscus repair and those who have not had surgery but are attempting conservative treatment
1. For Partial or Complete Meniscectomy
(athletes who have had part or all of the cartilage meniscus taken out)
Phase 1 (0-10 days)
- Wear a compressive brace or support to protect and help reduce the swelling.
Rangeof motion exercises as pain will allow (bending and straightening your knee as much as pain will allow).
- Quadriceps strengthening - start with static contractions and then straight leg raises.
- Cycling if
- Use crutches, partial weight bearing but move as quickly as you can to full weight bearing.
Phase 2 (10-21 days)
- Use a compressive brace or support if needed.
Rangeof motion exercises - you should be up to full range of motion by now.
- Continue to build on the straight leg raises perhaps introducing leg weights to make it more difficult.
- Start to perform more advanced strengthening exercises such as squats.
- When the wound has healed you can swim.
- Cycling - try do 20 minutes a day of aerobic exercise whether it is cycling or swimming - it will make you feel better.
Phase 3 (week 3 onwards)
Build on what has been achieved so far. Increase weights, swimming, and cycling.
Do not overdo the rehabilitation and if the athlete is struggling or in a lot of pain then they should stop and seek medical advice.
Do not get downhearted. Stay focused and remember you cannot stay injured forever. Try to do regular aerobic exercise even if it is swimming.
2. For a Meniscal Repair
(athletes who have had a repair of the cartilage)
Phase 1 ( 0-21 days)
- Wear a knee brace allowing
rangeof movement from 30 to 80 degrees. Rangeof motion exercises should be done passively (someone else moves the limb for you) while in the brace.
Exercises can be done in the brace very lightly. You should not go to the maximum effort. Straight leg raises(bent at 30 degrees) - lift, hold for 10 seconds, down, rest for three seconds, repeat 10 times, do 3 to 5 sets.
- Use electrical stimulation to contract muscles.
- Crutches (Non-weight bearing)
Phase 2 (3-6 weeks)
- Increase the range of movement allowed by the brace in flexion and extension (bending and straightening) by 10 degrees each week.
Rangeof motion exercises follows the movement allowed by the brace until at 6 weeks you have 0 degrees (straight) to 120 degrees (bent).
- Exercises - straight leg raises build on what you did before using a weight if possible.
- After 6 weeks you can do leg extensions and leg curls from 90 to 30 degrees.
Crutches - start this phase partial weight bearing and progress to full weight bearing by the 10th week you are full weight bearing.
Phase 3 (7 weeks onwards)
- Continue to build on all exercises. By now you should be able to do a full range of motion exercises and only use a brace if it is needed.
- The athlete should be able to swim and cycle.
A few final points
- Continue to train the quadriceps and hamstring muscles long after a return to sports activity. It is important these muscles are very strong to support the knee.
- Sometimes after complete removal of the meniscus, a new weaker tissue may grow in its' place. This new tissue can tear giving the same symptoms as before.
- People who had complete removal of the meniscus can (after many years) suffer degeneration or wear and tear at the ends of the bones.
3. Conservative Treatment - No Surgery
If surgery is not undertaken, a rehabilitation programme should be used to increase the movement and strength in the knee. In many cases (depending on the location and extent of the tear), a rehab programme can be very effective.
- Use R.I.C.E to reduce bleeding and swelling.
- Rest for a couple of days, or until walking is not painful.
- Start gentle mobility exercises and stretches to regain full knee range of motion.
- Once pain-free, start strengthening exercises for the thigh and calf muscles.
- Proprioception exercises are also recommended to increase balance and the sense of joint positioning. A wobble board is a fantastic product for this.