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Rehabilitation following meniscal repair

  • John T. CavanaughEmail author
  • Sarah E. Killian
Knee Rehabilitation (J Cavanaugh, Section Editor)

Abstract

It has become increasingly more evident that the meniscus plays an important role in contributing to knee joint longevity. Advances in surgical techniques by orthopaedic surgeons to repair traumatized menisci have led to better long term outcomes, decreasing the incidence of articular cartilage degeneration. Advances have also been made in rehabilitative techniques following meniscal repair. These techniques along with sound rehabilitation principles to include a criteria based progression have contributed to excellent outcomes and earlier return to function and sport. The role of the meniscus, recent advances in surgical repair and the current post-operative rehabilitation techniques employed by sports rehabilitation specialists today are discussed.

Keywords

Knee Meniscus Surgery Rehabilitation 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Howell GED. Clinical presentation of the knee. In: Bulstrode CJK, Buckwalter J, Carr A, Marsh L, Fairbank J, Wilson-MacDonald J, Bouden G, editors. Oxford textbook of orthopedics and trauma, vol. 2. New York: Oxford University Press; 2002. p. 1108–13.Google Scholar
  2. 2.
    Hede A, Jensen DB, Blyme P, et al. Epidemiology of meniscal lesions in the knee: 1.215 open operations in Copenhagen 1982-84. Acta Orthop Scand 5:435437, 1990Google Scholar
  3. 3.
    Allen PR, Denham RA, Swan AV. Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br. 1984;66(5):666–71.PubMedGoogle Scholar
  4. 4.
    Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30B(4):664–70.PubMedGoogle Scholar
  5. 5.
    Jorgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A. Long-term Follow-up of Meniscectomy in Athletes. A Prospective Longitudinal Study. J Bone Joint Surg Br. 1987;69B(1):80––83.Google Scholar
  6. 6.
    Cox JS, Nye CE, Schaefer WW, et al. The degenerative effects of partial and total resection of the medial meniscus in dogs’ knees. Clin Orthop. 1975;109:178–83.PubMedCrossRefGoogle Scholar
  7. 7.
    Macnicol MF, Thomas NP. The knee after meniscectomy. J Bone Joint Surg Br. 2000;82:157–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Rockborn P, Messner K. Long-term results of meniscus repair and meniscectomy: a 13-year functional and radiographic follow-up study [comments]. Knee Surg Sports Traumatol Arthrosc. 2000;8:2–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Packer JD, Rodeo SA. Meniscal allograft transplantation. Clin Sports Med. 2009;28(2):259–83.PubMedCrossRefGoogle Scholar
  10. 10.
    Seedhom BB, Gardreanes DJ. Transmission of load in the knee joint with special reference to the role of the menisci, part II. Experimental results, discussions, and conclusions. Eng Med Biol. 1979;B:220-8.Google Scholar
  11. 11.
    Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clinical Orthopedics. 1980;149:283–90.Google Scholar
  12. 12.
    Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. Journal of Bone and Joint Surgery Am. 1982;64A(6):883–8.Google Scholar
  13. 13.
    Wirth CJ, Peters G. Meniscus injuries of the knee joint: pathophysiology and treatment principles, in Baillière’s Clinical Orthopedics: Baillière Tindall. London,1997, pp123-44.Google Scholar
  14. 14.
    Warren RF, Arnoczky SP, Wickiewicz TL. Anatomy of the Knee. In: Nicholas JA, Hershman EB, editors. The lower extremity and spine in sports medicine. St. Louis: CV Mosby; 1986. p. 657–94.Google Scholar
  15. 15.
    Rath E, Richmond JC. The menisci: basic science and advances in treatment. Br J Sports Med. 2000;34:252–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Ghosh P, Taylor TK. The knee joint meniscus. A fibrocartilage of some distinction. Clin Orthop Relat Res 1987;(224):52–63.Google Scholar
  17. 17.
    Fithian DC, Kelly MA. Material properties and structure-function relationships in the menisci. Clin Orthop. 1990;252:19–31.PubMedGoogle Scholar
  18. 18.
    Cole BJ, Carter TR, Rodeo SA. Allograft meniscal transplantation: backround, technique and results. J Bone Joint Surg. 2002;84(7):1236–50.Google Scholar
  19. 19.
    Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10(2):90–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Day B, Mackenzie WG, Shim SS, Leung G. The vascular and nerve supply of the human meniscus. Arthroscopy. 1985;1(1):58–62.PubMedCrossRefGoogle Scholar
  21. 21.
    O’Connor BL, McConnaughey JS. The structure and innervation of cat knee menisci, and their relation to a “sensory hyposthesis” of meniscal function. Am J Anat. 1978;153:431–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Assimakpoulos AP, Katonis PG, Agapitos MV, Exarchou El. The innervation of the human meniscus. Clin Orthop. 1992;75:232–6. 8. Barber FA, Click S.Google Scholar
  23. 23.
    Gronblad M, Korkala O, Liesi P, Karaharju E. Innervation of synovial membrane and meniscus. Acta Orthop Scand. 1985;56:484–6.PubMedCrossRefGoogle Scholar
  24. 24.
    • Karahan M, Kocaoglu B, et al. Effect of partial medial meniscectomy on the proprioceptive function of the knee. Arch Orthop Trauma Surg. 2010 Mar;130(3):427-31. Epub 2009 Dec 10. This study aimed to assess the proprioception of the partial meniscectomized knee and if there is an effect on the knee proprioception. The results indicated that even a partial absence of menisci causes a deterioration of proprioceptive functions of the knee.PubMedCrossRefGoogle Scholar
  25. 25.
    Jerosch J, Prymka M. Proprioceptive deficits of the knee joint after rupture of the medial meniscus]. Unfallchirurg. 1997;100(6):444–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Fu FH, Thompson WO. Motion of the meniscus during knee flexion. In: Mow VC, Arnoczky SP, Jackson DW, editors. Knee meniscus: basic and clinical foundations. New York: Raven; 1992. p. 75–89.Google Scholar
  27. 27.
    Mow VC, Ratcliffe A, Chern KY, et al. Structure and function relationships of the menisci of the knee. In: Mow VC, Arnoczky SP, Jackson DW, editors. Knee meniscus: basic and clinical foundations. New York: Raven; 1992. p. 37–57.Google Scholar
  28. 28.
    • Bedi A, Kelly NH, Baad M, et al. Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy. J Bone Joint Surg Am. 2010 Jun;92(6):1398-408. This study measured the contact pressures transmitted to the medial tibial plateau under physiological loads as a function of the percentage of the meniscus involved by a radial tear or repair. The authors concluded that large radial tears of the medial meniscus are not functionally equivalent to meniscectomies and that the residual meniscus continues to provide some load transmission and distribution functions across the joint.PubMedCrossRefGoogle Scholar
  29. 29.
    Vedi V, Williams A, Tennant SJ, et al. Meniscal movement: an in-vivo study using dynamic MRI. J Bone Joint Surg Br. 1999;81:37–41.PubMedCrossRefGoogle Scholar
  30. 30.
    Ahmed AM, Burke DL. In-vitro measurement of static pressure distribution in synovial joints–Part I: Tibial surface of the knee. J Biomech Eng. 1983;105(3):216–25.PubMedCrossRefGoogle Scholar
  31. 31.
    Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clinical Orthopedics and Related Research. 1975;109:184–92.CrossRefGoogle Scholar
  32. 32.
    Muller W. The Knee. New York: Springer; 1982.Google Scholar
  33. 33.
    DeHaven KE. The role of the meniscus. In: Ewing JW, editor. Articular cartilage and knee joint function: basic science and arthroscopy. New York: Raven Press, Ltd.; 1990. p. 103–15.Google Scholar
  34. 34.
    Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisci. Clin Orthop Relat Res. 1990;252:19–31.PubMedGoogle Scholar
  35. 35.
    Radin EL. Factors influencing the progression of osteoarthrosis. In: Ewing JW, editor. Articular cartilage and knee joint function. New York: Raven; 1990. p. 301–9.Google Scholar
  36. 36.
    Arnoczky SP, Adams ME, DeHaven KE, et al. Meniscus. P. 427. In Woo SL-Y, BuckwalterJA (eds): Injury and Repair of the Musculoskeletal Soft Tissues. American Academy of Orthopaedic Surgeons, Park Ridge, IL., 1988.Google Scholar
  37. 37.
    Warren RF, Marshall J. Injuries of the anterior cruciate ligament and medial collateral ligament of the knee. Clin Orthop. 1978;136:191.PubMedGoogle Scholar
  38. 38.
    Hough AL, Webber RJ. Pathology of the meniscs. Clin Orthop. 1990;252:32–40.PubMedGoogle Scholar
  39. 39.
    Mesiha M, Zurakowski D, Soriano J, et al. Pathologic characteristics of the torn human meniscus. Am J Sports Med. 2007;35:103–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Swenson YM, Harner CD. Knee ligament and meniscal injuries. Orthop Clin North Am. 1995;26(3):529–46.PubMedGoogle Scholar
  41. 41.
    DeHaven KE. Injuries to the menisci of the knee. p.905.In Nicholas JA, Hershmann EB (eds): The Lower Extremity and Spine in Sports Medicine. CV Mosby, St.Louis 1986Google Scholar
  42. 42.
    Sgaglione NA, Steadman JR, Shaffer B, et al. Current concepts in meniscus surgery: resection to replacement. Arthroscopy. 2003;19 suppl 1:161–88.PubMedGoogle Scholar
  43. 43.
    Annandale T. An operation for displaced semilunar cartilage. Br Med J. 1885;1:779.PubMedCrossRefGoogle Scholar
  44. 44.
    Belzer J, Cannon W. Meniscal tears: treatment in the stable and unstable knee. Journal of the American Academy of Orthopedic Surgeons. 1993;1(1):41–7.Google Scholar
  45. 45.
    Gillquist J, Messner K. Long-term results of meniscal repair. Sports Medicine Arthroscopy. 1993;1:159–63.CrossRefGoogle Scholar
  46. 46.
    Cannon WD, Vittori JM. The incidence of healing in an arthroscopic meniscal repairs in ACL-reconstructed knees versus stable knees. Am J Sports Med. 1992;20(2):176–81.PubMedCrossRefGoogle Scholar
  47. 47.
    Sommerlath K, Gilquist J. Knee function after meniscus repair and total meniscectomy: A 7-year follow-up study. Arthroscopy. 1987;3(3):166–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Rubman MH, Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears. Am J Sports Med. 1998;26:87–95.PubMedGoogle Scholar
  49. 49.
    Morgan CD, Wojtys EM, Casscells CD, Casscells SW. Arthroscopic meniscal repair evaluated by second-look arthroscopy. Am J Sports Med. 1991;19:632–7.PubMedCrossRefGoogle Scholar
  50. 50.
    Nicholas SJ, Rodeo SA, Ghelman B, et al. Arthroscopic meniscal repair using the outside-in technique. Read at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting, Anaheim, California, 1991.Google Scholar
  51. 51.
    van Trommel MF, Simonian PT, Potter HG, Wickiewicz TL. Different healing rates with the outside-in technique for meniscal repair. Am J Sports Med. 1998;26:446–52.PubMedGoogle Scholar
  52. 52.
    Rodeo SA. Arthroscopic meniscal repair with use of the outside-in technique. Instr Course Lect. 2000;49:195–206.PubMedGoogle Scholar
  53. 53.
    Arnoczky SP, Warren RF, Spivak JM. Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Joint Surg Am. 1988;70(8):1209–17.PubMedGoogle Scholar
  54. 54.
    Cannon WD. Meniscal healing. In Arthroscopic Meniscal Repair, pp. 7-12. Edited by W. D. Cannon. Rosemont, Illinois, AmericanAcademy of Orthopaedic Surgeons, 1999.Google Scholar
  55. 55.
    Henning CE, Lynch MA, Yearout KM, et al. Arthroscopic meniscal repair using an exogenous fibrin clot. Clin Orthop. 1990;252:64–72.PubMedGoogle Scholar
  56. 56.
    Tenuta JJ, Arciero RA. Arthroscopic evaluation of meniscal repairs: factors that effect healing. Am J Sports Med. 1994;22:797–802.PubMedCrossRefGoogle Scholar
  57. 57.
    Zhang Z, Arnold JA, Williams T, et al. Repair by trephination and suturing of longitudinal injuries in the avascular area of the meniscus in goats. Am J Sports Med. 1995;23(1):35–41.PubMedCrossRefGoogle Scholar
  58. 58.
    Okuda K, Ochi M, Shu N, Uchio Y. Meniscal rasping for repair of meniscal tear in the avascular zone. Arthroscopy. 1999;15(3):281–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Uchio Y, Ochi M, Adachi N, et al. Results of rasping of meniscal tears with and without anterior cruciate ligament injury as evaluated by second-look arthroscopy. Arthroscopy. 2003;19(5):463–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Henning CE. Arthroscopic repair of meniscal tears. Orthopedics. 1983;6:1130–2.Google Scholar
  61. 61.
    Scott GA, Jolly BC, Henning CE. Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing. J Bone and Joint Surgery American. 1986;68(6):847–61.Google Scholar
  62. 62.
    Sgaglione NA, Steadman JR, Shaffer B, et al. Current concepts in meniscus surgery: resection to replacement. Arthroscopy. 2003;19 suppl 1:161–88.PubMedGoogle Scholar
  63. 63.
    Warren RF. Arthroscopic meniscus repair. Arthroscopy. 1985;1:170–2.PubMedCrossRefGoogle Scholar
  64. 64.
    Morgan CD, Casscells SW. Arthroscopic meniscus repair: a safe approach to the posterior horns. Arthroscopy. 1986;2(1):3–12.PubMedCrossRefGoogle Scholar
  65. 65.
    Rodeo SA. Arthroscopic meniscal repair with use of the outside-in technique. Journal Bone & Joint Surgery American. 2000;82(1):127–41.Google Scholar
  66. 66.
    Morgan CD. The “all-inside” meniscus repair. Arthroscopy. 1991;7(1):120–5.PubMedCrossRefGoogle Scholar
  67. 67.
    Cannon Jr WD, Morgan CD. Meniscal repair. Part II: Arthroscopic repair techniques. J Bone Joint Surg Br. 1994;76A:294–311.Google Scholar
  68. 68.
    Albrecht-Olsen P, Kristensen G, Burgaard P, et al. The arrow versus horizontal suture in arthroscopic meniscus repair. A prospective randomized study with arthroscopic evaluation. Knee Surg Sports Traumatol Arthrosc. 1999;7(5):268–73.PubMedCrossRefGoogle Scholar
  69. 69.
    Cavanaugh JT. Rehabilitation following meniscal surgery. In: Engle RP, editor. Knee Ligament Rehabilitation. New York: Churchill Livingston; 1991. p. 59–69.Google Scholar
  70. 70.
    Habata T, Ishimura M, Ohgushi H, et al. Axial alignment of the lower limb in patients with isolated meniscal tear. J Orthop Sci. 1998;3:85–9.PubMedCrossRefGoogle Scholar
  71. 71.
    Zarins B, Boyce J, Harris BA. Knee rehabilation following arthroscopic meniscectomy. Clin Orthop Rel Res. 1985;198:36.Google Scholar
  72. 72.
    Gray G. Successful strategies for closed chain testing and rehabilitation. Chain Research Seminar; May 1989.Google Scholar
  73. 73.
    Kegerreis S. The construction and implementation of a functional progression as a functional progression as a component of athletic rehabilitation. J Orthop Sports Phys Ther 1983; 14.Google Scholar
  74. 74.
    Bates A, Hanson N. The principles and properties of water. In: Aquatic exercise therapy. Philadelphia: WB Saunders, 1996:1–320.Google Scholar
  75. 75.
    Harrison RA, Hilman M, Bulstrode S. Loading of the lower limb when walking partially immersed: implications for clinical practice. Physiotherapy. 1992;78:164.CrossRefGoogle Scholar
  76. 76.
    Cavanaugh JT. Rehabilitation for non operative and operative management of knee injuries. In: Callaghan J, Simonian P, Wickiewicz T, editors. The adult knee. Lipponcott: Wilkens Publishers; 2003. p. 380–430.Google Scholar
  77. 77.
    Barber FA. Accelerated rehabilitation for meniscus repairs. Arthroscopy. 1994;10:206–10.PubMedCrossRefGoogle Scholar
  78. 78.
    Cooper DE, Arnoczky SP, Warren RF. Meniscal repair. Clin Sports Med. 1991;10(3):529–48.PubMedGoogle Scholar
  79. 79.
    DeHaven KE, Lohrer WA, Lovelock JE. Long term results of open meniscal repair. Am J Sports Med. 1995;23:524–30.PubMedCrossRefGoogle Scholar
  80. 80.
    Rispoli DM, Miller MD. Options in meniscal repair. Clin Sports Med. 1999;18:77–91.PubMedCrossRefGoogle Scholar
  81. 81.
    Kocabey Y, Nyland J, Isabell WM, Caborn DN. Patient outcomes following T-Fix meniscal repair and a modifiable, progressive rehabilitation program, a retrospective study. Arch Orthop Trauma Surg. 2004;124:592–6.PubMedCrossRefGoogle Scholar
  82. 82.
    Bryant D, Dill J, Litchfield R, et al. Effectiveness of bioabsorbable arrows compared with inside –out suturing for vertical, repairable meniscal lesions. American Orthopedic Society for Sports Medicine. 2007;35(7):889–96.Google Scholar
  83. 83.
    O’Shea JJ, Shelbourne KD. Repair of locked bucket-handle meniscal tears in knees with chronic anterior cruciate ligament deficiency. AJSM. 2003;31(2):216–20.Google Scholar
  84. 84.
    Noyes FR, Barber-Westin SD. Arthroscopic Repair of meniscus Tears Extending Into the Avascular Zone With or Without Anterior Cruciate Ligament Reconstruction in Patients 40 years of age and Older. Arthroscopy. The Journal of Arthrocopic and Related Surgery. 2000;16(8):822–9.CrossRefGoogle Scholar
  85. 85.
    Richards DP, Barber FA, Herbert MA. Compressive loads in longitudinal lateral meniscus tears: a biomechanical study in porcine knees. Arthroscopy. 2005;21:1452–6.PubMedCrossRefGoogle Scholar
  86. 86.
    Becker R, Wirz D, Wolf C, et al. Measurement of meniscofemoral contact pressure after repair of bucket-handle tears with biodegradable implants. Arch Orthop Trauma Surg. 2005;125:254–60.PubMedCrossRefGoogle Scholar
  87. 87.
    Gao J, Wei X, Messner K. Healing of the anterior attachment of the rabbit meniscus to bone. Clin Orthop Relat Res. 1998;348:246–58.PubMedCrossRefGoogle Scholar
  88. 88.
    Johal P, Williams A, Wragg P, et al. Tibiofemoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using “interventional” MRI. J Biomech. 2005;38:269–76.PubMedCrossRefGoogle Scholar
  89. 89.
    Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clinical Orthopedics and Related Research. 1975;109:184–92.CrossRefGoogle Scholar
  90. 90.
    Thompson WO, Thaete FL, Fu FH, Dye SF. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Am J Sports Med. 1991;19(3):210–5.PubMedCrossRefGoogle Scholar
  91. 91.
    Tienen TG, Buma P, Scholten JGF, et al. Displacement of the medial meniscus within the passive motion characteristics of the human knee joint: An RSA study in human cadaver knees. Knee Surg Sports Traumatol Arthrosc. 2005;13:287–92.PubMedCrossRefGoogle Scholar
  92. 92.
    Johal P, Williams A, Wragg P, et al. Tibiofemoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using “interventional” MRI. J Biomech. 2005;38:269–76.PubMedCrossRefGoogle Scholar
  93. 93.
    Kawai Y, Fukubayashi T, Nishino J. Meniscal suture an experimental study in the dog. Clin Orthop. 1989;243:286–93.PubMedGoogle Scholar
  94. 94.
    Fritz JM, Irrgang JJ, Harner CD. Rehabilitation following allograft meniscal transplantation: a review of the literature and case study. Journal of Orthopedic Sports Physical Therapy. 1996;24(2):98–106.Google Scholar
  95. 95.
    Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br. 1965;47:669–77.PubMedGoogle Scholar
  96. 96.
    Johansson H, Sjolander P, Soojka P. Activity in receptor afferents from the anterior cruciate ligament evokes reflex effects on fusimotor neurones. Neurosci Res. 1990;8:54–9.PubMedCrossRefGoogle Scholar
  97. 97.
    Cavanaugh JT, Gately CT. Meniscal Repair and Transplantation. In Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician Cioppa-Mosca J, Cahill JB, Cavanaugh JT, et al (eds) Elsevier Publishers pp. 453-468, 2006Google Scholar
  98. 98.
    Cavanaugh JT, Stump TJ. Forward step down test. J Orthop Sports Phys Ther. 2000;30(1):A-46.Google Scholar
  99. 99.
    Daniel DM, Malcolm L, Stone ML, et al. Quantification of knee stability and function. Contemp Orthop. 1982;5:83–91.Google Scholar
  100. 100.
    Barber SD, Noyes FR, Mangine RE, et al. Quantitative assessment of functional limitations in normal and anterior cruciate ligament deficient knees. Clin Orthop. 1990;255:204–14.PubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Sports Rehabilitation & Performance CenterHospital for Special SurgeryNew YorkUSA

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