Torn meniscus. Knee Ostero arthritis (OA) How physiotherapy can help and what to expect.
Written by Bianca Matheson Sports Physiotherapist at Back in Action Physiotherapy Whistler. BC
“Oh no I’ve torn my meniscus or knee cartilage! What should I do?”
Knee injuries are common! No shortage of those in our ski resort town.
As sports physiotherapists we often see these injuries first. Sometimes a torn meniscus can be treated successfully just with physiotherapy and rehab and you can avoid surgery (1). Sometimes though surgery is required but regardless the knee needs to be calmed down, range of motion restored and strength optimized prior to getting surgery.
AT Back in Action Physiotherapy Whistler, we like to read as much research as we can to help our patients. A large study in the US stands out. It was a multi center randomized controlled trial of 351 patients with meniscus tear and knee osteoarthritis (OA) followed up over 12 months found generally patients who received physiotherapy alone or physiotherapy after their meniscal surgery experience notable improvements in knee function and pain levels over 6 and 12 month follow up. Some patients did well with just physiotherapy and thus kept their meniscus cartilage (even though it is torn) doing its shock absorption job. Some patients required the surgery as the meniscus may have had a tear which was too large or unstable but still did better once physiotherapy was introduced.
An article in the National Institute of Arthritis and Musculoskeletal and Skin Diseased website quoted the articles authors as below:
“These results should help guide clinicians and patients when deciding how to manage meniscal tears and knee OA,” said lead investigator and author Jeffrey N. Katz, M.D., of Brigham and Women’s Hospital and Harvard Medical School. “It is reassuring to know that physical therapy for managing the condition is a valid choice for people who may want to avoid surgery. But, physical therapy will not help all patients, and for those who do not improve with it, surgery remains an effective option.”
What is a torn meniscus and how does it affect the knee joint?
The picture below is from the American academy of orthopedic surgeons and shows the types of tears.
The knee has 2 menisci (plural : meniscus), a medial meniscus and a lateral meniscus. These are semicircular shaped pieces of fibrocartilage wedged between the tibial plateau and the femoral joint surfaces. The function of the menisci is to absorb the shock forces through the knee and cushion the knee joint surfaces from impact.
A torn meniscus is a common injury and often occurs in sports with too much twisting force on the knee. Sports such as skiing, snowboarding, soccer and jumping/running sports see a lot of these injuries. As people age also the menisci can degenerate and lead to easier tearing. More than 40% of people over 65 will have tears in their menisci.
A torn meniscus produces symptoms including pain, swelling, popping or locking, clicking, giving way and difficulty bending or straightening. The range of symptoms is variable with some being minor and others quite debilitating.
The outer portion of the meniscus has some blood supply and may heal if the tear is small but the inner 2/3 of the meniscus does not have good blood supply and tears in this region will not heal on their own.
What should I do? How do I treat a torn meniscus?
If you visit your doctor, he or she might not order diagnostic tests immediately. MRI’s take time to get and given our research and clinical experience noted above, many of these injuries will resolve with several weeks of Physical Therapy. Even some of the larger tears that cannot heal on their own can can settle down with Physiotherapy. The tear although not healed, stays in place and the person experiences little or no problems. Our clinical experience as Physiotherapists in these cases show good outcomes without surgery. The person then keeps the shock absorbing cartilage instead of losing it.
If after some time of doing physiotherapy symptoms persist and the knee does not settle down the person will visit their doctor and a referral for an MRI and an Orthopedic consultation likely will take place. The surgeon can perform a partial menisectomy where they remove the torn part of the meniscus or sometimes they do a repair where they place stitches in the torn area and try to stabilize it.
Ideally it is beneficial to start Physio 3-5 days after surgery to reduce inflammation, pain and start the process of muscle activation and restoration of joint range
Physiotherapy rehabilitation in the first 1-2 weeks following the menisectomy or meniscal repair consists of targeted swelling and inflammation reduction, range of motion and strengthening.
After this time the physiotherapist and the surgeon collaborate to ensure the person’s rehabilitation is tailored to their life demands. The physio uses manual therapy, modalities and exercises to ensure muscle length and tension is restored to normal levels and the joint mobility is restored. Functional conditioning, proprioception and balance functions are restored with targeted rehabilitation.
The Physical Therapist helps the patient to understand the treatment phases as well as accompanying symptoms. In addition, the Physical Therapist develops and adjusts the patient’s exercise program from the most basic to highly complex and demanding.
1.Katz J et al.N Engl J Med. 2013 May2;368(18):1675-84, doi 10.1056/NEJMoa1301408. Epub 2013 Mar 18.
Surgery versus physical therapy for a meniscal tear and osteoarthritis
ABOUT OUR TEAM
Back in ACTION PHYSIO WHISTLER, ‘we keep you playing’ a whistler based Physio practice consisting of post-graduate trained specialist Sports and Spinal Manipulative Physiotherapists: Mike Conway, Therese leigh, Bianca Matheson and Aerin DeLiva. Presently these 4 physiotherapists are the sea to sky corridor’s only titled Diploma/ Masters Sports Physiotherapists holders and have extensive experience in sports injuries from elite to recreational. Our aim is to strive for continual excellence and improvement in the field of injury assessment and rehabilitation.
Please note: the above article is for guidelines only and is not intended to replace the therapist/patient relationship. Back in Action Physiotherapy also advises that rapid advancements and research into sports injuries mean articles may be outdated and a consultation is recommended for up to date information on injuries and conditions.