From the Guidelines
Rehabilitation of a lateral meniscus tear should start with non-surgical measures, including physical therapy and weight loss, rather than immediate surgical intervention.
Evidence-Based Plan
- Non-surgical treatment: The majority of patients with knee osteoarthritis and meniscus tears are unlikely to benefit from surgical treatment of the meniscus tear, and should instead start with non-surgical measures such as physical therapy and weight loss 1.
- Weight loss: Sustained weight loss has been shown to benefit pain and function in overweight and obese patients with knee osteoarthritis, and is a recommended approach for these patients 1.
- Physical therapy: Physical therapy is a recommended treatment for patients with knee osteoarthritis and meniscus tears, and can help improve pain and function 1.
- Medications: Oral nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can be used to manage pain and inflammation, but should be used with caution due to potential side effects 1.
- Intra-articular injections: Intra-articular corticosteroid injections can provide short-term relief of pain and inflammation, but the evidence for hyaluronic acid and platelet-rich plasma injections is less clear 1.
- Surgical intervention: Arthroscopic partial meniscectomy may be considered for patients with mild-to-moderate knee osteoarthritis and meniscus tears who have not responded to non-surgical treatment, but should not be used as a first-line treatment 1.
Important Considerations
- Patient selection: The decision to proceed with surgical intervention should be based on individual patient factors, including the severity of symptoms, the presence of mechanical symptoms, and the patient's response to non-surgical treatment 1.
- Limited evidence: The evidence base for many orthopaedic procedures, including arthroscopic partial meniscectomy, is limited and of low quality, highlighting the need for further research in this area 1.
From the Research
Rehabilitation Plan for Lateral Meniscus Tear
The rehabilitation plan for a lateral meniscus tear should be evidence-based and consider the individual's needs, type of surgical procedure, and presence of coexisting knee pathology.
- The goal of rehabilitation is to restore patient function, considering factors such as the type of meniscal tear, patient's age, preoperative knee status, and athletic expectations 2.
- Progressive weight bearing and joint stress are necessary to enhance the functionality of the meniscal repair, but excessive shear forces may be disruptive 2.
- Prolonged knee immobilization after surgery can result in muscular atrophy and delays in functional recovery, therefore accelerated joint mobility and weight-bearing components of rehabilitation protocols are recommended 2.
Rehabilitation Techniques
Several rehabilitation techniques have been shown to be effective in improving outcomes after meniscus repair, including:
- Neuromuscular electrical stimulation to improve quadriceps strength 3.
- Open versus closed kinetic chain exercises, which are similarly effective for quadriceps strength and self-reported function 3.
- Structured home-based versus structured in-person rehabilitation, which are similarly effective for quadriceps and hamstring strength and self-reported function 3.
- Aquatic therapy environment, which provides controlled weight bearing and mobility progressions 2.
Postoperative Care
Postoperative care is crucial to ensure proper healing of the meniscus repair.
- It is recommended to abstain from weight-bearing and deep knee flexion for the first 6 weeks after surgery 4.
- The use of postoperative knee bracing has been shown to be ineffective for physical function and laxity 3.
- Cryotherapy may be used to reduce pain and analgesic use, and psychological interventions may be used to improve anxiety/fear 3.