A medial meniscus tear is not unusual in basketball. Tearing the cartilage in the inner knee can result from repeated pressure on the joint from running and jumping. But it can also occur from an awkward twist of the knee or shearing of the two main bones of the knee joint from a sudden stop or improper landing.
Although it is similar to an ACL injury, a meniscus tear can occur at lower loads and forces, especially later in an athlete's career. Some athletes return to play very quickly, while others miss entire seasons with this injury.
Not all tears are repairable. It depends on the location, type and the size of the tear, as well as the age of the person injured. In some cases, the meniscus must be cut out instead of repaired. The meniscus is not highly vascularized (meaning it does not have good blood flow) in about two-thirds of its surface area, which means it won't heal if left alone. The amount of blood flow and viability of the meniscus worsens with wear and tear and the age of the joint.
Recovery typically takes about a month—two weeks of immobilization and two weeks of limited motion. Recent studies have shown that early weight-bearing and full range of motion do not put people at risk for re-tearing. This is important, because these activities can lower complications.
Other methods to speed the healing process include injecting an exogenous fibrin clot, platelet-rich plasma injections or even drilling into the bone to increase blood flow. The effectiveness of these methods varies depending on the person and the injury.
A meniscus tear feels different from an ACL rupture, patellar tendon rupture, muscle strain or joint dislocation. These are larger structures requiring more force to tear. Many times they are felt as a pop, stretch or tear with immediate burning and sharp pain. The meniscus is not as well innervated (meaning it doesn't have lots of nerve endings connected to it), it does not have as much local blood flow as these other structures, and it is not involved in joint stability, so the pain after an injury can be more subtle.
Pain related to the meniscus is generally more diffuse, meaning it is harder to pinpoint the location of the problem. An MRI is required for an accurate diagnosis. It's usually described as an ache, either to the front, or on either side or at a spot on the back of the knee that the injured athlete cannot necessarily touch. It is often associated with swelling, a loss of range of motion and pain while walking or running and at the extremes of range of motion. Many times the knee will "lock," "click," or pop with movement.
Everything regarding recovery from a meniscus repair is gradual.
Gradual return to full range of motion
Even under an accelerated protocol, recovering range of motion takes a few weeks due to the localized joint effusion, inflammation and pain.
What it takes: From you, effort. There is a fine line between "no pain, no gain" and restoring range of motion. You could overdo it and cause inflammation and swelling that will limit your progress. But, babying the joint and just stopping "because it hurts" could leave you with scar tissue improperly laid down and a knee that never works properly again.
From the therapist: You want skilled hands that can mobilize the knee cap, the soft tissue, the scar and the knee joint capsule to restore full mobility.
Gradual return to full weight bearing
Most protocols call for minimal to no weight bearing after the surgery, but more and more allow "weight bearing as tolerated," which simply means progressively putting more weight on the leg in a brace locked straight until you can walk on it without crutches. Again, this occurs in a step-wise fashion over the course of weeks, not days.
From the therapist: The expertise to know what is working and what is not—and how to make the program work for each individual.
Simple exercises may include:
- Wall Slides: Lying on your back and sliding your foot down the wall.
- Heel Slides: Lying on your back and using a towel to slide your heel and bend your knee into flexion.
- Supine Hangs: To fully straighten the knee requires gravity's help. The simplest way to do this is by lying on your back and propping your heel on a towel roll. Gravity will stretch your knee all the way straight.
What it takes: Time, patience, and some level of pain tolerance. After a meniscus repair, you will be on crutches and in a brace. Gradually you will progress from just putting your foot on the ground to fully bearing weight and walking normally.
Gradual restoration of strength
Any time a limb is immobilized, its muscles atrophy, meaning they lose size and strength. Due to the structure of the knee joint, adding load must be gradual, just like range of motion and weight bearing.
This is why getting the knee straight is so important. To restore a normal walking gait, the knee must fully extend when landing from taking a step. Then it must bend to swing. This takes time for most people to restore after a meniscus repair.
Walking up stairs
This requires almost full range of motion and definitely good strength to accomplish without hesitation or a limp. With any knee injury, restoration of functional movement patterns is difficult. Climbing stairs on crutches and in an immobilizer is especially challenging. Normal patterns up stairs can take as long as two months to restore.
Controlling knee movement
This is another component of returning from any knee injury. Really, it's about preventing a twisting the knee, which can shear the meniscus. Too much knee valgus occurs during squatting, jumping, landing or cutting when a knee or both knees bend in toward the middle (inside the hips). This mechanically stresses the ACL and puts the hamstrings at a disadvantage to protect it. Exercises like X-Band Walks, Sumo Deadlifts and Wide-Based Squats control knee position to prevent this.
Running can begin early in controlled environments but with discretion related to the amount of damage in a particular knee. The first requirement is to have full range of motion without swelling. The second is to have adequate single-leg strength to perform the activity. Many times running is not allowed until 16 weeks after surgery, but it can begin slightly earlier if the criteria are met. Also, it may begin earlier on an anti-gravity treadmill or in a pool on a treadmill.
Return to sport
The major steps to returning to your sport after a meniscus repair include, but are not limited to: allowing sufficient time for the repair to become fully healed; restoring full range of motion; eliminating swelling; and restoring at least 90 percent strength of one leg compared to the other when tested in a single-limb hop test for distance and a crossover hop test. You should have the ability to sprint, stop, cut, jump and land without pain or poor control of your knee position with any of these activities. You should also have restored sufficient Back Squat, Front Squat, and/or Deadlift strength relative to your body weight and previous ability.
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