Recovering from a Meniscus Tear with Physical Therapy
Meniscus tears are one of the most common sports injuries and most frequent knee injuries. The meniscus is a shock-absorbing pad of cartilage in the knee that lubricates, protects, and supports the bone of the knee joint. The meniscus can tear during any movement that puts excessive pressure on the knee or pushes the meniscus past its normal rotational range of motion, such as when twisting, squatting, or making quick positional changes. Physical therapy can help to facilitate optimal healing after a meniscus tear, restore full functionality, and achieve complete recovery through targeted strengthening and extensive rehabilitation if surgery is necessary, for a safe return to sport and activity.
What is the Meniscus?
There are two menisci in each knee. Each meniscus is a shock-absorbing pad of cartilage in the knee that lubricates, protects, and supports the bones of the knee joint. The primary function of the menisci is to distribute weight evenly and dissipate force on the knee, stabilize the knee when there’s rotation, lubricate and cushion the knee joint, facilitate joint stability and smooth fluid movement, and help to transmit directional load during high-impact activities.
The two menisci include the medial side, which is closest to the other knee, and the lateral side, which is closest to the outside of the leg. When you are active on your feet, the cartilage of the menisci cushions the amount of wear and tear on the surrounding articular cartilage (the protective layer on the ends of bones). The knee cannot be fully functional without two healthy menisci.
Meniscus Tear Injuries in Sports
Meniscus tears are one of the most common sports injuries and one of the most frequent knee injuries. Menisci are vulnerable to injury and can tear during any movement that puts excessive pressure on the joint or pushed the menisci past their normal rotational range of motion.
Most sports-related meniscus tears occur when an athlete twists or turns the upper leg while the foot is firmly planted and the knee is bent or when required to do a lot of squatting, twisting, or positional changes, such as in football, soccer, or basketball. A meniscus tear can also occur in older patients due to degeneration of the cartilage of the meniscus from aging and long-term wear and tear on the knee
Meniscus tears can tear longitudinally (displaced or bucket handle tear), horizontally (a flap tear), radially (a parrot beak tear), or in a complex way, in which two of these shapes cause damage in more than one direction.
Symptoms of a meniscus tear include:
Sharp, intense pain in the knee
Symptoms that worsen with additional strain and weight-bearing activity
Pop or tearing sensation in the knee at the time of acute injury
Swelling and stiffness within the first 24 hours of injury
Difficulty walking or going up and down stairs due to pain
Loss of range of motion in the knee and weakness during activity
Catching or locking sensation in the knee during movement
Difficulty straightening or bending the knee fully
It is critical to treat meniscus tears early and effectively. Even a minor tear needs attention and proper care to heal fully and moderate to severe tears can require surgery. Diagnostic imaging can help to determine the extent and severity of a meniscal tear. If a tear is within the outer third of the meniscus, conservative treatment with ice, rest, compression, and physical therapy exercise can be effective because this part of the meniscus has a rich blood supply that can help regenerate new, healthy cartilage tissue. If conservative treatment doesn’t achieve full functionality in the knee, then meniscus repair surgery is the next step.
If the meniscal tear affects the inner two-thirds of the meniscus, however, it cannot heal itself as that area of the cartilage lacks blood flow. That part of the meniscus must be trimmed down to keep from tearing further or completely removed and replaced with a meniscus transplant.
Physical Therapy for Meniscus Tears
Physical therapy can help facilitate optimal healing, restore full functionality, and achieve complete recovery through targeted strengthening and extensive rehabilitation should surgery be necessary, for a safe return to sport.
First, the physical therapist performs a physical exam to assess the knee joint for swelling, tenderness, range of motion limitations, and clicking in the joint. The therapist also evaluates the patient’s leg strength, gait, and ability to bend or extend the knee. The therapist works with the patient’s physician to coordinate diagnostic testing, surgery discussion, and preparation for surgery if needed.
If the meniscus tear is minor and in the outer third of the meniscus that has a rich blood supply, conservative treatment with physical therapy over 4-8 weeks can achieve normal function in the knee.
Physical therapy treatment for a meniscus tear can include:
Ice and use of a compressive leg cuff to reduce swelling and manage pain.
Manual therapy involving stretching and joint mobilization of the knee to reduce stiffness and restore range of motion.
Neuromuscular electrical stimulation to gently stimulate and contract muscles around the knee to improve strength.
Targeted strengthening exercises to build and maintain strength in the knee and restore full movement in the knee. The therapist specifically targets the hamstring and quadricep muscles to help ease pressure on the healing knee tissues.
However, if the meniscus tear is moderate to severe or doesn’t respond to conservative treatment, surgery may be necessary. Leaving a torn meniscus untreated can lead to long-term damage of the knee, causing joint-limiting instability and issues like osteoarthritis. For degenerative medial meniscus tears, one study found that a 12-week exercise physical therapy program was just as effective as surgery and that those in the exercise group had improved muscle strength compared to those who underwent surgery. Surgery generally has the best results when the primary issue of the meniscus tear is mechanical, causing catching or locking in the knee.
There are three types of meniscus surgeries that can be performed depending on the type of meniscus tear. Post-surgical physical therapy after meniscus surgery is crucial to ensure proper healing and a return to full function in the knee.
The three types of meniscus surgeries include:
Partial or total meniscectomy: this is the most common type of surgery, accounting for 90% of all meniscus surgeries in which the surgeon trims back the torn portion of the meniscus and leaves behind as much of the fully functioning meniscus as possible. It is an outpatient surgery that requires post-surgery physical therapy over the course of 4-6 weeks.
Meniscus repair: this type of surgery is typically done for younger patients and is often done along with ACL or PCL ligament reconstruction. It is done for certain types of meniscus tears to preserve as much of the meniscus as possible.
Meniscus allograft or transplant: this surgery is done for patients who have had their meniscus trimmed in the past and have continued to have pain and instability in the meniscus. It is not a common surgery. This surgery can help to restore the force distribution across the knee and reduce symptoms.
Current research shows a high return to play rate for athletes that do undergo meniscus surgery. A 2021 review of 19 studies assessing 872 patients noted that following an all-inside meniscus repair, there was a 90% return-to-sport rate and high postoperative activity level.
Before a return to sport, our physical therapists guide athletes through a return to sport (RTS) protocol involving jumping, loading, and change-in-direction drills to test the knee and ensure the athlete can safely return to competition post-meniscus tear. The therapist conducts a functional RTS testing protocol to objectively determine the effectiveness of rehabilitation and readiness to return to sport by measuring the athlete’s functional movement patterns, running mechanics, strength, power, endurance, aerobic capacity, speed and agility, and balance and proprioception.
Are you an athlete who has experienced a meniscus tear? Work with a physical therapist to regain strength and mobility in the knee and effectively heal from surgery!
