Treatment of Meniscus Tears: Physiotherapy or Surgery?

 

Conservative treatment and physiotherapy are a mainstay in the management of most meniscal tear injuries. However individual treatment plans will be based on the severity and type of tear, as well as your life circumstances and specific needs. In some cases when the tear is severe, surgical treatment may be warranted.

Initial treatment is aimed at reducing knee pain and swelling

Generally in all cases of meniscus tears, initial measures should include resting your injured knee, along with other measures that are intended to protect the injured area, minimise swelling, reduce knee pain and facilitate healing. Together, this is referred to as RICE therapy, which should be carried out during the first few days, and includes:

–          Rest: It’s often recommended that you avoid taking part in any activities such as sports that may worsen the pain in your knee.

–          Ice: The application of an ice pack can help alleviate pain and swelling in your knee. This can be done 15-20 minutes at a time, every few hours when necessary.

–          Compression: Wearing an elastic compression bandage around your affected joint helps keep it from swelling further.

–          Elevation: This is another way to settle the swelling and pain in your knee – but resting it elevated above the level of your heart when lying down.

 

Over-the-counter medications can also be taken to help relieve your meniscal tear pain. Painkillers that are used include paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs). Consult your doctor about whether taking medication is appropriate for you.

Physiotherapy and rehab for meniscus tears

For a meniscus tear to completely heal, it typically takes between 6 to 8 weeks. With the right treatment and rehabilitation, patients are often able to regain their pre-injury function. Physiotherapy visits are recommended for at least 8 weeks, and form an important part of the management of meniscal tears, whether or not surgery is carried out.

In many cases, conservative treatment can help improve resolve your meniscal injury, and you can achieve rehabilitation with physiotherapy. Or, if surgery is required, physiotherapy is necessary to help with the recovery process. But even before surgery is considered, a few weeks of pre-operative physiotherapy may still be recommended to strengthen the knee.

The goals of physiotherapy are straightforward. Physiotherapy and rehab is needed to help with reducing knee pain and inflammation, healing the meniscal tear, strengthening your knee joint and restoring function. Generally, the earlier you start, the better. But the pace of your physiotherapy also depends on the level of pain and swelling in your joint.

The physiotherapist will devise an individual coordinated program for you that will address your specific needs and lifestyle. To start with, they may advise you about what particular activities to avoid and whether you need to keep weight off the affected knee. Depending on the severity of the meniscal tear or if you’ve had surgery to it, you may need to use crutches to remove all weight bearing from that knee. Additionally, a hinged knee brace may be worn to protect and stabilize your joint if necessary.

Physiotherapy for this type of knee injury involves many different exercises and address a variety of issues. Typically, physiotherapy treatments for meniscal tears include:

–          Muscle strengthening exercises: These are aimed at strengthening the muscles surrounding your knee joint, particularly the hamstrings and quadriceps. Increasing muscle strength helps improve stability and support to your joint. Exercises also focus on lower limb, hip and pelvis muscles to improve overall leg strength, as well as core strength.

–          Joint range of motion: Gentle mobility exercises are done to help normalise the range of motion of your affected joint. During the initial stages, range of motion is limited by pain and other factors, but over time, physiotherapy helps you overcome these limitations.

–          Balance and knee joint sense: Exercises may be needed to help you regain control of your joint, and ensure your balance is normal.

–          Gait (walking): Meniscus tears may cause abnormalities with your gait and physiotherapy is designed to address this. If you require crutches to avoid weight bearing, initial sessions focus on helping you walk with the crutches. Subsequently, regaining the ability to independently walk normally is a key focus.

–          Restoring function: As well as walking, exercises are performed to help you regain function with your leg in other respects. This depends on your age and individual needs. For example, if you play sport, the physiotherapist can provide the necessary rehab for running, kicking, landing, squatting and other movements.

Surgery

Depending on the severity and type of meniscal tear or its response to conservative management, surgery may be advised. This is done to keep further damage from occurring and preserve healthy meniscal tissue.

Surgery is often required when dealing with large meniscal tears that are more than 1cm, or when non-surgical measures have failed to resolve symptoms such as pain or joint locking. In such cases, surgery is undertaken using an arthroscope. This is a minimally invasive procedure, where a tiny camera, the arthroscope, is inserted through a small incision at the knee joint to visualize structures in the joint space.

Depending on the type of tear, meniscal repair or removal (meniscectomy) is carried out:

–          Meniscal repair: This involves stitching the tear together, and is usually done when the tear is peripheral and in a region of healthy, vascularised tissue. The tear also has to be clear and clean to ensure a stable repair can be achieved. Healing with rehab after a meniscal repair takes up to 3 months.

–          Meniscectomy: In some cases, such as when dealing with degenerative meniscal tears where the tissue is unhealthy, partial meniscectomy is recommended. Complete meniscectomies are rarely needed, but only may be done when the tear is very large or involves the whole meniscus. After a partial meniscectomy, patients can resume their normal activities within a few days, but need to wait longer before playing sports. Complete healing with rehab after a meniscectomy usually takes about 3 to 4 weeks.

While most meniscal tears are managed conservatively, physiotherapy and rehab have a key role to play regardless. With conservative management, physiotherapy can facilitate joint healing and restore function the leg without the need for invasive surgical measures. But when surgery is indicated, post-operative rehab is crucial in achieving proper recovery, stabilising and strengthening the joint, as well as restoring function.

Should you need further advice about your knee injury don’t hesitate to call us on 0800 110031 to book your FREE Physiotherapy Assessment at either of our Auckland clinics: Howick or Pakuranga.

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