Case Studies of the Knee:Meniscus Tears

and Osteochondral Fractures

Jennifer Ho (Injury A)Joshua Honrado (Injury

B)Claire DeBolt (Injury C)

Knee aNATOMY

KNEE ANATOMY

Injury a

• 20 year old male track athlete• 5k and 10k distance events

• 3 years prior, consistent discomfort and pain along L medial joint line

• 4 weeks prior, escalated to extreme pain

• Spoke with ATC and consulted physicians• Preoperative exam and MRI revealed a medial

meniscus tear

• Did not respond well to conservative treatments

• Surgery on Jan 21, 2011

Injury B

• 20 year old male track athlete• High jump, triple jump

• Athlete c/o pain x1wk and swelling in R knee after playing basketball, unable to run/ jump w/o pain (pain similar to initial surgery)

• Spoke with ATC and consulted physicians• Preoperative exam and MRI revealed

possible medial meniscus tear

• Did not respond well to conservative treatment and Celebrex

• Surgery on October 21, 2010

INJURY C

• Previous knee injuries

• Pain and effusion in the right knee; no specific mechanism

• MRI results: anterolateral meniscal abnormality

• Pain over the lateral joint line; negative for special tests

• Diagnosis: Lateral meniscal tear

• Arthroscopic menisectomy

MenisCectomy

MENISCECTOMY IMAGING

Surgery a, b oUTCOMEs

• Partial meniscectomy of the L medial meniscus

• Arthroscopy revealed complex degenerative tear of the posterior horn of the medial meniscus in the white-white zone • Horizontal and vertical tears

• Partial meniscectomy of R medial meniscus

• Arthroscopy revealed mild superficial fraying of posterior horn of medial meniscus in the white-white zone • Same area where original meniscectomy was performed• Originally resected only the torn unstable parts of the

medial meniscus

SURGERY A, B

cHONDRAL FRACTUREs

Screw Fixation and Microfracture Basis

CHONDRAL FRACTURES

General rehabilitation plan

• Decrease Pain and Reduce Swelling; RICE

• Knee Joint Mobilizations• Reduces arthrofibrosis

• Flexibility/ ROM

• Muscular Strength • Quads, hamstrings, abd, add, gastroc

• Neuromuscular Control; Proprioception

• Cardiorespiratory Fitness • Non-weight bearing

• Functional Progression • Sport-specific skills

Rehab a

• Week 1-2: Control pain and swelling, core, ankle and hip passive ROM and strength, balance• Modalities: russian stim, micromassage, cryopress, soft tissue massage

• Gentle stretching, clamshells, calf raises, SL airex balance

• Week 3-8: strengthening and balance, cardiovascular fitness, effusion reduction• Cycling, swimEx, elliptical, decreased activity due to persistent effusion

• Prone hangs (knee extension), 4 way ankle TB exercises, DL squats, russian twists, monster walks, forward/backward walks

• Jump rope, DL/SL squats, lunges, increased time on cardio workouts

• Modalities: graston, microflush, soft tissue massage

• Week 9-11: reduce posterior capsule tightness, proprioceptive + dynamic stability, cardiovascular fitness• DL/SL squats, airex lunge, tennis balance, step-ups, walking supermans, knee grabs, ABC skips,

slide board, AlterG progression

• Modalities: graston

• Week 12-Present: functional progression, return-to-sport• FMS (21), cleared to begin running

• Currently running on the track every other day, slowly adding mileage

REHAB B

• Rehabilitation was a lot faster than initial surgery• Swelling reduced and full ROM by 5th week

• Winter break slowed progression

• Focused on proprioception (SL balance), box jumps, progression of short step approaches

• 4 months after surgery cleared PT eval with FMS screening for in-door high jump• Later cleared for outdoor long-jump

REHAB C

• Weeks 1-3: Decreasing pain and swelling, achieving full extension, slowly increasing ROM, increasing quad control and VMO tone, maintaining glute, hip• Modalities (Russian, microcurrent); Soft tissue mobilization;

Cryotherapy• Ankle pumps; Quad and HS sets; Adductor sets, supine hip flexion,

prone glute activation; Bike (ROM)

• Week 3: PWB (50%), ROM 0-30; Goals: effusion control, maintain extension, gait activity• Extension exercises

• Week 4-7: Passive ROM 1-110; Goals: effusion control, soft tissue and joint mobilization, maintain full extension, FOCUS: VMO• Wall slides • Heel slides, Double leg bridges with squeeze, weight shifts, calf raises,

balance

REHAB C

• Week 7; X-Ray 2: Screw and fragment intact; FWB permitted• Swim-Ex• Balance Exercises• SL exercises

• Week 8; X- Ray 3:No evidence of hardware complication; etc. No pain, little swelling observed.

• Weeks 9-12: Maintained rehab program• 3-way hip, clamsheels (TB), DL bridged (med ball), SL

bridges, SLR, TB side steps, calf raises• Swim Ex: 4 way hip, flutter and bike kicks, jogging

REHAB c

• SURGERY 2: Hardware removal

• Lower extremity strengthening; proprioception

• 3 way hip, clam shells, squatting, side stepping, wall sits, bridging, calf raises, balance exercises

• Lunges, bridge walk-outs, power-ups, monster walks, slide-board, squatting

aTHLETE a: cURRENT STATUS

• As of 11.5 week post-op he was discharged from PT and began to slowly increase mileage

• Currently progressed to 3 miles every other day

• Occasionally feels discomfort from the site of partial meniscectomy when speeding up

Athlete b:current status

• Full participation in outdoor track and field• Does high-jump, long jump, but no longer does

triple jump

• Recently had a case of shin-splints

• Occasionally feels pain discomfort from site of meniscectomy

Athlete C: Current Status

• ~5 weeks post surgery

• Progressing smoothly• Alter G: 50% 60%

• Expected to return to full play by summer ball

THE END