The most common traumatic injury evaluated by trainers in the sports medicine field is the tearing or rupturing of the meniscus. Upon diagnosis by a physician, a key member of sports medicine teams, appropriate treatment may be administered to preserve as much function in the knee as possible. When conservative treatment alone will not return a player to near pre-injury level performance, surgery, particularly meniscal allograft reconstruction, may be required.
Injuries to the meniscus are very prevalent in today’s athletes and therefore must be evaluated carefully. Perhaps the reasoning behind so many meniscal injuries can be linked to the stress that occurs particularly on the posterior horn of the knee during flexion. Combined with the everyday shearing that occurs when the knee twists during the movement, the stress upon the meniscus can cause it to tear. To determine if a patient has a meniscal injury during a physical evaluation, one must focus on whether the knee lacks or maintains effusion, if there is tenderness along the joint line, or if there is crepitance within the tibial femoral join. A history of knee injuries is important in evaluating the severity of the injury and determing if meniscal reconstructive surgery is necessary. If left as it is without reconstructive surgery, but rather completely removed, the patient will have slight tenderness along both the medial and lateral sides of the knee regardless where the meniscal deficiency is located. Other than the occasional clicking, locking, or popping within the joint, generally patients only have mild discomfort.
Much as other more mild injuries to the knee, a conservative treatment method is desirable in remedying meniscal tears. An easy treatment to make a patient more comfortable and mobile is to do something as simple as modifying the type of shoes they wear. Doctors can administer non-sterioidal anti-inflammatory medicines, cortisone injections, and hyaluronic acid injections to ease pain. Often these conservative medical treatments in addition to heel wedges and physical therapy will restore a player to an adaptable level of mobility and comfort.
Unfortunately, conservative measures in treatment are not always adequate and surgery must be performed. Injured athletes with diagnosed meniscal deficient knees and possess the early signs of degenerative changes, may be eligible to receive meniscal allograft reconstruction. Often however, if the degeneration has become too severe, this form of surgery is not an option. Once it has been determined that the patient is an appropriate candidate for the surgery, a sizing of the meniscus is conducted with either plain x-rays, MRI’s, or CT scans. The actual surgical procedure itself is usually done on an outpatient basis via small arthroscopic openings and a peripatellar tendon arthrotomy. Advanced meniscal repair procedures are coupled with the addition of securing the anterior and posterior roots of the meniscus to the tibial plateau to comprise meniscal allograft reconstruction.
Rehabilitation measures are the next important post-operative step in regaining full function of an athlete’s damaged knee. Weight bearing is limited for the first several days, and the patient must not participate in sports activities for about six weeks though it can be as long as ten to twelve weeks. After approximately two months of careful rehabilitation, the bone plugs and the meniscus should have healed.