This mini-series will examine some of the more common sports injuries. The first post will be on menisci injuries. The meniscus is a section of cartilage in the knee.
- Shock absorbers that act as an impact cushion
- They spread load – without it, the femur would smash against the tibia in a small area so the force is much higher, by spreading the meniscus out across the tibia, is disperses the load.
- Stabilises the joint
- Nutrition and lubrication – in the peripheral areas, there is a healthy blood supply in the menisci
Mechanisms of Injury:
- Most commonly arises from a twisting injury
- Degenerative tears are also common – for example there may be a slight tear in the meniscus which causes no issues when walking but serious injury then occurs with twisting.
- It can also be associated with another injury, for example ACL tears.
- Sharp pain when doing something particular
- Swelling and loss of extension ability
- X-Ray can be used but sometimes it’s difficult to see some cracks as it can be torn in variety of ways; arthroscopy can also be used to a degree of success
- With time, a lot will settle – especially if there is a good blood supply available
- Gluing the tear is done though is not overwhelmingly successful
- In previous years, removing the meniscus was routine however this results in knee degeneration and is no longer recommended
- The most common route is to surgically remove all the tear but leave as much mensicus as possible. The surgeon must ensure that a slight crack isn’t left as it is likely to tear fully again.
- Bio-absorbable stitches can be used, but they will not heal without a blood supply.
- Rehab will depend upon the pathology of the injury – how big, the angle, what percentage is lost to surgery, muscle atrophy
- Muscular atrophy – the vastus medialis oblique (VMO) plays a vital role in patella control but can atrophy within three days.
- Movement resolves swelling so in early stages, athletes can go on an exercise bike at low speeds and resistance to regain movement as there is no knee rotation involved. Progression could be onto a cross trainer as this is low impact. Following that, running in a straight line followed by increasing agility by running round sets of cones.
- Open and close chain activities – open focus on whole muscle groups whereas closed hone in on just one
- Remember the athlete is being rehabilitated not just the injury and it is a holistic process.