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Anatomy and Function: The menisci are C-shaped fibrocartilaginous structures located between the femur and tibia. Each knee has two menisci:
• Medial meniscus: Larger and less mobile
• Lateral meniscus: Smaller and more mobile
Functions of the menisci include:
• Load distribution and shock absorption
• Joint stability
• Lubrication and nutrition of articular cartilage
• Proprioception
Mechanisms of Injury: Meniscal injuries can occur through various mechanisms:
• Acute traumatic injuries: Often seen in contact sports
– Sudden twisting or cutting motions
– Direct blows to the knee
• Degenerative injuries: More common in older athletes
– Repetitive microtrauma
– Age
-related tissue degeneration
Common sports associated with meniscal injuries:
• Football
• Basketball
• Soccer
• Wrestling
• Skiing
Types of Meniscal Tears:
• Longitudinal tears
• Radial tears
• Horizontal tears
• Bucket-handle tears
• Complex or degenerative tears
Clinical Presentation: Athletes with meniscal injuries may present with:
• Joint line pain
• Swelling
• Mechanical symptoms (locking, catching, or giving way)
• Limited range of motion
• Difficulty with pivoting or twisting movements
Non-surgical management:
• RICE protocol (Rest, Ice, Compression, Elevation)
• NSAIDs for pain and inflammation
• Physical therapy to improve strength and flexibility
• Activity modification
Surgical management:
1. Meniscal repair:
• Indicated for peripheral, vascularized tears
• Techniques: Inside-out, outside-in, all-inside repair
• Better long-term outcomes, especially in younger athletes
2. Partial meniscectomy:
• Removal of damaged meniscal tissue
• Indicated for complex, degenerative, or irreparable tears
• Quicker return to play, but increased risk of osteoarthritis
3. Meniscal allograft transplantation:
• For young patients with total or subtotal meniscectomy
• Aims to restore knee biomechanics and prevent early osteoarthritis
Rehabilitation and Return to Play: Rehabilitation protocols vary based on the treatment approach:
Meniscal repair:
• Phase 1 (0-6 weeks): Protection, ROM exercises, partial weight-bearing
• Phase 2 (6-12 weeks): Progressive weight-bearing, strengthening
• Phase 3 (12-16 weeks): Sport-specific training
• Return to play: 4-6 months post-surgery
Partial meniscectomy:
• Accelerated protocol compared to meniscal repair
• Early weight-bearing and ROM exercises
• Strengthening and proprioception training
• Return to play: 4-6 weeks post-surgery
Key components of rehabilitation:
• Quadriceps and hamstring strengthening
• Core stability exercises
• Proprioception and balance training
• Gradual return to sport-specific activities
Prevention Strategies: Implementing prevention strategies is crucial for reducing the risk of meniscal injuries:
• Proper warm-up and cool-down routines
• Neuromuscular training programs
• Technique modification in high-risk sports
• Appropriate footwear and playing surfaces
• Maintaining a healthy body weight
Long-term Outcomes and Considerations:
• Risk of post-traumatic osteoarthritis:
– Higher following meniscectomy compared to repair
– Influenced by factors such as age, BMI, and activity level
• Impact on athletic performance:
– Many athletes return to pre-injury level of play
– Some may experience decreased performance or early retirement
• Need for ongoing monitoring and management:
– Regular follow-ups to assess knee function and symptoms
– Potential for repeat injuries or degenerative changes
Emerging Trends and Future Directions:
1. Biological augmentation:
• Platelet-rich plasma (PRP) injections
• Stem cell therapy
• Growth factors to enhance meniscal healing
2. Tissue engineering:
• Development of biocompatible scaffolds
• 3D-printed meniscal implants
3. Advanced imaging techniques:
• Quantitative MRI for improved diagnosis and monitoring
4. Minimally invasive surgical techniques:
• Continued refinement of all-inside repair methods
Meniscal injuries remain a significant challenge in sports medicine. A comprehensive approach involving accurate diagnosis, appropriate treatment selection, and tailored rehabilitation is essential for optimal outcomes. As our understanding of meniscal biology and biomechanics continues to evolve, new treatment modalities and prevention strategies are likely to emerge, further improving the management of these common sports-related injuries.
©2025 Dr Frank McCormick All Rights Reserved.
©2025 Dr Frank McCormick All Rights Reserved.
