meniscus injury/knee pain matthew e. mitchell m.d

Meniscus Injury/Knee PainMeniscus Injury/Knee Pain

Matthew E. Mitchell M.D.Matthew E. Mitchell M.D.

mattmitchellmd.commattmitchellmd.com

Knee PainKnee Pain

Many conditions cause knee painMany conditions cause knee pain Non Mechanical CausesNon Mechanical Causes

– Anterior Knee painAnterior Knee pain– Patellofemoral painPatellofemoral pain

Mechanical CausesMechanical Causes– Meniscus TearMeniscus Tear– ACL tearACL tear– Loose bodiesLoose bodies


DisclaimerDisclaimer

Patients should discuss specific injuries with Patients should discuss specific injuries with their primary care doctor or surgeon. This their primary care doctor or surgeon. This site is meant to give general information to site is meant to give general information to patients about specific patient problems. It patients about specific patient problems. It is impossible to individualize this discussion is impossible to individualize this discussion to specific patient issues.to specific patient issues.


Non MechanicalNon Mechanical

Anterior Knee painAnterior Knee pain– Most common cause of knee pain in my Most common cause of knee pain in my

practicepractice– Often both knees involvedOften both knees involved– Pain with stairs and extended knee flexion Pain with stairs and extended knee flexion

“movie sign”“movie sign”– Affects both the young and old as well as Affects both the young and old as well as

athletes and non atheletesathletes and non atheletes


TreatmentTreatment

Physical Therapy mainstay of treamentPhysical Therapy mainstay of treament– Strengthen quadriceps muscleStrengthen quadriceps muscle– Strengthen hip abductorsStrengthen hip abductors– Robust stretching programRobust stretching program– Avoid knee extension machine at Gym!Avoid knee extension machine at Gym!

Neoprene sleevesNeoprene sleeves Injections (steroid)Injections (steroid)


Anterior Knee PainAnterior Knee PainTreatmentTreatment

SurgerySurgery– ArthroscopyArthroscopy– Lateral ReleaseLateral Release– RealignmentRealignment– OsteotomiesOsteotomies– Articular transplants for defects on patellaArticular transplants for defects on patella


Results of TreatmentResults of Treatment

Most patients get better with physical Most patients get better with physical therapy and modifications to activity in 6 therapy and modifications to activity in 6 monthsmonths

Surgery has variable results with success Surgery has variable results with success ranging from 40% to 90%ranging from 40% to 90%


Mechanical CausesMechanical Causes

ACL (please see the other talk)ACL (please see the other talk) Loose BodiesLoose Bodies

– Fragments of bone in the kneeFragments of bone in the knee– These cause giving wayThese cause giving way– Usually seen on Xrays of kneeUsually seen on Xrays of knee– Treatment is arthroscopy and removalTreatment is arthroscopy and removal



Meniscus SymptomsMeniscus Symptoms– Cause giving wayCause giving way– Locking and catching symptomsLocking and catching symptoms– Can be stable and unstableCan be stable and unstable

Stable injuries can be treated electivelyStable injuries can be treated electively Primarily pain on one side of kneePrimarily pain on one side of knee No locking and catchingNo locking and catching Usually seen on MRIUsually seen on MRI

Arthroscopic View of Normal Meniscus



Meniscus Unstable InjuriesMeniscus Unstable Injuries– Locking and catching symptomsLocking and catching symptoms

Must be differentiated from “popping and clicking”Must be differentiated from “popping and clicking”

– Sometimes cannot extend kneeSometimes cannot extend knee– Surgery is indicated sooner because possible damage Surgery is indicated sooner because possible damage

to knee from unstable meniscusto knee from unstable meniscus


Mechanical CausesMechanical CausesTreatmentTreatment

Physical therapy for stable mensicus tearsPhysical therapy for stable mensicus tears Surgery for loose bodies, unstable meniscus Surgery for loose bodies, unstable meniscus

tearstears Meniscus RepairMeniscus Repair

– Works better in younger patientsWorks better in younger patients– Must be right kind of tear (peripheral tears Must be right kind of tear (peripheral tears

better)better)– Slower rehabilitation to protect repairSlower rehabilitation to protect repair– May need a second surgery if repair failsMay need a second surgery if repair fails


ExpectationsExpectations

Best expectations are with “true” mechanical Best expectations are with “true” mechanical symptomssymptoms

Unstable mensical tears and loose bodies Unstable mensical tears and loose bodies immediate improvementimmediate improvement

Stable meniscal tears less predictable. Stable meniscal tears less predictable. Hard to know whether mensical tear is the Hard to know whether mensical tear is the actual cause of painactual cause of pain


RehabilitationRehabilitation

Meniscal Repair: crutches for 4-6 weeksMeniscal Repair: crutches for 4-6 weeks– No running until 3 months after surgeryNo running until 3 months after surgery

Loose Bodies and Meniscal ResectionsLoose Bodies and Meniscal Resections Start range of motion earlyStart range of motion early Strengthening after 2 weeksStrengthening after 2 weeks Return to sports 6-8 weeks as toleratedReturn to sports 6-8 weeks as tolerated

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meniscus injury/knee pain matthew e. mitchell m.d

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