Meniscal lesions cover a wide range of knee injuries, and can cause different types of knee pain based on how they came about. Sports injuries here usually result in stinging pain in the knee, whereas lesions due to banal movements, or cartilage degeneration are more often associated with dull knee pain that flares up during certain movements.
We use MRI and CT scans to observe what is happening at a musculoskeletal level here, before beginning a rehabilitation programme focusing on hydrotherapy and physiotherapy to treat knee pain, and its underlying causes.
These arthroscopic surgeries are only performed after particularly serious injuries, or where conservative treatments have been unsuccessful. There are four main categories of procedure here: meniscal suture; selective meniscectomy; implantation of meniscal scaffolding; implantation of meniscus from a donor (allograft).
Meniscal suture: If the size and location of the lesion will allow it, the surgeon will make a meniscal repair using a suture. Rehabilitation here last much longer than in simpler medial meniscectomies.
Selective meniscectomy: Where meniscal suturing is not an option, a surgeon will have to remove the detached meniscal fragments in order to restore the meniscal profile to normal. This type of surgery typically involves a very short period of time in hospital.
Meniscal scaffolding implants: This surgical technique was preceded by a long evaluation period. Currently it is a very popular technique as it results in extremely positive outcomes. A synthetic meniscal prosthesis is introduced arthroscopically, encouraging the growth of new meniscal tissue, thus delaying the onset of osteoarthritis.
Implantation of meniscus from a donor, or allograft: This surgical technique involves the implantation of meniscal tissue obtained from a donor which is then sutured into the knee of the recipient. As in the case with meniscal scaffolding, the time for the biological integration of new tissue requires some cautious monitoring, and recovery times will be much longer than for simple meniscectomies.
Regardless of the type of surgery used, post-operative recovery plans include intense physiotherapy, aquatherapy to allow patients to exercise with little load, and on-field rehab to rebuild specific skills.
Conservative treatment after meniscus lesion is becoming the treatment of choice because the meniscus, especially the medial one, takes part in the stability of the knee. It is our duty to inform the patient that what you are doing is an attempt to recover and if unsuccessful it will resort to surgery.
The initial therapeutic protocol aims to minimize the pain, reduce swelling and recover joint movement, without forcing the decline particularly beyond 90 °.
Early on are very important the rehabilitation sessions in pool because it allows a reduction of the load, greater muscle relaxation and an early recovery of the range of motion.
Past the initial inflammatory process you can pass to the stage of muscle recovery of the quadriceps, the real shock of the vertical loads, both in concentric and eccentric mode for flexor and calf, especially in eccentric ways, gluteal and core muscles. You will also perform a balance and proprioception exercises and movement education. In the rehabilitation of this type of injury it is important the recovery phase of the sport specific gesture in field with exercises that aim to improve the cushioning of loads and a conscious use of motor strategies to carry out a preventive exercise program especially for the first year after the injury.