Further Outpatient Care

Patients with meniscal injuries (operative or nonoperative) are recommended to receive outpatient physical therapy for rehabilitation. Please refer to the Physical Therapy section for appropriate treatment goals and guidelines.

Prognosis

Return to play after a meniscus injury is expected. The timing varies and depends on the injury, treatment, and rehabilitation protocol. In many cases, athletes can return to their sport as soon as 2-3 weeks status post arthroscopic partial meniscectomy or 6-8 weeks status post meniscal repair.

Over the long term, meniscal repairs fail to heal in 5-10% of patients. Failure rates are lower when the tears are repaired in patients with concomitant ACL reconstruction.

Also over the long term, meniscal injuries predispose to osteoarthritis secondary to increased loads on the articular surfaces of the knee.^[51]However, the degree of correlation between meniscal injuries and osteoarthritis has not been well established in the literature.

A study by Everhart et al indicated that in middle-aged adults, meniscal tears and lateral meniscal extrusion accelerate loss of joint space. Patients with medial meniscal tears, regardless of whether or not extrusion had occurred, suffered an additional mean medial space loss of 0.05 mm/year, while those with lateral tears underwent an additional mean lateral space loss of 0.09 mm/year. Moreover, lateral extrusion was associated with an additional mean lateral space loss of 0.1 mm/year. Patients without lateral extrusion had a 0.5% annual incidence of knee arthroplasty, compared with a 1.5% rate for those with a lateral extrusion of less than 2.0 mm, and a 3.7% rate for those with an extrusion of 2.0 mm or more.^[52]

A retrospective, dual-center study by Ronnblad et al of 918 patients who underwent meniscal repair indicated that surgeries using bioabsorbable arrows are more likely to fail than those employing all-inside sutures with anchors (hazard ratio [HR] = 1.8), with the failure rate also being higher for medial, rather than lateral, meniscal repairs (HR = 3.7).^[53]

Patient Education

Unfortunately, most injuries to menisci occur during accidents that are, at times, not preventable. However, the following may help in avoidance of these injuries:

Having strong thigh and hamstring muscles
Gently stretching the legs before and after exercise
Wearing shoes that fit properly when exercising and ensuring the shoes are appropriate for the activity being performed
When skiing, ensuring that ski bindings are set correctly by a trained professional so that the skis release when a fall occurs

Questions

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Media Gallery

Magnetic resonance imaging scan showing a normal meniscus.
Magnetic resonance imaging scan showing a torn medial meniscus.
Arthroscopic probing of a posterior horn complex meniscal tear with multiple flaps.
Arthroscopic view of medial meniscus after excision of flap tear.

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Author

Sarjoo M Bhagia, MD † Consulting Staff, OrthoCarolina; Voluntary Teaching Faculty, Carolinas Rehabilitation

Sarjoo M Bhagia, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, North American Spine Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Selina Yingqi Xing, MD, MS Staff Physician, Department of Physical Medicine and Rehabilitation, Temple University

Selina Yingqi Xing, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Medical Association

Disclosure: Nothing to disclose.

Michael Weinik, DO Associate Chairman, Associate Professor, Physical Medicine and Rehabilitation, Temple University Hospital

Michael Weinik, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Bradley S Baker, MD Orthopedic Surgeon, American Board of Orthopaedic Surgery Certified in Orthopaedic Surgery and Orthopaedic Sports Medicine; Partner, Nevada Orthopedic and Spine Center

Bradley S Baker, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Ryan O Stephenson, DO Associate Professor of Clinical Practice, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director of Polytrauma and Brain Injury (Polytrauma Network Site), Department of Physical Medicine and Rehabilitation, Eastern Colorado Veterans Affairs Medical Center

Ryan O Stephenson, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

James H Lubowitz, MD Director, Taos Orthopaedic Institute, Taos Orthopaedic Institute Research Foundation (TOIRF), and Taos Orthopaedic Institute Sports Medicine Fellowship Training Program; Clinical Professor, Department of Orthopaedic Surgery, University of New Mexico School of Medicine

James H Lubowitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America

Disclosure: Received consulting fee from Arthrex for consulting; Received salary from AANA for employment; Received royalty from Arthrex for other.

Bryce T Wolf, MD Sports Medicine Fellow, Taos Orthopedic Institute

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors wish to thank Kavita Gupta, DO, MEng, Department of Orthopedics, Center of Physical Medicine and Rehabilitation, University of Dentistry and Medicine of New Jersey, for her previous contributions to this article.

Sections Meniscal Injury
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Presentation
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- Physical
- Causes
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Meniscal Injury Follow-up

Further Outpatient Care

Prognosis

Patient Education

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