1. Meniscus Injury/Knee Pain Matthew E. Mitchell M.D.

2. mattmitchellmd.com Knee Pain  Many conditions cause knee pain  Non Mechanical Causes –Anterior Knee pain –Patellofemoral pain  Mechanical Causes –Meniscus Tear –ACL tear –Loose bodies

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

4. mattmitchellmd.com Non Mechanical  Anterior Knee pain –Most common cause of knee pain in my practice –Often both knees involved –Pain with stairs and extended knee flexion “movie sign” –Affects both the young and old as well as athletes and non atheletes

5. mattmitchellmd.com Treatment  Physical Therapy mainstay of treament –Strengthen quadriceps muscle –Strengthen hip abductors –Robust stretching program –Avoid knee extension machine at Gym!  Neoprene sleeves  Injections (steroid)

6. mattmitchellmd.com Anterior Knee Pain Treatment  Surgery –Arthroscopy –Lateral Release –Realignment –Osteotomies –Articular transplants for defects on patella

7. mattmitchellmd.com Results of Treatment  Most patients get better with physical therapy and modifications to activity in 6 months  Surgery has variable results with success ranging from 40% to 90%

8. mattmitchellmd.com Mechanical Causes  ACL (please see the other talk)  Loose Bodies –Fragments of bone in the knee –These cause giving way –Usually seen on Xrays of knee –Treatment is arthroscopy and removal

9. mattmitchellmd.com Mechanical Causes  Meniscus Symptoms –Cause giving way –Locking and catching symptoms –Can be stable and unstable  Stable injuries can be treated electively  Primarily pain on one side of knee  No locking and catching  Usually seen on MRI Arthroscopic View of Normal Meniscus

10. mattmitchellmd.com Mechanical Causes  Meniscus Unstable Injuries –Locking and catching symptoms  Must be differentiated from “popping and clicking” –Sometimes cannot extend knee –Surgery is indicated sooner because possible damage to knee from unstable meniscus

11. mattmitchellmd.com Mechanical Causes Treatment  Physical therapy for stable mensicus tears  Surgery for loose bodies, unstable meniscus tears  Meniscus Repair –Works better in younger patients –Must be right kind of tear (peripheral tears better) –Slower rehabilitation to protect repair –May need a second surgery if repair fails

12. mattmitchellmd.com Expectations  Best expectations are with “true” mechanical symptoms  Unstable mensical tears and loose bodies immediate improvement  Stable meniscal tears less predictable. Hard to know whether mensical tear is the actual cause of pain

13. mattmitchellmd.com Rehabilitation  Meniscal Repair: crutches for 4-6 weeks –No running until 3 months after surgery  Loose Bodies and Meniscal Resections  Start range of motion early  Strengthening after 2 weeks  Return to sports 6-8 weeks as tolerated Back to Patient Information