Surgical Criteria for Meniscus Injuries in Athletes

The talk in soccer circles this week is the imminent return to action of Theo Walcott, the Arsenal and England star who damaged his knee back at the start of 2014. After 286 days of rehab, Walcott made a return to Arsenal’s Under 21 team last week. This has left journalists salivating at finding out when he will be returning to the main team.

For a young professional sports person, nine months is a long time out of the game. For Walcott, missing out on this Summer’s soccer World Cup in Brazil was perhaps more than just rubbing salt into the wound.

In issue 139 of Sports Injury Bulletin, I present a case study of a similar problem in a rugby player of identical age. This big lump of a kid ruptured his lateral meniscus in the knee — a bit different to Walcott’s ACL injury. However, this player also missed a big chunk of the season (17 weeks) and I had to live with his personal frustrations, and the yo-yo of daily emotions.

The piece shows the knee anatomy, details the types, clinical features and management of meniscus tears, and the required post-surgical rehabilitation.

On a recent Rehab Trainer course, one of the participants asked me what she should do about the small lateral meniscal tear in her knee. This is a bit like answering “how long is a piece of string?”, as it depends on so many things.

But to wrap it up in a nutshell, the surgeon will use a set of criteria to determine if a meniscal tear needs repairing, removing, or to be left well alone.

Criteria for Surgery

1. Age

The younger the patient, the more comfortable surgeons are about operating. Often the small degeneration tears in older patients are just a precursor to a knee that is about to become arthritic. With older patients, many surgeons will try for rehab first.

2. Function

This depends on what the knee has to do. If the patient does nothing but collect stamps all day and the knee does not bother them, then clearly the surgeon will want to leave it alone. But if the patient is an athlete with a repetitive catching and locking knee due to a meniscal tear, they will be more comfortable about operating.

3. Type of tear

Issue 139 of Sports Injury Bulletin details the types of tears we see in meniscus. In short, tears such as bucket handle tears do not do well without surgery, while small longitudinal tears can do well without surgery.

4. Location of tear

The outer portion of the meniscus has a nice, rich blood supply (hence, called the “red-red zone”). These areas can do well if left alone. Inner third zone tears (the “white zone”) with no blood supply don’t heal, so they need repairing or removing.

So, if the patient is lucky and fits the criteria for conservative management, or let’s say they simply don’t want surgery, then what options do we have to prevent the injury from getting worse?

Suggestions to Avoid Further Meniscus Injuries

Avoid positions that catch the meniscus. For example, full squatting may catch the posterior horn of the meniscus and flare it up, so the patient has to learn to avoid these positions if possible.

Keep the quadriceps working. If the quads remain strong and active then the shearing effect of the tibia moving across the femur is reduced. This will limit the stress to the meniscus.

Watch for swelling. Regular assessments for a knee effusion (called a “fluctuation test”) may need to be done a few times a week to make sure the knee stays dry. The knee’s biggest enemy is an effusion as it shuts off the quads straight away.

Intervene if the knee has an effusion. Donut felt compression, regular icing, NSAIDS if indicated, needle aspiration if indicated. Avoiding an effusion at all costs is pretty important for any knee injury. blog picture of a green button with a phone receiver icon and 24h underneath

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Preventing Sports Injuries

Many athletes largely depend on chiropractic care to enhance their physical performance. New research studies have determined that aside from maintaining overall health and wellness, chiropractic can also help prevent sports injuries. Chiropractic is an alternative treatment option utilized by athletes to improve their strength, mobility and flexibility. Spinal adjustments and manual manipulations performed by a chiropractor can also help correct spinal issues, speeding up an athlete’s recovery process to help them return-to-play as soon as possible.

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Dr Alexander Jimenez ♛
Chiropractor💡 Author • Researcher • Clinician @ PUSH-as-Rx® 915-850-0900 📞
Hello and Welcome 👊🏻.
Purpose & Passions: I am a Doctor of Chiropractic specializing in progressive cutting-edge therapies and functional rehabilitation procedures focused on total health, strength training and complete conditioning. We focus on restoring normal body functions after neck, back, spinal and soft tissue injuries. We take a global physiological treatment approach in order to regain total functional health.

We use Specialized Chiropractic Techniques, Balanced Diet Plans, Agility Training programs, Cross-Fit techniques, the PUSH-Rx Rehabilitation System and a highly specialized program for our Veterans.

We’ve been blessed to perfect our methods with thousand of El Pasoans over the last 26 years. This has allowed us to improve health and restore true fitness through researched methods and total wellness programs. These programs are natural and use the body’s own ability to achieve goals of improvement, rather than introducing harmful chemicals, controversial hormone replacement, surgery, or addictive drugs. We want you to live a life that is fulfilled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.

As an extension to dynamic rehabilitation, we also offer our patients, disabled veterans, athletes, young and elder a diverse portfolio of strength equipment, high performance exercises and advanced agility options. We are very proud to have teamed up with the cities premier therapist and trainers in order to provide high level competitive athletes the option to push themselves to their highest abilities within our facility.

Come learn how to improve your health for yourself and your loved ones.

With a bit of work, we can achieve optimal health together, no matter the age or disability.

Its all about: LIVING, LOVING & MATTERING! 🍎

God Bless

Injury Medical & Chiropractic Clinic
6440 Gateway East Ste. B
El Paso, TX 79905

Office / Clinic: 915-850-0900 ✔️

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