REHABILITATION FOCUS REHABILITATIONMENISCAL

● Function of the menisci - load transmission, shock absorption, joint lubrication, and joint stability ● Menisci transmit 50-60% of compressive loads at the knee joint ● At 90 degrees of flexion this increases to 85% ● Lateral meniscus transmits greater % to medial in relative joint compartment ● Lateral meniscus has greater mobility due to its non-attachment to the lateral collateral ligament and the disturbance of its capsular attachment via the passage of the popliteus tendon

By Dave Fevre, MCSP

In the athletic population most meniscal injuries eventually require surgical intervention. This article has been written to cover pre-operative baseline assessment details and appropriate post-operative rehabilitation, the pathways being dependent on surgical approach, post-operative assessment and sport-specific athletic demands.

A completely accurate diagnosis and choice of subsequent surgi- cal procedure is only possible via arthroscopic examination. However in the interim period between assessment/physical diag- nosis and surgery, the athlete has the ideal opportunity to utilise this time to commence their ‘prehabilitation’ programme. In the ideal world, the early part of the functional rehabilitation pro- gramme should be taught prior to surgery so that the athlete has a full understanding of what is expected of them in that first week following surgery.

Pre-operative factors to consider In the ideal world, a pre-operative physical assessment is very useful for the physiotherapist. This will provide baseline informa- tion on the athlete’s pre-operative physical and mental state. Factors to consider may include:

Spinal assessment ● Standing ● Active and passive movement ● Manual spinal tests ● Neural tests

Pelvic and lower limb assessment ● Passive movement ● Active movement ● Functional tests

Biomechanical assessment ● Patellar orientation in relation to the patello-femoral joint ● Pelvic and lower limb mechanics ● Standing, walking, running (multi-directional)

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● Video/digital analysis of functional movement patterns ● Examination of daily footwear (training shoes, moulded and studded boots)

Isokinetic assessment ● Isometric and concentric/eccentric patterns related to the knee joint, injured and non-injured

● Emphasis on quadriceps/hamstrings in relation to knee flexion/extension and tibial internal/external rotation

● Assessment in sitting (classical test position) and lying (func- tional) positions.

Functional tests To assess the functional state of the injured knee and give indi- vidual baseline measurements for the non-injured knee: 1. Figure of eight hop test Hop in a figure of eight over a 5m distance as fast as possible. Measure the time taken over two consecutive laps. 2. Up-down hop test (Fig.1) Hop vertically up and down a 20cm high step for 10 repetitions

Figure 1: Up-down hop test

Figure 2: Side hop test

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