Meniscus Review Of Basic Principle

Journal of Athletic Training
2001;36(2):160–169
by the National Athletic Trainers’ Association, Inc
www.journalofathletictraining.org

The Meniscus: Review of Basic Principles
With Application to Surgery and
Rehabilitation
Timothy Brindle*; John Nyland†; Darren L. Johnson*
*University of Kentucky, Lexington, KY; †University of South Florida, Tampa, FL
Timothy Brindle, MS, PT, ATC; JohnNyland, EdD, PT, SCS, ATC; and Darren L. Johnson, MD, contributed to conception and
design; analysis and interpretation of the data; and drafting, critical revision, and final approval of the article.
Address correspondence to John Nyland, EdD, PT, SCS, ATC, School of Physical Therapy, College of Medicine, MDC 77,
12901 Bruce B. Downs Boulevard, Tampa, FL 33612-4766. Address e-mail tojnyland@hsc.usf.edu.
Objective: To review basic meniscal anatomy, histology, and
biomechanical principles as they apply to surgery and rehabilitation.
Data Sources: We searched MEDLINE and CINAHL for the
years 1960–1999 using the terms meniscus, surgery, rehabilitation, meniscal repair, and arthroscopy.
Data Synthesis: Injuries to a healthy meniscus are usually
produced by a compressive force coupledwith transverseplane tibiofemoral rotation as the knee moves from flexion to
extension during rapid cutting or pivoting. The goal of meniscal
surgery is to restore a functional meniscus to prevent the development of degenerative osteoarthritis in the involved knee.
The goal of rehabilitation is to restore patient function based on
individual needs, considering the type of surgical procedure,which meniscus was repaired, the presence of coexisting knee
pathology (particularly ligamentous laxity or articular cartilage
degeneration), the type of meniscal tear, the patient’s age, preoperative knee status (including time between injury and sur-

gery), decreased range of motion or strength, and the patient’s
athletic expectations and motivations. Progressive weight bearing and jointstress are necessary to enhance the functionality
of the meniscal repair; however, excessive shear forces may
be disruptive. Prolonged knee immobilization after surgery can
result in the rapid development of muscular atrophy and greater
delays in functional recovery.
Conclusions/Recommendations: Accelerated joint mobility
and weight-bearing components of rehabilitation protocols represent theconfidence placed in innovative surgical fixation
methods. After wound healing, an aquatic therapy environment
may be ideal during all phases of rehabilitation after meniscal
surgery (regardless of the exact procedure), providing the advantages of controlled weight bearing and mobility progressions. Well-designed, controlled, longitudinal outcome studies
for patients who have undergonemeniscectomy, meniscal repair, or meniscal reconstruction are lacking.
Key Words: biomechanics, knee anatomy, exercise

K

eral ligament, the anterior cruciate ligament (ACL), and the medial meniscus5,6; however, recent reports suggest that the lateral
meniscus is more commonly injured.7–10 Acute ACL disruption
associated with sudden transverse-plane rotary forces more commonly damages the lateralmeniscus as excessive lateral compartment compression and shear forces stress the posterolateral
tibiofemoral articulation.9 Medial meniscus injury is usually associated with repetitious anterior translation in the chronic ACLdeficient knee, disrupting articular surfaces11 and leading to the
early onset of osteoarthritis (OA).12
Knee injury management is a concern for most sports medicine healthcare providers. Our objective is to provide a review
of basic anatomic, histologic, and biomechanical principles of
the meniscus. This information is then assimilated with current
surgical and rehabilitation methods to provide clinicians with a
complete overview of the present state of meniscal injury management. The ultimate challenge is to return the athlete to sport
with normal or...