Orthopedic Articles

Treating a Post-Meniscectomy Patient

In this post, we’ll be talking about some of the complications that can arise from having a meniscectomy. We’ll go over the importance of physical therapy after the surgery. And we’re also going to talk about what medical providers can do and should do and what they should look for when they are evaluating their patients, you know after they’ve had a meniscectomy.

What we need to remember now is that not all patients have a complete meniscectomy. Okay, most of them don’t like they used to in the past when I first started physical therapy, but 29 years ago, it wasn’t uncommon to see somebody who had a tournament discus have it completely meniscectomy. So take the whole meniscus out. And as time has gone on, we’ve learned that the more meniscus you can retain, the less apt you are to develop arthritis in the knee. So we are going to be talking about partial meniscectomy is now you know, it should be easy to treat, right? The problem we have with treating post op meniscectomy, especially in physical therapy is that people are told that this is a very easy procedure, okay, and it’s it’s easy to do, it’s quick you’re in, you’re out, you’re on crutches for a couple days, and then you’re back at it and you’re doing quite well. And what I find is that people probably had these meniscus injuries for quite a long time prior to surgery. So they’ve developed some atrophy, some swelling, some quads shut down, they have the surgery done. And most patients now don’t even go to physical therapy, after they’ve had this particular surgery, they’re just told, you know, use crutches for a couple days, get the leg elevated, and you’ll be fine after that. And what my problem is with that, and this is not a this is not a sales pitch for physical therapy, by all means, okay.

But I am going to ask you all to do something. And, and that is, you know,
the patient had surgery, that knee was invaded, it is swollen, it’s inflamed, it shut down. And sometimes patients need a little help getting over that. Okay, so I’m really going to encourage you, and this is any medical provider out there to to have your patients or have your patients ask to have physical therapy, after they’ve had a partial meniscectomy. Okay, and it’s it doesn’t have to be a lot of visits, it can be 123 visits. Some people require more than that, but others don’t, and they do really well afterwards.

But the most important thing here is education. We need to educate that patient on how to properly elevate that leg to get rid of that swelling. We know that swelling and pain cause reflex inhibition, the quad shuts down. Okay, we want to teach them how to use compressions. And as compression can really help get that swelling down. So they can function a little bit better. If they have a little more confidence. And the knee is compressed a little, they typically walk better, they don’t limp as much. These folks need to be taught to not twist, you know with a planted foot and not pivot. They should avoid deep squatting. And if they need to use crutches, they need to be properly shown how to use those crutches and especially when they’re doing stairs.

So there is a lot of education that could happen in one or two visits after a meniscectomy. And but the most important thing I see here is long term quad shutdown because what happens down the road six months to a year down the road. Most people do fairly well but there is a fairly large number of people that don’t do very well. And you’ll see them walking with a flex knee. You’ll see them having a limp maybe when they’re going down stairs going downhill, they have a hard time controlling themselves, some people will develop patellofemoral dysfunction.

We can really nip this in the bud way earlier, if we can treat these people right after surgery, give them that education. Now there are a lot of people that just can’t reactivate that quad very well. And sometimes they need a little bit of assistance, they need some Russian stimulation or neuro muscular, you know, emfs. So we need to make sure that we get those people back on track. So, you know, when I talk to medical providers, you know, you could you can be an NP, you could be a PA, just a medical provider, family, Doctor, whatever it may be, if you’re doing a physical on a patient, let’s say and, and or an exam for one issue, but you see that they’ve come in, they’ve had knee surgery, and you recognize that there are some quadricep atrophy there, and maybe they can’t tighten their quad very well.

They may need some intervention needed to prevent some long term problems, it’s always good to rule out you know, if they have a DVT, if they have a limp, you know, get that corrected right away, because the longer people limp, the longer they’re going to want to live. And it gets to a point where they don’t even know that they’re limping. And we need to get them out of that. So we want to prevent long term problems.

Most people will do well on their own, but others that don’t really have some trouble down the road. And so you know, it’s good that we can get them educated and teach them you know, how to get headed into the right direction right away. So again, not a big sales pitch or physical therapy. Like I said, sometimes it’s just one or two visits afterwards to answer questions and get them heading in the right direction. But that’s really all I’m asking for. This was a very short episode today. Be sure to check out our YouTube channel, we’re throwing out some new videos all the time, some really interesting stuff. So please get on there. You know, like us and subscribe and you know, make comments because I try to answer as many of those as I possibly can. Be sure to check out our sponsors, our new sponsors, the folks who made core professionals, they have a great lineup of equipment, these folks have great customer service. So check out their link in the show notes and see what they have to offer.