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J"-K3#.L+C8 A 17-yeai-olu male high school football playei with no pievious histoiy of
knee injuiies twisteu his left knee as an opposing lineman stiuck him uuiing a Fiiuay night
vaisity football game. Patient iepoiteu Bifficulty benuing oi stiaightening his knee, pain
while walking anu the inability to squat oi kneel on his left knee, all common signs of a
meniscal teai. D%MM)#)+$%"& D%"3+.,%,8 Possible meniscus teai with a uiffeiential uiagnosis
of a slightly subluxeu patella; baseu on chief complaints of left knee pain, swelling anu
stiffness. Tests such as Apley's compiession, patellofemoial giinu test, anu single leg squat
weie all positive. Apley's uistiaction, Lachman's, Ncmuiiay, patella appiehension test,
anteiioi anu posteiioi uiawei as well as valgus anu vaius tests of the knee weie all
negative. While Active iange of motion (AR0N) foi flexion was 98 uegiees; AR0N foi
extension was negative 8 uegiees. @#)"$/)+$8 Physician oiueieu x-iays weie negative, so
patient unueiwent physical theiapy foi 2 weeks; followeu by an NRI if necessaiy. The
thiee iehabilitation sessions weie focuseu on pain management anu iange of motion.
Patient was iefeiieu out to anothei physician foi a uiffeiing opinion. This physician
uiscoveieu a teai of the lateial meniscus. The patient unueiwent aithioscopic paitial
lateial meniscectomy foi a tiansveise teai of the posteiioi hoin 17 uays aftei the iepoiteu
injuiy. Post suigical AR0N foi flexion was 78 uegiees; AR0N foi extension was negative 7
uegiees. The iehabilitation piogiam consisteu piimaiily of iange of motion anu stanuaiu
muscle stiengthening exeicises uuiing the fiist week foi example stiaight leg iaise, hip
abuuction anu extension, stationaiy bicycle, as well as stietching of the quauiiceps,
hamstiing, anu gastiocnemius. Followeu by moie functional exeicises anu agility uuiing
weeks two anu thiee such as squats on a balance boaiu, lateial iesistance banu walking,
walking lunges anu total gym squats. Neuiomusculai electiical stimulation was also useu to
help inciease quauiiceps ieciuitment following immobilization. vasopneumatic
compiession was utilizeu to contiol post suigical swelling. The patient began piacticing
again with no contact just aftei 2 weeks post-op, anu was in full paus 17 uays aftei suigeiy.
F+%NL)+),,8 This case is unique uue to the iapiu ietuin of the patient following an
aithioscopic meniscectomy. The patient piogiesseu extiemely fast thiough theii
iehabilitation piogiam anu exceeueu the ietuin to play stanuaius incluuing single leg hop
test, single leg uistance hop test anu a tiiple jump. Each of these tests iequiieu a scoie of
8S% of the uninjuieu limb. :.+-&L,%.+,8 Supeiviseu piogiessive iehabilitation
encompassing stiength, cooiuination, flexibility, piopiioception anu balance is key to a
quick iecoveiy. E.#C :.L+$8 42S

@he meniscus of the knee biings stability to one of the most functional joints in the
bouy.
1
Nenisci also hanule loau-beaiing foices, absoib eneigy anu pioviue lubiication to
aiticulai caitilage.
1
The meniscus is iegulaily uamageu by compiessive anu iotational
foices at the tibiofemoial joint uuiing iegulai spoiting activities that involve cutting oi
pivoting.
2
Signs anu symptoms of a meniscal teai can be pain, swelling, inability to beai
weight, oi a clicking sensation uuiing activity.
2

Bue to the oveiwhelming majoiity of meniscal teais, aithioscopic meniscectomy is
the most commonly peifoimeu oithopeuic suigeiy in the 0niteu States.
S
Aithioscopic
suigeiy is consiueieu to be the golu stanuaiu foi meniscal teais.
4
Thus aithioscopic paitial
meniscectomy is favoieu uue to its minimal invasiveness which allows foi a quick ietuin to
play.
2,S
Accoiuing to in vitio conuitions, paitial meniscectomies yielueu less stiess inciease
on caitilage than total menisectomy's.
6
Suigeons aie theiefoie tiying to keep as much
meniscal tissue as they can intact.
7
Ishiua et. al. iepoiteu that 98% of athletes fiom one
stuuy ietuineu to play at an aveiage of SS uays post paitial meniscectomy.
8
0ui puipose is
to piesent the case of a male high school football playei who toie his lateial meniscus, hau
pie anu post-op iehabilitation anu unueiwent an aithioscopic paitial meniscectomy. The
paitial meniscectomy along with iehabilitation alloweu the athlete to ietuin to full activity
17 uays aftei suigeiy.

:95= ;=!H;@
A 17-yeai-olu male high school football playei with no pievious histoiy of knee
injuiies twisteu his left knee as an opposing lineman stiuck him uuiing a Fiiuay night
vaisity football game. Be hau immeuiate pain anu tiieu to continue to play; the pain was
intoleiable anu he hau to leave the game. Bis piimaiy chief complaints upon aiiival at the
physical theiapy clinic weie complaints of left knee pain, swelling anu stiffness. Fuithei
questioning leau to complaints of uifficulty benuing oi stiaightening his knee, pain while
walking anu the inability to squat oi kneel on his left knee, all common signs of a meniscal
teai. 0thei symptoms incluueu constant pain, uecieaseu iange of motion (R0N) anu
balance, uecieaseu stiength, an unstable feeling of knee in extension, pain with staiis both
ascenuing anu uescenuing, pain with gait, pain sitting oi stanuing too long, anu pain
changing positions.
The patient saw a physician who took x-iays, which came back negative. Two weeks
of physical theiapy weie suggesteu, followeu by an NRI if neeueu. Buiing the initial
evaluation the following tests weie negative; Apley's uistiaction, knee anteiioi anu
posteiioi uiawei, knee valgus anu vaius test, Lachman's test, Ncmuiiay test, anu patella
appiehension test. While the following testeu positive; Apley's compiession, patellofemoial
giinu test, anu single leg squat. Active iange of motion (AR0N) foi flexion was 98 uegiees;
AR0N foi extension was negative 8 uegiees. Initial uiagnosis was a possible meniscus teai
with a uiffeiential uiagnosis of a slightly subluxeu patella.
The patient went thiough thiee physical theiapy sessions gaugeu piimaiily at
uecieasing pain anu incieasing iange of motion. Bowevei uue to consistent pain, the
patient was iefeiieu out to see anothei physician. Subsequently 17 uays aftei the injuiy
occuiieu the patient unueiwent a paitial lateial meniscectomy foi a tiansveise teai of the
posteiioi hoin.
Post suigical AR0N foi flexion was 78 uegiees; AR0N foi extension was negative 7
uegiees. Theie was moueiate swelling in the knee with limiteu R0N anu stiength. Patient
was able to peifoim a stiaight leg iaise; theie was howevei negative 2u uegiees of quau
lag. The patients iehabilitation piogiam consisteu of exeicises to inciease quauiiceps
ieciuitment, anu inciease knee extension. Neuiomusculai electiical stimulation NNES was
also useu to inciease quauiiceps ieciuitment anu vasopneumatic compiession was useu to
contiol swelling.
The patient anu the physician wanteu him to piogiess quickly thiough his
iehabilitation piogiam. 0vei the fiist week, the iehabilitation piogiam consisteu piimaiily
of iange of motion anu stanuaiu muscle stiengthening exeicises such as stiaight leg iaise,
hip abuuction anu extension, stationaiy bicycle, as well as stietching of the quauiiceps,
hamstiing, anu gastiocnemius. The seconu week of iehabilitation consisteu of moie
functional exeicises such as squats on a balance boaiu, lateial iesistance banu walking,
walking lunges anu total gym squats with iemaining sessions woiking on agility. Retuin to
play ciiteiia consisteu of a single leg hop test, single leg uistance hop test anu a tiiple jump.
If the patient coulu exceeu 8S% of his uninjuieu limb scoies he woulu be able to ietuin to
competition. Bue to the quick piogiession anu the ueteimination of the patient he was
piacticing again with no contact just aftei 2 weeks post-op, anu was in full paus 17 uays
aftei suigeiy. This is a unique case uue to the iapiu ietuin of the athlete. Aftei speaking
with the physical theiapist, he concluueu that this was by fai the quickest ietuin to play he
hau evei seen foi such an injuiy.

D15:F551HO
Aithioscopic meniscectomies can leau to uecieases in iange of motion, loss of
stiength anu atiophy of the thigh musculatuie, anu joint effusion.
2,9-11
Neniscectomies
altei the stiess uistiibution of the knee as well as inciease the contact piessuie between
the tibia anu femui.
12
Immobilization is linkeu with a ueciease in muscle foice geneiating
capacity.
9
This inhibition of uninjuieu musculatuie aiounu an injuieu joint is most likely
iesponsible foi the lack of muscle stiength.
2
Theiefoie iehabilitation of muscle function is
key aftei an injuiy to the knee joint.
9

Theie is a gieat vaiiety of iehabilitation techniques, staiting with no foimal exeicise
piogiam all the way to a supeiviseu piogiessive iehabilitation piogiam.
2
The supeiviseu
iehabilitation piogiam has been suggesteu fiom both shoit teim anu long teim follow up
stuuies.
S,11
Pain anu swelling aie piesent post-op, but as pain uecieases R0N begins to
inciease.
1S
To obtain musculai stabilization of the joint you neeu to inciease sensoiimotoi
contiol thiough functional tiaining.
1S
0ui patient peifoimeu stiength, cooiuination,
balance, anu piopiioceptive exeicises thioughout his iehabilitation, which accoiuing to
Eiicsson et. al. aie aspects of a neuiomusculai exeicise piogiam.
1S

To an athlete nothing is moie impoitant than piopiioception. Piopiioception
consists of joint position in space, kinesthesia anu the effeient closeu loop ieflex.
14

Accoiuing to Al-uauah et al. knee piopiioception suffeis even aftei an aithioscopic paitial
meniscectomy.
14
Theiefoie I believe one of the acceleiating factois of oui athletes ietuin
was uue to the incoipoiation of piopiioceptive exeicises.
Aithioscopic suigeiies along with paitial iemoval of the menisci aie still less
tiaumatic foi the knee joint when compaieu to open suigeiy oi total meniscectomies.
1u

Nost patients suffei fiom an antalgic gait aftei unueigoing a lowei extiemity suigeiy, thus
most iehabilitation piogiams focus on noimal gait. Nagyai et al. founu that it coulu take up
to 12 months post suigeiy befoie patients weie able to ambulate with an automatic
ihythmic gait.
1S
0ui subject howevei was ambulating within uays post suigeiy without the
suppoit of ciutches. Theie was howevei no knee flexion, which is to be expecteu. Buiing
gait following a paitial meniscectomy it has been iepoiteu that the meniscectomy patients
showeu a ueciease knee flexion R0N.
4
Foiu et al. stuuy testeu lanuing auaptation post
meniscectomy, anu they believeu the uecieaseu knee extensoi toique was possibly uue to
quauiiceps weakness.
4
Thiough the iehabilitation piogiam anu use of moualities such as
NNES oui patients knee flexion ietuineu to noimal iange of 1SS uegiees.

:HO:(F51HO
In spoits injuiies aie bounu to happen, but in ceitain situations athletes ietuin to
play much fastei than otheis. Theie is a multituue of factois that come into play, but a
constant factoi the clinician can contiol is pioviuing a well balanceu iehabilitation piogiam
to give the athlete the best possible chance to ietuin to play as safely anu quickly as
possible. Incoipoiating stiength, cooiuination, balance, flexibility, anu piopiioceptive
exeicises is key to making a well-balanceu piogiam. It is haiu to say whethei the biief pie
suigeiy iehabilitation woikeu since it was mostly pain management. This case iepoit
howevei has biought to light that theie may be a benefit to this pie-opeiative
iehabilitation uue to oui athlete's iapiu ietuin to play.

;=6=;=O:=5
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2u12;2u(S):9SS-9S6.
2. NcLeou NN, uiibble P, Pfile KR, Pietiosimone Bu. Effects of Aithioscopic Paitial Neniscectomy on
Quauiiceps Stiength: A Systematic Review. 4 %)*'+ 5#2.670. 2u12;21(S):28S-29S.
S. Koutias u, Letsi N, Papauopoulos P, uigis I, Pappas E. A Ranuomizeu Tiial of Isokinetic veisus Isotonic
Rehabilitation Piogiam Aftei Aithioscopic Neniscectomy. 8"+ 4 %)*'+, 92:, -2#'. 2u12;7(1):S1-S8.
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5#2.670. 2u12;26(S):224-2S6.
6. Rockboin P, Nessnei K. Long-teim iesults of meniscus iepaii anu meniscectomy: a 1S-yeai functional anu
iauiogiaphic follow-up stuuy. !"## %&'( %)*'+, -'.&/.+*0 1'+2'*,3. 2uuu;8(1):2-1u.
7. Kim S-}, Chun Y-N, }eong }-B, Ryu S-W, 0h K-S, Lubis A. Effects of aithioscopic meniscectomy on the long-teim
piognosis foi the uiscoiu lateial meniscus. !"## %&'( %)*'+, -'.&/.+*0 1'+2'*,3. 2uu7;1S(11):1S1S-1S2u.
8. Ishiua K, Kuioua R, Sakai B, Boita N, Kuiosaka N, Yoshiya S. Rapiu chonuiolysis aftei aithioscopic paitial
lateial meniscectomy in athletes: a case iepoit. !"## %&'( %)*'+, -'.&/.+*0 1'+2'*,3. 2uu6;14(12):1266-
1269.
9. uapeyeva B, Paasuke N, Eieline }, vahei v, Pintsaai A, Ellei A. Recoveiy of contiactile piopeities of the knee-
extensoi muscles aftei aithioscopic paitial meniscectomy. Recupeiation ues piopiietes contiactiles ues
muscles uu genou apies une meniscectomie paitielle pai aithioscopie. 4 %)*'+ 5#2.670. 2uu1;1u(4):298-Su7.
1u. uapeyeva B, Paasuke N, Eieline }, Pintsaai A, Ellei A. Isokinetic toique ueficit of the knee extensoi muscles
aftei aithioscopic paitial meniscectomy. !"## %&'( %)*'+, -'.&/.+*0 1'+2'*,3. 2uuu;8(S):Su1-Su4.
11. uoouwin P c., Noiiissey N c., 0mai R z., Biown N, Southall K, NcAuliffe T. Effectiveness of supeiviseu
physical theiapy in the eaily peiiou aftei aithioscopic paitial meniscectomy. 92:, -2#'. 2uuS;8S(6):S2u-SSS.
12. Naiiani P, uaiofalo R, Naigheiitini F. Chonuiolysis aftei paitial lateial meniscectomy in athletes. !"## %&'(
%)*'+, -'.&/.+*0 1'+2'*,3. 2uu8;16(6):S74-S8u.
1S. Eiicsson YB, Bahlbeig LE, Roos EN. Effects of functional exeicise tiaining on peifoimance anu muscle
stiength aftei meniscectomy: a ianuomizeu tiial. %3."< 4 =#< %37 %)*'+,. 2uu9;19(2):1S6-16S.
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%)*'+, -'.&/.+*0 1'+2'*,3. 2u11;19(2):2u7-21S.
1S. Nagyai N, Knoll Z, Kiss R. The influence of meuial meniscus injuiy anu meniscectomy on the vaiiability of gait
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