February 18th, 2018
With this past month's JOSPT, an updated Clinical Practice Guideline (CPG) for Knee Meniscus and Articular Cartilage Lesions was released. Meniscus tears and cartilage lesions are commonly seen in the physical therapy setting. Once thought to require surgery, significant research has since revealed that outcomes are similar whether you have had surgery or physical therapy about a year later.
While being able to identify the potentially injured tissue can be beneficial, treating the impairments remains the basis for intervention. However, because of the research that has been accumulated in managing meniscus and articular cartilage injuries, it is still recommended that we identify when these structures may be involved.
Now, some of the research for treating these injuries conservatively is based off of post-surgical management. A lot of the rehab is what you would expect: start with progressive active and passive ROM training and weight-bearing, followed by strength training in open- and closed-kinetic chain and neuromuscular training of lower quarter. Those are generally vague component to rehab but can be highly effective. Of course, not all cases are "text book." Sometimes (or often), the patient's perspective of what the injury is, or what they think it is, is more important than anything. It is extremely beneficial to educate the patient on the current pain science research, the lack of correlation between pathoanatomical injuries, and the success of conservative rehab for meniscus/cartilage injuries.
The importance of progressive loading cannot be overstated. While part of the CPG, using regular and progressive loading can have both mechanical and psychological benefits. There is some research out there that high repetition, low load exercise can be beneficial for cartilage repair. On the biopsychosocial side, progressive loading of the injured area can address some of the fear and apprehension associated with injury. Either way, the main message to take away is that physical therapy can be a possible treatment for meniscus or articular cartilage lesions, based on the recent CPG's, mechanotransduction, and/or psychological benefit.
-Dr. Chris Fox, PT, DPT, OCS
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