Meniscus Tear

imageedit_4_4053006943By Mary Larkin

PT and Senior Sports Injury Analysis

 

 

Meniscus Tear And NFL Players

Meniscus and the NFL Football Player

Image source: aaos.org

 

The knee meniscus is a thick (fibrocartilaginous) tissue, which sits between the femur (thigh) and the shin (tibial) bone. Each knee has a inside (medial) and outside (lateral) meniscus, and acts as a cushion between these two bones, preventing friction and wear on the surface of these bones. Meniscus tears are very common among NFL athletes, and can vary greatly in severity. All positions on the football field are vulnerable to a meniscus injury, due to the high level of stress and repetitive force placed on the knee.

 

 

Function of the Menisci

The function of the meniscus is to cushion the space between the femur and tibia bone, to prevent friction and wear and tear. They also act as a shock absorber. When the meniscus is torn, it can cause pain due to fraying or fragments of the tissue braking loose, and causing disruption of the joint. If the injured tissue gets compressed between the two bones, it can cause significant pain in weight bearing positions. For a football player, this will limit the ability to run, jump, cut, and perform power motions. Meniscal fragments in the joint can also cause varying levels of swelling, which will inhibit overall athletic function.

 

 

Types of Meniscus Tears

Menisus Tear and NFL Football Player

Image source brown.edu

There are several different types of Meniscal tears, which are presented in the picture to the right. Meniscus injuries can occur due to a traumatic force to the knee, or can be degenerative over time, due to repetitive physical activity. Medial mensical tears tend to be more common than lateral tears. Some tears can be minor causing little to no pain, and other tears can be debilitating. Generally, bucket handle tears tend to be very painful and cause athletes to be sidelined. In most cases, this injury will require surgery to fix.

 

Symptoms of a meniscal tear may include:

  • Pain and tenderness at the joint line
  • Swelling
  • Locking or buckling of the knee with ambulation
  • Limited range of motion with bending and straightening of the knee

 

Treatment

Unless a significant tear is seen on an MRI, most mensical tears are treated conservatively during the season. Physical therapy is indicated to reduce swelling, eliminate pain, restore range of motion, maximize strength, and restore an athlete to their prior athletic function. These goals are the same for surgical cases, but will take a longer time to achieve these goals.

 

Time Frame for Return to Sport

Non-Surgical: 1 week (+) – Depending on the severity of the tear, athletes can return to play by the next game with only one week of treatment, or it may take several weeks for recovery Mild tears to the outside of the meniscus (radial tears) may only take one week to recover, but horn or bucket-handle tears may take up to 4 weeks. Note: if conservative treatment does not work, the athlete will require surgery.

 

Surgical:  A surgeon can either remove or repair the damaged portion of the meniscus. Repairs preserve the knee’s long-term health at the expense of a longer recovery, while removals allow an athlete to return to play more quickly but come with a higher risk of problems years from the surgery.

During arthroscopic surgery, the surgeon will go in and clean out and smooth the surface surrounding the tear. During the players offseason, the doctor and athlete may decide they want to repair (sew) the tear. The healing time can be anywhere from 3(+) months, and does not have a high success rate. If an athlete wants to return to play in-season, a debridement will most likely be done. Return to play can be anywhere from 2-6 weeks depending on the athlete, the extent of the tear, and the position of the player. It is not uncommon for professional football players to push the envelope and return sooner than they should. Positions like linemen and linebackers may tolerate playing on a healing or post-surgical knee one week after surgery, and will usually require a sports brace to limit rotation. Running backs, cornerbacks, and receivers will take longer to return, due to the more dynamic requirement of their positions.

 

 

Return to Play Study:

A study published by Dr. Danyal Nawabi in the American Journal of Sports Medicine uncovered a median” return-to-play time of seven weeks for elite soccer players following a partial lateral meniscectomy. Medial” operations, on the other hand, required just five weeks.

Even more striking, Nawabi et al. identified 29 players, or 69 percent of the study’s lateral group participants, who experienced knee pain or swelling in the early recovery period following a lateral meniscectom. Just four patients, or eight percent of the medial group, developed complications after a medial-sided operation. The studies overarching conclusion—one that lateral meniscus tears are generally more troublesome

 

NFL Players with Meniscal injuries:

Meniscal tears are very common in NFL football players due to the high level of impact and repetitive stress the knee endures. Below are examples of professional athletes and their time frames for return to play:

  • Packers starting right tackle Bryan Bulaga tor his meniscus and missed four weeks.
  • Buffalo Bills running back Anthony Dixon rushed for 432 yards and two touchdowns in 2014, and he says he did so with a partially torn meniscus in his knee.
  • Texans outside linebacker Jadeveon Clowney returned to practice October 18 for the first time since undergoing arthroscopic knee surgery on Sept. 8 for a torn meniscus. He made his return exactly six weeks and  wore a brace on his right knee.
  • Former UCLA linebacker Myles Jack tor his meniscus in September during practice and cleared to play in March.

 

 

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