Literature Review on PT for Knee Injuries
Knee injuries are extremely common, especially among athletes who participate in high-impact sports. The knee is a complex joint that is responsible for bearing a significant amount of weight and stress, which makes it susceptible to injury. Physical therapy is an effective treatment for knee injuries that can help to relieve pain, increase range of motion, and improve function. A physical therapist will design a personalized treatment plan based on the specific needs of the patient (Chirichella et al., 2019). Treatment may include exercises, stretches, electrical stimulation, ice or heat therapy, and massage (Culvenor et al., 2022). In addition to reducing pain and improving function, physical therapy can also help to prevent future injuries by strengthening the muscles around the knee. For these reasons, physical therapy is an important treatment option for patients with knee injuries.
Anatomy and Physiology of Knee Joint
The knee joint is a complex structure consisting of the femur, tibia, and patella, which are held together by a number of ligaments. The meniscus is a crescent-shaped piece of cartilage that sits between the femur and tibia and acts as a shock absorber for the joint. The knee joint is essentially a hinge joint that allows the leg to bend and straighten. The knee joint is formed by the lower end of the femur (thighbone), which articulates with the upper end of the tibia (shinbone). The patella (kneecap) sits in front of the knee joint and protects it from impact. The knee joint is stabilized by a number of ligaments, tendons, and muscles. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) provide stability to the knee joint by preventing it from moving too far in either direction. The posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) are located within the knee joint and prevent the femur from sliding backward or forward on the tibia. The quadriceps muscle group straightens the leg at the knee, while the hamstrings muscle group bends the leg at the knee. Together, these muscles allow for a wide range of motion at the knee joint.
The anatomy and physiology of the knee joint are closely interrelated. For example, the MCL is present to prevent dislocation of the knee joint; however, if the MCL is torn, it can cause instability in the knee joint. Similarly, the ACL prevents excessive forward movement of the femur on the tibia; however, a torn ACL can lead to instability and pain in the knee joint. Understanding how these different structures work together is essential for proper diagnosis and treatment of injuries to the knee joint.
Pathology of Meniscus Injuries
Meniscus injuries are relatively common, especially in athletes who participate in sports that involve contact or collision. The most common type of meniscus injury is a tear, which can occur when the joint is suddenly rotated or flexed beyond its normal range of motion, when the joint is twisted or when there is sudden impact to the knee, such as from a fall. Meniscus tears can range from small tears that cause minimal pain to large tears that may require surgery (Chirichella et al., 2019).
Epidemiology of Meniscus Injuries
The most common complication of a meniscus tear is chronic knee pain. If not treated properly, a meniscus tear can lead to degenerative changes in the knee joint, such as osteoarthritis. Treatment for meniscus injuries typically focuses on relieving pain and inflammation and restoring range of motion to the joint. Physical therapy can be an important part of this treatment, as it can help to stretch and strengthen the muscles around the joint, as well as improve range of motion. Additionally, physical therapists can provide instruction on proper joint alignment and weight-bearing, which can help to prevent future injury (Culvenor et al., 2022).
This literature review will discuss knee injury types, risk factors, causes, management, and rehabilitation.
The meniscus is a C-shaped piece of cartilage that cushions the knee. There are two menisci in each knee, one at the inner edge and one at the outer edge. These menisci act as shock absorbers and help to distribute weight evenly across the knee joint. Tears of the meniscus are a common knee injury, particularly among athletes.
There are two types of meniscus tears: acute tears and degenerative tears. Acute tears occur when the meniscus is forcefully compressed, such as when landing after a jump. Degenerative tears occur gradually over time due to wear and tear. Acute tears are usually the result of a sudden twisting injury, while degenerative tears occur slowly over time as the cartilage weakens and wears down. Both types of tears can be painful and may cause the knee to swell. In some cases, surgery may be necessary to repair the meniscus. However, many people with meniscus tears are able to find relief with nonsurgical treatments such as ice, rest, elevation, and physical therapy (Chirichella et al., 2019).
Symptoms of a meniscus tear include pain, swelling, and stiffness. The pain is typically worse when twisting or rotating the knee. The feeling of pain is often worse when the knee is bent, and it may be difficult to fully extend the leg. In some cases, a clicking or popping sound may be audible when the injury occurs (Mahmoud et al., 2022).
A physician can diagnose a meniscus tear with a physical examination and imaging tests such as an MRI. An MRI is often used to confirm the diagnosis and to assess the extent of the injury. Treatment for a meniscus tear may include rest, ice, and physical therapy. In some cases, surgery may be necessary to repair the tear (Harput et al., 2020).
Meniscal tears are more common in people over the age of 40 and in those with osteoarthritis of the knee. Other risk factors include prior knee injuries, genetic factors, and participation in high-impact sports. The majority of meniscus tears are thought to be the result of degenerative changes, rather than acute trauma. Risk factors ultimately depend upon the sociodemographic characteristics of the patient as well as psychological factors (Masten et al., 2014; Metz et al., 2021). Law et al. (2021) found that age, rehabilitation and surgery characteristics are re-injury risk factors for adolescents following anterior cruciate ligament reconstruction.
Impact on Quality of Life
Knee injuries can have a significant impact on patients quality of life, due to the pain and loss of function that they can cause. In addition to the physical effects, knee injuries can also lead to emotional distress and financial burdens. Patients may struggle to return to activities that they enjoyed prior to their injury, and they may also suffer from depression and anxiety (Masten et al., 2014; Truong et al., 2020).
The financial costs of knee injuries can be significant, as patients may need to pay for doctors visits, medication, and physical therapy. For some patients, knee injuries may even lead to lost wages if they are unable to work. In addition, knee injuries can become a major economic burden, with the cost of treatment and rehabilitation often running into thousands of pounds.
With early diagnosis and appropriate treatment, many knee injuries can be successfully managed, allowing patients to return to an active and enjoyable lifestyle.
There are three primary options for managing a meniscus tear: conservative management, surgical management, and other options.
Conservative management includes rest, ice, compression, and elevation (RICE). The aim of RICE is to reduce swelling and pain in the affected area. Resting the joint helps to prevent further damage, while icing contributes to reducing inflammation. Compression helps to support the joint and prevent excessive swelling, while elevation helps to reduce pain and swellig by promoting drainage. While RICE is not a cure for knee injuries, it can help to speed up the healing process and reduce the risk of further damage (Harput et al., 2020).
Conservative management may also involve the use of over-the-counter pain medications or physical therapy. For some people, conservative management is enough to relieve symptoms and allow them to return to their usual activities. However, others may find that their symptoms persist or that their range of motion is limited. In these cases, surgical management may be recommended (Culvenor et al., 2022).
Surgical management of a meniscus tear typically involves arthroscopic surgery. During this procedure, a small camera is inserted into the joint through a small incision. The surgeon then uses special instruments to trim or repair the damaged tissue. In most cases, surgery is successful in relieving symptoms and restoring range of motion. However, there is always a risk of complications, such as infection or bleeding.
Surgery is often the recommended treatment for a meniscus tear, especially if the tear is large or the knee joint is unstable (Harput et al., 2020). The goal of surgery is to repair or remove the damaged meniscus and to stabilize the knee joint. There are several different types of surgical procedures that can be used, and the specific procedure will depend on the size and location of the tear, as well as the overall condition of the knee (Mowbray & Ireland, 2022).
Other options for treating a meniscus tear include injections of corticosteroids or platelet-rich plasma (PRP). These treatments can help to reduce inflammation and pain. PRP injections are relatively new and there is not yet a lot of data on their efficacy. However, they may be an option for people who do not want to undergo surgery or who are not good candidates for surgery. Corticosteroids are anti-inflammatory drugs that can be injected directly into the knee joint. They work by reducing inflammation, which helps to reduce pain and swelling. PRP, on the other hand, is a concentration of platelets that is injected into the knee joint. Platelets are cells that play an important role in wound healing, and PRP has been shown to accelerate the healing process. In terms of effectiveness, there is some evidence that PRP is more effective than corticosteroids in reducing pain and improving function (Culvenor et al., 2022).
Meniscus tears can be extremely painful and disruptive. However, there are many treatment options available that can help people to manage their symptoms and return to their usual activities.
Rehabilitation following a meniscus or knee injury is critical in order to restore full function of the joint. There are various methods of rehabilitation that can be employed, and the most effective approach depends on the individual case. Mahmoud et al. (2022) found for instance that a nursing rehabilitation program can improve knee function in patients undergoing arthroscopic meniscus surgery. However, Metz et al. (2021) showed that not all programs are effective for all patients; in their study, they identified sociodemographic factors associated with decreased compliance to prescribed rehabilitation after surgical treatment of knee injuries in pediatric patients.
Physical therapy is often used as it can help to improve range of motion and muscle strength.
Other methods of rehabilitation include electrical stimulation, laser therapy, ultrasound, and biomechanics. Biomechanical rehabilitation is a type of physical therapy that uses principles of biomechanics, mechanical engineering, and neuroscience to help patients recover from injuries. Biomechanical rehabilitation specifically for meniscus tear/knee injury patients often includes exercises that improve the patient’s motor control and proprioception (Theisen et al., 2022). Proprioception is the ability to sense the position and movement of one’s body in space. Improving proprioception after a knee injury is important because it can help the patient avoid further injury by providing feedback about their movement and position. Biomechanical rehabilitation can also help to improve the strength, flexibility, and range of motion of the injured joint. In addition, patients may also receive education about how to protect their injured joint and prevent future injuries.
The rehabilitation process should be tailored to the individual needs of the patient in order to maximize recovery (Walker et al., 2021). Different approaches may be more or less effective depending on the type and severity of the injury, so it is important to consult with a healthcare professional to determine the best course of action, as there are a variety of factors that need to be considered when tailoring the rehabilitation process, including the type of injury or illness, the severity of the condition, and the patient’s prior level of functioning. By taking all of these factors into account, healthcare professionals can develop a rehabilitation plan that is specifically designed to meet the needs of the individual patient. This tailored approach is essential for maximizing recovery and helping patients to regain their prior level of functioning.
With proper rehabilitation, patients can expect to regain full function of their knee and resume normal activity levels. Barring a severe tear, the literature recommends that patients first step in rehabilitation be to rest the knee and allow the initial swelling to go down. Once the swelling has subsided, patients should begin physical therapy, which will focus on regaining range of motion and strengthening the muscles around the knee. Depending on the extent of the injury, patients may also need to use crutches or a knee brace during this process. With time and dedication, most patients will make a complete recovery and be able to return to their previous level of activity.
Chirichella, P. S., Jow, S., Iacono, S., Wey, H. E., & Malanga, G. A. (2019). Treatment of knee meniscus pathology: Rehabilitation, surgery, and orthobiologics. PM and R, 11(3), 292308. https://doi.org/10.1016/j.pmrj.2018.08.384
Culvenor, A. G., Girdwood, M. A., Juhl, C. B., Patterson, B. E., Haberfield, M. J., Holm, P. M., Bricca, A., Whittaker, J. L., Roos, E. M., & Crossley, K. M. (2022). Rehabilitation after anterior cruciate ligament and meniscal injuries: a best-evidence synthesis of systematic reviews for the OPTIKNEE consensus. In British Journal of Sports Medicine. BMJ Publishing Group. https://doi.org/10.1136/bjsports-2022-105495
Harput, G., Guney-Deniz, H., Nyland, J., & Kocabey, Y. (2020). Postoperative rehabilitation and outcomes following arthroscopic isolated meniscus repairs: A systematic review. In Physical Therapy in Sport (Vol. 45, pp. 7685). Churchill Livingstone. https://doi.org/10.1016/j.ptsp.2020.06.011
Law, M. A., Ko, Y. A., Miller, A. L., Lauterbach, K. N., Hendley, C. L., Johnson, J. E., & Tsai, L. C. (2021). Age, rehabilitation and surgery characteristics are re-injury risk factors for adolescents following anterior cruciate ligament reconstruction. Physical Therapy in Sport, 49, 196203. https://doi.org/10.1016/j.ptsp.2021.03.003
Mahmoud, H., Fathy Ahmed Dawood, R., Ahmed Mohamed Eldesoky, H., Author, C., & Ahmed Eldesoky Author, H. (2022). Effect of Nursing Rehabilitation Program on Knee Functional Outcomes for Patients undergoing Arthroscopic Meniscus Surgery. In Original Article Egyptian Journal of Health Care (Vol. 13, Issue 2).
Masten, R., Tuak, M., Straar, K., Zupanc, O., Drobni?, M., Marinek, M., & Kandare, M. (2014). Psychological factors of rehabilitation of athletes after knee injury. Zdravstveno Varstvo, 53(3), 226236. https://doi.org/10.2478/sjph-2014-0023
Metz, A. K., Bs, , Hart-Johnson, T., Blackwood, R. A., Crawford, E. A., & Md, . (2021). Sociodemographic Factors Associated with Decreased Compliance to Prescribed Rehabilitation After Surgical Treatment of Knee Injuries in ediatric Patients. The Orthopedic Journal of Sports Medicine, 9(11). https://doi.org/10.1177/23259671211052021
Mowbray, M. A. S., & Ireland, J. (2022). Personal and narrative review of the current management of the injured anterior cruciate ligament of the knee in the UK with reference to surgical treatment versus rehabilitation. BMJ Open Sport & Exercise Medicine, 8(3), e001410. https://doi.org/10.1136/bmjsem-2022-001410
Theisen, B. J., Larson, P. D., & Chambers, C. C. (2022). Optimizing Rehabilitation and Return to Sport in Athletes with Anterior Knee Pain Using a Biomechanical Perspective. Arthroscopy, Sports Medicine, and Rehabilitation, 4(1), e199e207. https://doi.org/10.1016/j.asmr.2021.10.028
Truong, L. K., Mosewich, A. D., Holt, C. J., Le, C. Y., Miciak, M., & Whittaker, J. L. (2020). Psychological, social and contextual factors across recovery stages following a sport-related knee injury: A scoping review. In British Journal of Sports Medicine (Vol. 54, Issue 19, pp. 11491156). BMJ Publishing Group. https://doi.org/10.1136/bjsports-2019-101206
Walker, A., Hing, W., Lorimer, A., & Rathbone, E. (2021). Rehabilitation characteristics and patient barriers to and facilitators of ACL reconstruction rehabilitation: A cross-sectional survey. Physical Therapy in Sport, 48, 169176. https://doi.org/10.1016/j.ptsp.2021.01.001
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