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Lateral Meniscus Tear in a 19 Year Old Male Football Player’s Right Knee: A Case Report
Keiran Bibbs
Pathology and Evaluation of Orthopedic Injuries I
Leavy
Lateral Meniscus Tear in a 19 Year Old Male Football Player’s Right Knee: A Case Report
Keiran Bibbs
Abstract
Objective: The objective of this paper is to study a 19 year old male football player that suffered
a lateral meniscus tear. In addition, the paper will discuss the functions of the knee, anatomy, the
mechanism of injury and possible reason of his susceptibility to the injury. Background: The
athlete saw the team physician during preseason with a pre-existing meniscal tear. During a pickup game the athlete planted his foot and tried to make a quick change of direction or “cut”. The
athlete heard a pop followed by pain and swelling. Diagnosis: The athlete saw his physician after
the injury occurred and was sent for an MRI thereafter was diagnosed with a lateral meniscal
tear. Treatment: Since the injury occurred before the pre-season the team physician postponed
the surgery until the conclusion of the season. The athlete had been given a rehab program that
he would follow for the remainder of the season. The rehab consisted of ultrasound, massage,
ice, wall squats, straight leg raises, leg press, knee extension, balance cup drill, calf raises, heel
taps, ball bridges, glute/hamstring raises, cybex machine, agility ladder, hurdles, squat hops, and
ball tosses. These were utilized to strengthen the muscle groups around the knee (quadriceps and
hamstrings) in addition to controlling pain/swelling. The athlete will also undergo an
arthroscopic surgery to repair the tear after the season. Uniqueness: The injury that the athlete
suffered is rare. The medial meniscus is typically torn more often due to larger size and
immobility compared to the lateral meniscus. Conclusion: The tearing of the meniscus is a very
prominent injury within the knee and athletics. The study will give a summary of an athlete’s
lateral meniscal tear in addition to the rehabilitation processes, diagnosis, and evaluation. Key
Words: Arthroscopic surgery, lateral meniscus tear, knee anatomy, football.
To understand the knee and the problems associated with the knee you must understand
its anatomy. 1 The knee complex is made up of the tibiofemoral, tibiofibular, and patellofemoral
joints with little help from bone structure the knee must rely on soft tissue and ligamentous
structures to control forces placed upon it on a daily basis. These structures help support the knee
and are present both medially and laterally. The muscular structures are the vastus medialis,
vastus lateralis, vastus intermedius, rectus femoris, biceps femoris, semitendonosis,
semimembranosus, and the Iliotibial Band. Together the muscles provide knee flexion,
extension, internal rotation, external rotation, and lateral movements. The ligamentous structures
consist of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament,
lateral collateral ligament, and the arcuate ligament. These ligaments prevent from anterior,
posterior, lateral and medial translation of the tibiofemoral joint. “This tibiofemoral joint is
connected by the medial and lateral femoral condyles. The condyles articulate with the tibia
which have 2 sides also known as plateaus”.1 Within the plateaus is the injured structure the
menisci which provide a “seat” for the condyles.1 2
The Menisci are two oval (semilunar) fibrocartilages that deepen articular facets of the
tibia, cushion any stresses placed on the knee joint and maintain spacing between the femoral
condyles and tibial plateau.3 There is a lateral and medial menisci the lateral menisci is smaller
yet more mobile whereas the medial menisci is larger and less mobile leaving it more susceptible
to tearing. Approximately 81% of meniscal tears are medial and 19% are lateral meniscal tears.
An instability in other ligaments may predispose one to meniscal tears.4 In this case there is a
potential that the knee was predisposed to this injury due to previous hyperextension that
occurred before this injury. In addition the menisci has a poor blood supply which is very
important to know when dealing with meniscal tears.3 The meniscal boarders both medial and
lateral only receives up to 30% of direct blood which is just enough to supply.4 The very little
blood supply makes injury hard to recover from without proper care/surgery. 3,4
The meniscus due to its shape has different types of tears longitudinal, oblique,
horizontal, radial and complex. Although surgical repair is an option not all are considered
repairable on its own like other injuries. The ones that are not considered repairable are the
horizontal, radial, and complex. The other two are repaired through resting, icing, and
compressing the injury along with proper strengthening. With the other three tears a procedure
called arthroscopic surgery will be utilized which is when the tear is removed to promote the
healing process. In addition the patient will regain function in the knee and more stability.
Following the surgery the patient will go through rehab and functional exercises to optimize their
performance and recovery. 4
A 19 year old male Division III Collegiate football player suffered a right lateral meniscal
tear during a pick-up game during the preseason. The athlete said while running he planted his
foot to change direction quickly and heard a sudden pop as he continued through the motion. The
sound was followed by immediate pain. The athlete had also mentioned that he as previously
history of a hyperextended of that same knee not too long before he re-injured it. He was unable
to finish the rest of the game after the occurrence of the injury due to the 10 out of 10 pain scale
the athlete claimed he had. The athlete had immediate swelling, throbbing, but no ecchymosis
was present. He also had pain with going up and down the stairs, and walking. He claimed that
he limped around and as the swelling became worse his limp was worse, in addition to the
guarding of his knee because of the pain. Due to the injury occurring outside of the season the
athlete saw his own physician where the athlete’s knee was then palpated, observed, and tested.
The physician saw the swelling around the knee and saw the limp that he had coming into
the facility. Following his observation the physician would go through palpations of both soft
tissue and bony landmarks for any deformities or pain which would indicate a positive test. The
structures the physician would palpate are the patella, Lateral Collateral Ligament, Medial
Collateral Ligament, condyles of the femur, patellar tendon, tibial plateaus, and medial meniscus/
medial joint line, lateral meniscus/ lateral joint line. The physician would have found that the
athlete would have pain on the lateral join line or where the meniscus would be or pain on the
lateral side of the knee. The athlete then would go through the different ranges of motion.
Passive flexion didn’t hurt until he was around 90 degrees and extension didn’t seem to hurt the
athlete at all. The athlete had slight pain with actively extending his knee, and had even more
pain flexing his knee. The resistive range of motion was not performed due to the amount of pain
the athlete had during the time. The physician would have implicated that the athletes extension
range of motion were within normal limits while his flexion was not. Following the range of
motion the physician would have formed manual muscle tests. The rectus femoris would be the
anterior muscle tested which the athlete claimed hurt but had enough strength. The posterior
muscle group or hamstring muscles would also be tested by the physician specifically the biceps
femoris, semitendinosus, and semimembranosus. The grading for the muscle tests for the rectus
femoris would have been around 3/5 and for the other muscles a 5/5.
No Neurological tests were performed because the patient didn’t have any numbness or
tingling. The special tests that the physician would perform suspecting a lateral meniscus tear
would be the duck walk, medial lateral grind, Apley’s compression, bounce home, Varus/Valgus
stress tests, Lachman’s, McMurray’s. Following these tests the physician wrote down that it was
a lateral meniscal tear and appointed him to have Magnetic Resonance Imaging also known as a
MRI for his right knee. When his results came in the MRI solidified that it was in fact a lateral
meniscal tear.
I believe the diagnosis of the lateral meniscal tear was correct. The mechanism of the
injury matched exactly what a lateral meniscal tear would come from which is the quick change
of direction with a shear force. Also the knee was very swollen and was point tender when
palpated. Most of the athlete’s only had pain along the lateral side of the knee. The greater pain
was specifically on the lateral meniscus or the lateral joint line where it is located. The athlete’s
pain with range of motion also hinted a possible meniscal tear. One of the bigger aspects that
assured it was a lateral meniscal tear was the positives for all the special tests performed on him.
The athlete claimed when he was told to do the duck walk he couldn’t squat and claimed the
bounce home test hurt a lot along with the medial lateral grind test.
With the MRI coming back as a positive meniscal tear the physician left the decision up
to the athlete and the team physician whether to play the year or sit out and undergo surgery. The
athlete and team physician decided to postpone the surgery until the season ended. In the
meantime the athlete’s physician gave him a rehabilitation program to utilize throughout the
season. The goals of the program were to maintain/gain strength around the aspects of his knee,
reduce pain, and swelling. The athlete received cortisone shot to relieve pain he was having so it
was more bearable to play on during the preseason and another the last quarter of the season. His
pain went from 10 out of 10 to approximately 5 out of 10. He received a lot of ice, stim, and
massage therapy to help with the pain and swelling that was present in his knee. He continued
these modalities throughout the season to ensure the swelling and pain remained at a minimum.
Since there is not much one may do for a meniscal tear the athlete had a less aggressive
strengthening aspect of the rehabilitation program. The exercise program consisted of a 10
minute warm up and 3sets by 10 reps of the following exercises wall squats, straight leg raises,
leg press, knee extension, balance cup drill, calf raises, heel taps, ball bridges, glute/hamstring
raises, cybex machine, squat hops, ball squeeze, lunges, 4 way hip machine and ball tosses. The
athlete made great leaps forward with the amount of pain the pain and strength he had. His
strength increased along with his balance so he felt as though he was more stable. The swelling
in his knee was almost gone although it will be hard to have it all go away because scar tissue is
still present in the knee. A friction message would be utilized but is contraindicated because of
the pain it would cause and inflammation within the knee.
The athlete would be ready to return when he has little or no pain with his ranges of
motion. The athlete also must be able to perform functional exercises. He is a defensive back so
he would need to perform side shuffles, karaoke, sprints, back pedals, opening his hips and
running, hopping on one leg, jumping up in the air, and quick change of direction drills. He
would need to do these with minimal or no pain and absolutely no limping. In addition a brace
must need to be worn or tape to ensure the knee has optimal support throughout the practices.
It is important to know about this case study because the tearing of the meniscus is a very
common athletic injury. Yet, just because you are not an athlete it does not mean you are not at
risk to tear your meniscus. Although tearing structures can be common they are very serious and
can lead to many complications if left untreated. The meniscus plays a big role within the knee
and without a meniscus the whole knee complex is compromised.
References
1) Blackburn A. T., Craig, E. (1980) Knee Anatomy: A Brief Overview. Physical Therapy
60:1556-1560
2) Brown D. S., Ryan J., Startkley C. (1959) Examination of Orthopedic and Athletic
Injuries 3: 289-295
3) Prentice E. W. (2011) Principles of Athletic Training: A Competency-Based Approach
14: 557-578
4) Baker E. B., Peckham C. A., Pupparo F., Sanborn C. J. (1985) Review of meniscal injury
and associated sports. The American Journal of Sports Medicine 13(1), 1-4.