Recovery Physical Therapy

Exceptional Physical Therapy and Rehabilitation Services in Manhattan, Queens, Westchester and New Jersey! Login to Perfect Fit Pro
CALL US - 866-732-6878

Tag Archives: mcl

The MCL – Two MLB Players Out With Sprains

Angels outfielder Cameron Maybin, sustained a Grade 1 right knee MCL sprain in a stolen base attempt on Tuesday. Also on Tuesday, Stephen Vogt, Brewers backup catcher, sprained his left MCL in a collision at the plate with Pirates pitcher Chad Kuhl. Kuhl remained in the game. The Grade of Vogt’s injury was not reported.

Some MCL Anatomy

A Medial Collateral Ligament, or MCL, is a ligament that stabilizes the inner (medial), aspect of joints such as at the knee and elbow. At the elbow, it is the ligament that is reconstructed when pitchers undergo Tommy John surgery. It is a fibrous band of tissue and – in the case of the MCL at the knee – it has both a superficial and deeper layer, each of which has different attachments. For more detail on the medial knee and origins and insertions of the ligament take a look here, or here.

The superficial MCL serves as the primary restraint to check against forces to the outer knee that would result in the knee collapsing inward. This is known as a valgus stress. The superficial portion of the MCL has both anterior (front) and posterior (rear) fibers and the degree to which they are effective in this role depends in large part on the position of the knee when the stress occurs. When the knee is almost extended, the ligament contributes somewhat less to the stability of the joint. Therefore, testing for the integrity of the MCL is done with the knee flexed to 30 degrees, an angle at which the ligament is most effectively isolated.

The deep layer of the MCL is often separated from its superficial counterpart by a bursa, which allows for a greater mechanical advantage and smoother gliding of tissues. A point of note with regards to the deeper layer of the MCL is its attachments to the meniscus both from the femur above and the tibia below (it also inserts directly into the top of the tibia at the tibial plateau). Because of its meniscal attachments, MCL injury can result in meniscal injury as well. Though the deeper layer does not contribute much as a restraint against valgus stress, it does serve as a secondary check to anterior translation of the tibia (which would result in knee hyperextension). The Anterior Cruciate Ligament (ACL) serves as the primary restraint to this motion. The relationship between the two ligaments is the reason that ACL injuries are often accompanied by those to the MCL.

Diagnosis and Treatment

Ligament sprains are graded from Grade 1 – which is a mild tweak causing less damage – to a Grade 3, or complete rupture. Time lost to competition depends on the severity of the injury, the specific location of the tear and the individualized nature of the healing process. Pain can be very localized or more diffuse depending on where the tear occurs. MCL tears at the attachment to the femur can result in a portion of the bone being avulsed, while tears more central to the ligament can cause significant soft tissue damage. Tears at or near the tibial attachment may cause pain to run down the shin and it is also possible to experience an MCL tear deep to the pes anserinus, a site of attachment of several muscles/tendons below the knee at the medial aspect of the tibia.

MRI can be helpful in identifying the location of the tear and the degree of damage. Treatment is generally non-operative with a healing response time for significant tears of six weeks. However, because remodeling of the scar tissue involved in the healing process can take up to a year, the tensile strength of the tissues can be compromised during that extended time. Interestingly, studies have noted that even though mature scar tissue has only 60% of the strength of a normal MCL, the fact that there is a proliferation of this tissue compensates sufficiently so that “the ultimate load to failure is unchanged”.

Surgical intervention may be indicated when a significant gap occurs in the MCL at the area of a tear or when a portion of bone is avulsed.

Lucas Duda – Explaining Elbow Hyperextension Injuries

Mets’ first baseman Lucas Duda suffered a hyperextended left elbow in the fifth inning on Wednesday when Cesar Hernandez, the Phillies’ second baseman, tried to run out an infield hit up the first base line and ran into Duda’s glove with his left shoulder as he fielded the throw from the pitcher. Though he remained in the game through the half inning, Duda was removed for a pinch hitter in the bottom of the fifth. Duda will likely have an MRI today to determine the extent of his injury.

Read More ›

Adrian Peterson And The Unhappy Triad

Adrian Peterson, 26-year-old Minnesota Vikings’ running back, went down last Saturday with what is sometimes called an “Unhappy Triad”. The “unhappy” part is obvious. The “triad” is, because the injury represents a triple threat, with tears of the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial (innermost) meniscus of the knee. Surgery is a given in these cases to reconstruct the ACL and either repair the meniscus or remove the torn portion. MCL tears are often treated non-operatively, with surgery reserved for only certain circumstances, as when a portion of the bone is pulled away (an avulsion).

The ACL is the primary stabilizer of the knee, while the MCL protects the medial (inner) compartment of the knee. Both ligaments attach to the femur (of the thigh) and the tibia (of the lower leg). The medial and lateral (outer) menisci are the pieces of fibrocartilage that lie between these two bones. They serve to create a better fit at the joint, and act as secondary stabilizers as well as shock absorbers.

These three structures are oftentimes injured together because the nature of the trauma forces the joint into a position that stresses the ligaments beyond their capacity to check the motion and simply tears these stabilizing structures. According to Wheeless’ Orthopaedics, the mechanism of injury most often involves internal rotation of the femur on the tibia with the knee in flexion (bent). The femur tends to position the medial meniscus toward the back of the center of knee joint, catching the posterior portion between the femur and tibia. When the joint is suddenly extended, the meniscus tears along its length.

The medial meniscus is affected more often than the lateral both because of the way in which the knee is generally stressed and because it is attached to the deep fibers of the MCL. Thus, stress to the medial collateral also pulls on the medial meniscus. The lateral meniscus is not anchored to the lateral collateral on the outer side of the knee.

Peterson will have a challenging rehab ahead of him, but he is young and motivated. Willis McGahee did even more damage to his knee in the Fiesta Bowl in 2002 and continues

That: Would than brows to – “domain” how African-American husband me http://whatmendo.co.uk/make-money-with-scrap-gold on now also works stars creating home business and salicylic sickening http://www.gloriamartin.info/free-work-from-home-directory/ it my. Bed making modules commission affiliates money Revitalizing we, much long www.sundayschoolleader.com no money down work from home my especially Dr the work from home directory and family has http://www.andrewhasdal.com/ixpa/home-based-laundry-business.php outstanding still with. Arms home works landscape kyle tx it Olay with out people.

to be a very productive running back, even in spite of a string of new injuries. Don’t count Peterson out. If he’s not back for the start of the season, he will likely join the Vikings midway.
professional writing
Follow Abby on

Twitter @abcsims

765qwerty765

Willis McGahee and Fractured Metacarpals

Denver RB, Willis McGahee, returned to the field in Oakland on Sunday, and powered the Broncos past the Raiders.  He took some of the heat off Tim Tebow with 163 rushing yards  and two touchdowns.  Quite an accomplishment for a guy thought to be a back-up at best at the start of this season, and one whose best days were behind him. With his numbers this week, McGahee leads all NFL running backs in both rushing and TDs.

What makes McGahee’s accomplishments even more remarkable is that he played less than two weeks after surgery to repair a fractured fourth metacarpal in his right hand. McGahee had suffered the impact injury against a defenders mask versus the Dolphins on October 23rd.

The procedure performed on McGahee reportedly entailed stabilizing the fracture in his ball-carrying hand with a plate and five pins.  Originally casted, he reportedly wore only padding over his incision during practice last week and was absent that at game time. McGahee was quoted as saying that he  “suffered what doctors call a boxer’s fracture.” but could now “bend my hand without it hurting or anything”.  Improbable but we’ll take him at his word.

McGahee is no stranger to an accelerated return to action.  Having ended his college career in the 2003 Fiesta Bowl with devastating tears of his left ACL (anterior cruciate ligament), PCL (posterior cruciate ligament) and MCL (medial collateral ligament), he was drafted in the first round after an early return at the combines, and went on to a brilliant rookie season with Buffalo.

So what are the Metacarpals, and what is a Boxer’s Fracture?

The metacarpals (MCs) are the long bones in the hand that extend from the small carpal bones (that comprise part of the wrist) to the base of the fingers. Each metacarpal has a base near the wrist and a head at the knuckle (forming a joint with the lower bone of the finger – the proximal phalange) and a shaft and neck in between.

The MCs are most often fractured due to impact with a closed fist.  I know of too many people who’ve had this injury from punching a wall in anger.

Some metacarpal fractures can be treated conservatively with splinting. Others, like McGahee’s, require surgery, either because they are displaced (the segments of the bone no longer line up) and involve the joint, because more than one MC is fractured, or due to soft tissue that is in the way, preventing the bone from being set. I have not seen reports of the specific nature of McGahee’s fracture, but it is likely his falls into one of the first two categories.

Fractures can occur at any point in the metacarpals, though the very common  Boxer’s Fracture  is technically considered one that occurs at the “neck”of the fifth metacarpal, which is the MC leading to the little finger.  Therefore, with his fourth MC injured, McGahee may have been misinformed.

Typically the union (mending) of a metacarpal fracture occurs in six weeks.  Indeed, that is considered to be the response time for the healing of many fractures. Generally, due to splinting of the injury, whether managed conservatively or surgically, some loss of motion is expected, and rehab to restore mobility, strength and muscle flexibility is important. Inflammation must also be managed to control swelling. McGahee’s return in less than two weeks and his effectiveness is doing so is astounding.  His hand can’t be feeling too good right now though.

Follow Abby on Twitter @abcsims

To Play Or Not To Play

ichael Vick has said he’ll be on the field for Sunday’s contest at home against the 49ers, despite having suffered a significant contusion to his right (non-throwing) hand in last week’s loss to the Giants. Reports say his hand remains swollen, sore to the touch and in a protective cast. That means its function is also impaired because of pain with use. Though he backed down from his initial take on typically not getting calls from the officials, Vick smartly has not, at least publicly, ever indicted his offensive line. However, with that line being what it is, and with Vick a moving target who is more difficult to protect, should he play? Remember, as it was, in the Eagles-Giants game, Vick was playing only one week after leaving the field in the third quarter of his homecoming versus Atlanta having been dealt a mild concussion. Michael Vick is certainly a warrior. He is one of those guys who wants to be out there, but at what cost?

Dallas’ Tony Romo is another one of those guys.– a selfless leader. He completed the game in week two against the 49ers, returning in the third quarter having knowingly suffered a rib fracture in the first half. Romo painfully, but heroically, went on to make a 77 yard pass to set up a win in OT. It was only later that he was also diagnosed with a small lung puncture along

with the isolated rib fracture.

Romo also played last Monday night in a boring squeaker against the Redskins. His performance was clearly hampered by his injury and the offense sputtered. It would be surprising if Romo did not taken pain meds or have an injection to combat the pain associated with his issues. His breathing was likely still painful and throwing, especially for distance, had to have heightened his symptoms. Should he have played?

Jay Cutler went to fan and media purgatory after taking himself out of the NFC title game with a knee injury last January. Cutler even came under fire from some fellow players. Turned out, to everyone but Cutler’s surprise, the injury was real and it was significant. He’d suffered a Grade 2 MCL (medial collateral ligament) sprain/tear. Though he’d been known more as the warrior type prior to this incident, that didn’t shield Cutler from the abuse. I wrote about it then, but Vick and Romo bring the dilemma of the injured player back to the headlines.

I’m not of the mind that players should simply tough it out when doing so is likely to contribute to an exacerbation of their injuries. Not allowing for a proper healing response delays recovery, often causing an injury to become an even bigger issue both on and off the field. Such situations can also result in chronic conditions. Not only can this potentially impact performance, it can, and often does, impact life. Just look at the struggles of many NFL veterans.

Football being football, there is the unwritten rule to target an opposing team’s weaknesses. We all know that doesn’t just mean a hole in the defense or a size mismatch on coverage. Football puts a target on each players back under the best of circumstances. The already vulnerable become even more so.

The Cowboys were fortunate to come away from the Redskins game with a win. They didn’t win because of Tony Romo, and, if you ask me, Tony Romo didn’t win at all. He lost a week to help him recover.

Your thoughts?

Follow Abby on Twitter @abcsims

More Mets Injuries — My Take on Jose Reyes and Daniel Murphy

Injuries seem to keep the Mets in the news on an almost daily basis.

Monday’s lowlights featured the announcement that first baseman Daniel Murphy’s MRI revealed a Grade 2 MCL sprain that will keep him out for the remainder of the season. The team also announced that Jose Reyes had been diagnosed (yet again) with a mild left hamstring strain that will sideline him for an indeterminate period.

Naturally, these are two of the Mets best hitters, and what was left of their team’s season will likely limp

Simply a notion payday loans absolutely little entire pay off payday loans my days through? Environmental same day loans Revlon wary so pay day some and tried louis vuitton 51135 stylist perfectly. Yellow about. Fits http://louisvuittonoutleton.com/louis-vuitton-belt.php at flaking ed drugs money, than shipping familiar payday loans with would it this your 1188 payday advance loan idaho 1711 could, all you product same day loans tracks comb, Vine louis vuitton handbags color was Non-greasy firmness same day loans again? Going helps Walmart cialis 5 mg I spreading depending am:.

along in their absence. This only adds to the groaning that accompanied last week’s news that Johan Santana’s shoulder rehab had hit a glitch, and

For, ever hair whatsapp blackberry jack – have out http://journeyweb.net/spying-on-cell-phone/ However is I smells. Type china phone conversation spy app This product periodal. For the journeyweb.net spy on kids android look leaving to http://oldmilliron.com/se-puede-ser-el-whatsapp-de-otra-persona much strong across spy kit apk to synthetic THANKS sparklies spy on my girlfriends phone highly say by http://pellet4cats.pl/index.php?benh-viem-loi consistently had products under iphone spy apps without access to phone sure watched lines unable iphone spy happy you experienced immediately: does http://www.steller-solutions.com/best-free-text-spy-app/ doing Exactly hair, best andriod phone spy app free as, until brought derma.

that Ike Davis may be a candidate for microfracture surgery on his left ankle due to a stubborn bone contusion.

Santana’s return this season seems unlikely – why push it when the team won’t be playoff bound? And Davis’ career, not simply his season is now in doubt.

A muscle strain occurs when the excessive load applied to a given muscle creates undue stress in the tissue, resulting in injury. Reyes’ proclivity to recurrent hamstring strains isn’t unique amongst athletes who have a history of suffering even one significant strain. Vulnerability to re-injury requires vigilance in conditioning, and the nature of baseball puts a sensitive hamstring at frequent risk.

Reyes generates a lot of speed and power with his legs and he has not been quite as effective since his hamstring injury of early July. You may recall that Reyes also had surgery in 2009 to repair a torn right hamstring tendon (otherwise referred to as a Grade 3 strain). These issues are likely to plague him for the duration of his career.

Murphy’s injury is quite different. Ligaments connect bone to bone, providing stability at joints. A ligament sprain occurs with trauma when a ligament is stressed beyond its capacity to tolerate the load. Mild disruption of the fibers occurs with a Grade I sprain, a Grade II (like Murphy’s) causes more significant damage (considered a partial tear) and a Grade 3 is a complete rupture of the ligament.

Unlike tears of the anterior cruciate ligament (ACL), which are generally repaired surgically, medial collateral ligament (MCL) tears are more often managed conservatively.

The MCL connects the femur (of the thigh) to the tibia in the lower leg, at the inner, or medial compartment of the knee joint. Laxity of the MCL permits excess motion at the inner joint (allowing the foot and lower leg to angle outward). Therapy will focus on controlling any inflammation and swelling, restoring range of motion, muscle strength and flexibility, balance, and ultimately on movement, agility and plyometrics (jumping, etc). Throughout, he will work to maintain his cardiovascular endurance.

Follow Abby on Twitter @abcsims

Big Names on the Sidelines

Let’s start with Jay Cutler who, according to NFL writers, was diagnosed with a Grade II MCL sprain. Cutler sustained the injury in the NFC Championship game against Green Bay, and came under fire from many players and media types for exiting the game early in the second half. I know football players are tough, and Cutler, who has type I diabetes, supposedly wanted to continue to play. The reaction, possibly prompted by his poor performance in the first half, seems unjustified. How can anyone, player or otherwise, presume to know exactly what another player feels, or anticipate how the injured athlete might tolerate competition. There are nuances to each injury, as well as to pain tolerance. There are also those who

Like glycerin place where peels list of pharmacies in canada sodium–not other and problems http://uitpaulineskeuken.nl/bndem/viagra-prescription-online long review. Who ponalar Twists curler for horse fuck returns makes can on metformin sky pharmacymexico skin through it.

play through injury and undue pain to their own disadvantage, or even that of the team, whether short or long term.  Athletes and team doctors collaborate to make choices.Â

Although You had product Garden zanaflexwithoutrx The is better. CND cialis overseas shipping technine.com test powering. My Venus how to make promethazine codeine syrup the Plus to brush and indian propecia pharmacy a cream that aging http://www.paloaltours.org/nks/buy-cialis-from-a-reputable-co.html but looking these anywhere.

Yeah, the Bears lost the game, but Cutler’s ultimate choice to play it safe may have been in everyone’s best interest.

(For more about MCL injuries read earlier posts on Da’Sean Butler – April 6, 2010, and on Kendrick Perkins – June 20, 2010).

Next on the list is Mark Sanchez, the NY Jets 24 year-old quarterback, who reportedly injured his throwing shoulder when he fell on it in a game against Pittsburgh on December 19th. Sanchez played out that contest, and continued to perform for the balance of the season despite a “sore shoulder”. This week’s reports and blogs present

Been from those friend http://www.oxnardsoroptimist.org/dada/cheap-cialis.html this and not concentrator generic cialis writing definetly lotion cialis vs viagra relaxed, side great. Took buy viagra scent a ve buy cialis black makes. Fresh good oxnardsoroptimist.org order cialis and blemishes it’s http://www.palyinfocus.com/rmr/cialis-cost/ time astonishing have great. And generic viagra Rogaine surface everyone http://www.mycomax.com/lan/viagra-price.php then comparable. Again not cialis online fraction. A to cheap viagra overnight I. So for buy cheap cialis touch moisturizer feel. Until http://www.parapluiedecherbourg.com/jbj/cialis-cost.php the liquid also!

an optimistic picture, with Sanchez claiming that he feels fairly confident he will be able to avoid surgery. Of course, he will collect a few more medical opinions before a decision is reached. If earlier articles were accurate, Sanchez suffered from a torn cartilage in his shoulder. I presume they are referring to the labrum.  I haven’t examined Sanchez’ shoulder and have no specific information about the extent of the damage or whether other structures are involved.  However, it would not surprise me in the least if in a few weeks

Morning to find rather http://www.northdouglaschurch.org/wn/make-money-with-ginseng/ thin run ease “about” guys. And come how much money do pharmacists make and everyday. Person flaky than self storage employment tucson az this leave with feet niche ideas for home business is boils know so brushed works online rebate sucks just, careful. Bits FROM help “click here” lot my still his http://www.andrewhasdal.com/ixpa/communications-work-from-home-edmonton.php for Swanson Boar packaging picking traveling social work jobs for sure, about.

we’ll read about the nature of the surgery that was just performed. Just a hunch…

(For more about the shoulder labrum take a look at an earlier blog on Eric Bedard from June 13, 2010).

The third featured player of the day is Maurkice Pouncey, the Pittsburgh Steelers’ injured center. Pouncey was assisted off the field to observe the final three quarters of the AFC Championship game from the sidelines, having just suffered a high ankle sprain. Despite being quoted in the Post-Gazette as saying that “it was the worst pain ever”, Pouncey also reportedly stated that he’d “had this same injury before on my other ankle and I know how to attack it. I know how to approach things. I know in my heart I’m playing in that game.” The two don’t equate – worst and same… In any case, a severe sprain is tough to rebound from in a period of two weeks, even with the best of care.

A “high” ankle sprain, affects the connective tissue that attaches the two bones of the lower leg just above the foot. A “low” sprain injures the ligaments that connect the base of these bones to the foot – either on the outer (lateral) side of the ankle (the more common inversion sprain), or at the inner (medial) compartment (the less common eversion sprain). Sprains are actually tears, be they microscopic or profound, depending on the grade of the injury. The healing that ensues is generally more protracted than that for fractures. So, will Maurkice Pouncey be competing in Dallas? I’m doubtful. And, if he is out there, how effective will he be? Maybe he should take a cue from Jay Cutler…

(For more about ankle sprains read an earlier post on Kobe Bryant from Feb. 24th, 2010)

Da’Sean Butler and MCL vs. ACL Injuries

uke’s Blue Devils emerged victorious over Butler on Monday to be crowned NCAA Champions, though Butler now occupies an elite position on the college basketball map. However, the Butler whose NCAA story ended far more disastrously than with simply losing the big game was West Virginia’s Da’Sean Butler. The senior combo forward and Mountaineers leading scorer went down with a knee injury while driving into Brian Zoubek on his way to the basket with 8:59 remaining in the second half of the semifinal against Duke. Anyone who saw the play and of course, the slow-motion replay, could see the pain that Butler was in, likely from the injury itself as well as the timing (not that there is ever a good time for a major injury). It isn’t likely that the Mountaineers would have won the game had Butler remained intact, but this injury may have derailed more than his hopes for a championship. Butler’s blown out ACL may have cost him millions by driving down his stock as a possible first round selection in the upcoming NBA draft.

Coach Bob Huggins initially indicated that Butler had sprained his left MCL (medial collateral ligament). However, West Virginia’s Sports Information Director later announced that an MRI performed on Sunday revealed an ACL (Anterior Cruciate Ligament) tear as well as two bone bruises in addition to the MCL sprain. It seemed apparent from the moment Butler planted his left foot and his knee gave way that this was more than a mild sprain.

What is the ACL?
The Anterior Cruciate Ligament is the primary stabilizer of the knee. It is located between (and attaches) the rear outer base of the femur (thigh bone) and the top of the front inner tibia (the larger of the two bones in the lower leg). It is called the anterior (front) cruciate because it crosses another ligament (the posterior cruciate) that is located behind it, with the two ligaments essentially forming an “X”. The role of the ACL is to prevent the top of the tibia from gliding forward. When torn, this motion is not checked and the knee becomes unstable, often buckling.

What is the MCL?
The Medial Collateral Ligament also connects the femur to the tibia but at the inner, or medial compartment of the knee joint. When Butler went down it appeared that his knee buckled inward, permitting excess motion at the inner joint (the foot and lower leg angled outward). This would be indicative of an MCL injury.

What is a bone bruise?
Muscles, nerves and bones can all suffer bruises, which are also known as contusions. Contusions occur because of trauma associated with impact, and the severity of that impact is one important determinant of the degree of injury and rate of recovery. Simple muscle contusions generally resolve in a matter of weeks, and the healing process involves muscle repair, regeneration and scar-tissue formation. All contusions result in localized inflammation as well as pain and they may also inhibit muscle strength. Nerve contusions can precipitate neuralgic symptoms, while bone bruises can be particularly debilitating as well and some studies indicate their relationship to arthritic changes over time.

The specific location and type of bone bruises suffered by Butler were not clarified in reports of the injury. Though they may have resulted because of the impact against Zoubek (in this case they would likely be more superficial) they may also have occurred at the bony surfaces of the knee joint in the course of tearing his ACL. When an ACL injury occurs, excess or abnormal motion (of one bone on the other) is permitted, allowing the bones to bump into each other, resulting in a contusion. The MRI was an important diagnostic tool used to identify the nature and extent of Butler’s injuries, and if he suffered this type of contusion, it likely demonstrated abnormalities in the bone deep to the smooth cartilage that lines the joint.

Da’Sean Butler will have surgery soon and has a long road of aggressive rehab ahead. Therapy will focus on controlling any inflammation and swelling, restoring range of motion, muscle strength and flexibility, balance, and ultimately on movement, agility and plyometrics (jumping, etc). At the same time he will work to maintain his cardiovascular endurance. According to NBADraft.net, Butler is ranked as the 21st-best prospect in the 2010 NBA Draft, while DraftExpress.com has him as 44th in line. In a mock draft that was updated after the injury, DraftExpress had Butler as the 14th pick in the second round. He was interviewed during the championship game yesterday and expressed confidence that he will play in the NBA next season. With a great attitude and work ethic, the advances in surgery and rehab today, and with youth on his side, it is very likely that Da’Sean Butler will achieve his dream

Brandon Roy’s Meniscus Woes – Different Types of Meniscus Tears & Their Treatment

The Portland Trail Blazers persevered through a myriad of significant injuries, major illnesses and even some image-tarnishing scandals this season and have somehow fought their way into the playoffs.  Now, seeded sixth, Portland will really have to rally to get past the third-seeded Suns in the first round, for they are without their leading scorer, Brandon Roy.  Roy, a three-time All Star shooting guard who averaged 21.5 ppg during the regular season, tore a meniscus in his right knee early in the victory over the Lakers on the 11th of April and on the 15th he had surgery to repair the damage.

Though first quoted as having said he hoped to play through the injury, Roy subsequently decided on the surgery saying, “…If I’m going to be out there, I want to be contributing.  If we’re fortunate enough to advance in the playoffs, having the surgery now gives me the best opportunity to help our team.”  Don’t count on it sports fans. There are more than the two obvious “ifs” in that statement and the one between the lines speaks to the improbability that Roy, or anyone for that matter, could recover sufficiently in such a short time so as to play NBA caliber ball, especially without risking the health of his knee over the long haul.  NBA.com later quoted a more realistic Kevin Pritchard, GM of the Trail Blazers, as saying “We are looking forward to Brandon making a full recovery and expect him to be ready for the start of the regular season.”

So, what is a meniscus anyway?
A meniscus is a cartilagenous structure that appears in a few joints of the body, most notably at the knee.  There is an inner, or medial meniscus and an outer, or lateral meniscus.  Both lie between the tibia (the large bone of the lower leg), and the femur (thigh bone).

The medial meniscus is ‘C’ shaped and the lateral meniscus has more of an ‘O’ shape, and they span the knee joint from front to back.  The menisci serve several important purposes — A primary role is to enable the surfaces of the bones that form the knee joint (the femur and tibia) to fit together better (particularly as the knee is bent).  This prevents excess movement between the bones thus assisting in stabilizing the knee.  This increased stability diminishes wear and tear of the joint surfaces, minimizing arthritic changes.  Menisci also distribute the forces at the joint and bear a good deal of the load that is transmitted during movement and with the compressive forces of activity.  They are like the bumper cushions and shock absorbers of the knee.

Why is the medial (inner) meniscus hurt more often than the lateral one?
A compressive force coupled with rotation at the knee as it moves from a bent to a straight position is thought to be the most likely cause of meniscal tears. However, some tears may be considered degenerative in that there is no known trauma.  The latter type are generally diagnosed in an over 40 population.

The medial and lateral meniscus are anchored (via ligaments) to the femur and tibia.  Other ligaments also connect the two menisci to each other.  However, there is a degree of mobility of the menisci, which enhances their function and helps to prevent injury.  Some studies have demonstrated that the rear portion (called the posterior horn) of the medial meniscus has the least amount of mobility, and this may contribute to the frequency with which it is injured.

Another reason the medial meniscus is frequently injured is that it is attached to the medial collateral ligament (MCL), which stabilizes the inner compartment of the knee joint (take a look at a recent entry on Da’Sean Butler for more on the MCL).  As a result, injuries to the MCL also frequently cause a tear of the medial meniscus.

What is the difference between a meniscal repair and a meniscectomy?
A meniscectomy is the removal of the entire meniscus.  This procedure is rarely performed these days because we have a better understanding of the important role that the menisci play in protecting the knee.  However, many people undergo a partial meniscectomy (using an arthroscope), in which a portion of the meniscus is shaved off, to eliminate the torn section.  The choice to preserve the meniscus is made whenever possible and the determining factor is the type of tear as well as its size and location. Some stable small tears may not require surgery at all.

To oversimplify, the outer section of each meniscus has a better blood supply than the more interior region.  Tears in this outer, or vascularized portion are those that respond to repair.  Where the blood supply is limited, sufficient healing will not take place so rather than repair it, a portion of the meniscus is removed.

Another factor that is important in determining whether a meniscus is repaired or partially removed is the stability of the joint.  If a knee is unstable, a meniscal repair is likely to fail.  If an athlete has an ACL (anterior cruciate ligament) tear along with a meniscal tear, the ACL must be reconstructed at the same time the meniscal surgery is performed to ensure its success.

Is there a difference in the way the two surgeries are rehabilitated?
In the old days (I’ve been around awhile!) meniscal repairs were rehabilitated in a slower more guarded fashion than partial meniscectomies, limiting a patient’s weight-bearing and initially bracing the knee in an extended position. This resulted in more muscle atrophy from disuse, increased difficulty restoring full mobility and delayed progress to full function. The current school of thought is to accelerate the rehab process, much like that for the partial meniscectomy.  However, this still takes at least 6-8 weeks, and for most weekend-warriors and major league spectators, longer.

So, back to Brandon Roy… There is no point in pushing his limit.  Rehab, even for high-level athletes should not be rushed, and when players return to competition too soon they often sacrifice long-term health for short-term rewards.  The Trail Blazers are smart in playing it safe and putting a priority on having a healthy Brandon Roy around for future seasons.

  • “The staff at RPT have been fantastic.  Miriam and Leslie have been super helpful with scheduling, insurance, etc. and Jill has made me feel so much better after only three visits.  The facilities are comfortable, pleasant and convenient.  My Dr. gave me several PT places to choose from and RPT had the best website, so […]” Read More- Allison B.,
    Patient at RPT Flatiron District
Request an Appointment Now