knee manipulation

[Becky496]

I had a menisectomy in June.  Since then I've not been able to reach full extension and have suffered from a small patellar tendon tear that my dr. is telling me should heal itself.   My pt has told me he thinks my lack of estension which is about 15 degrees is due to my tight hamstrings and soft tissue problems(tendonitis), but my dr. wants to try a manipulation then cast me to get my extension back.  I've been doing some research on the M.U.A. and it seeems like everyone has had flexion problems after tkr not extension from meniscus and tendon problems.  I got a 2nd opinion and the dr. wanted to do a posterior capsular release which is even more invasive.  After all this I'm just not sure my lack of extension is even caused by arthrofibrosis! Anybody, have any opinions as I'm not sure I should go through with the M.U.A.  I'm just trying to find an answer because I'm in alot of pain and I just want my full ROM.

[Dr Vinod]

Hello!

The meniscus is an important load bearing structure that supports 70% of the load transmitted through the lateral compartment and 50% medially and decreasing pressure directly on the articular cartilage and remember you had menisectomy. After menisectomy I would suggest you to go for physical exercises and exercises to strengthen your quadrceps femoris muscle before thinking about surgical procedures. Rehabilitation after arthroscopic meniscectomy carries little or no risk. Rehabilitation is continued until the knee has regained full range of motion and strength . Strengthening and coordination exercises can be tried after discussing with your orthopedician: Lateral lunges, front lunges, half squats, leg press, lateral step ups, knee extension (90-40 degrees), hamstring curls, hip adduction and abduction, hip flexion and extension, toe raises, try all of these under an instructor. I would suggest you to apply ice packs regularly to decrease the pain and inflammation and take intermittent pain killers and go for an MRI and also a second opinion.

Take care!

[amiey2217]

if you have been pretty aggressive with PT and have yet to regain full extension, I would try the casting before a surgical release. Try the least invasive and if it fails then you can choose to go forward with the more invasive approach. Following the casting, you will again have to be pretty aggressive with PT to regain muscle strength that will inevitably be lost during casting. Good luck!