NFL Injury Series- Meniscus Tear

Read up on what the meniscus is, how it is injured, indications for surgery, and recovery times.

Today on Banged Up Bills, we will detail the ever common meniscus tear. This post will identify what the meniscus is, it’s function, and the severity of a tear which could affect whether a player misses weeks or the season. This is an injury that we have seen in past seasons and will continue to see.

Last season, we saw TE Charles Clay and WR Kelvin Benjamin both tear their meniscus during different points of the season with varying availability following the injury. Clay missed 3 games while Benjamin missed 2. Clay required surgery to fix his issue immediately while Benjamin was able to tough it out the rest of the season with eventual surgery. There are many reasons why there are differences in meniscus tear management despite the same outcomes.

To understand proper management of the meniscus after injury, the structure must be understood. The meniscus is two concave structures that are c-shaped and lie over the tibia in each knee. The meniscus is comprised of a medial and lateral meniscus and act as shock absorbers during activity. These meniscus also help deepen the joint so that the femur can articulate with the tibia, providing stability. During meniscus tears, a rotational force is applied to the area while the knee is bent and causes a shearing motion, causing a portion of the meniscus to tear.

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Credit: physio-pedia.com

There are various types of tears which include but are not limited to: complete or partial, horizontal or vertical, longitudinal or transverse. Acute tears are more likely to present as longitudinal/bucket handle and radial tears most likely seen in football players. Symptoms of a meniscal tear typically consist of pain, tenderness, and swelling, locking or clicking during knee movement, and initially difficulty in placing weight through the knee. Meniscal tears are typically seen in conjunction with MCL sprains/tears and ACL tears due to the rotational forces through the knee during impact.

Overall, these types of injuries can slow up a player but not entirely derail their season. Several tests to identify meniscal tears include Apley’s, McMurray’s, joint line tenderness, and Thessaly’s test all assist in identifying whether a meniscal tear is present. However, these tests are not always reliable or specific which means they may identify pain and restrictions but will not be able to identify type or severity of tear. These tests replicate the mechanism that would cause the meniscal tear. This typically warrants further imaging such as MRI to identify specific lesions which will determine the appropriate interventions.

Once a tear has been identified, the type of tear can affect healing rates: longitudinal tears heal better than radial; simple tears heal better than complex; traumatic and acute tears heal better than degenerative. Based on location and length of tear will determine proper management. The meniscus has several “zones of vascularity” which include: red-red zone, red-white zone, and white-white zone. The red-red zone has the highest blood supply and lie on the outermost portion of the meniscus. The red-white zone is the area that connects the red-red and white-white zone and contains some blood supply. The white-white zone has a poor blood supply and demonstrate the poorest area for healing. If the tear is small, conservative management or a meniscectomy may be performed to remove to remove the offending piece. If the tear is larger, then a suture repair of the meniscus is warranted and an extended rehab is required.

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Credit: physio-pedia.com

Regardless of whether surgery is required, rehab typically consists of restoring range of motion, controlling swelling/pain, and restoring strength to the knee. Once the immediate objectives are met, then further increasing strength and return to play activities are initiated to ensure that the athlete can play at their full abilities. In the event of WR Kelvin Benjamin, he was able to play through his minor tear due to effective rehab and an understanding of the type of tear which most likely allowed him to rest, recover, and eventually return to full participation knowing the tear was stable enough to play through. In the event of TE Charles Clay, his tear may have been blocking motion and been more severe, warranting surgery to remove the offending piece before rehab could begin.

In the option that surgery is performed during the season, recovery times for a meniscectomy can last anywhere from 2-6 weeks or even longer based on the severity of the tear and corresponding damage. In the event of a major tear, surgery is indicated and recovery time can last for up to 3 months which could end a season for most players depending on the time in the season it was torn. The preferred method years ago used to be cut out the offending piece. However, surgeons later found out that each time they cut a piece out, it accelerated arthritic changes in the knee which reduced healing and the ability for players to return to full health for a prolonged career. They have also found recently that surgeries do no better than rehab alone when compared to long term results in the normal population. However, surgery is still recommended when a return to sport is necessary and will quicken the recovery in dealing with the NFL.

Meniscal injuries are still concerning but can still allow a player to play through the injury despite requiring further interventions in the future. If a player sustains a meniscus injury, they will miss some time but can return to play later in the season with favorable results after testing and a positive response to rehab. Despite returning to play, there are still instances where players will not be 100% and their production will noticeably decrease. Overall, a concerning but not season ending injury.

Continue to check back regarding further updates and injuries throughout the season. Follow on Twitter @BangedUpBills, Facebook at Banged Up Bills, on Reddit at u/BangedUpBills and http://www.bangedupbills.com. As always, thank you for reading and GO BILLS!

Kelvin Benjamin’s Partial Meniscectomy & Recovery

Detailing the injury process of a meniscus tear, the surgical procedure known as a partial meniscectomy and recovery.

As the season is over, several Bills players are slated for surgical procedures to address injuries sustained during the season. Kelvin Benjamin is one of them.

The 4th year WR’s partial meniscectomy has been long expected following his Week 11 injury against the Chargers. Benjamin had to miss several games following the injury but was able to return to play through the final stretch of the season, becoming a buoying presence for the wide receiver corps, helping the Bills to the playoffs. Today’s post will briefly review what a meniscus tear consists of, mechanisms of injury, and the surgical procedure and rehab that generally speaking is required to return to full health. For a greater detailed description of the meniscus and its role in knee movement, please reference my previous article.

The meniscus lies over the tibia and acts as a shock absorber between the tibia and femur. It is made up two wedge shaped areas that assist in deepening the area that the femur articulates with the tibia. During meniscus tears, a rotational force is applied to the area while the knee is bent resulting in a shearing motion, causing a portion of the meniscus to tear. There are many types and degrees of meniscus tears that could occur which include complete or partial, horizontal or vertical, longitudinal or transverse.

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Credit: http://samimimd.com/services/knee/knee-meniscus-repair/

Symptoms of meniscal tears typically consist of pain, tenderness, and swelling, locking or clicking during knee movement, and initial difficulty in placing weight through the knee. Meniscal tears are typically seen in conjunction with MCL sprains/tears and ACL tears due to the rotational forces through the knee during impact. The size and location of the tear can vary, which determines the most effective course of treatment.

Thankfully, Benjamin only requires a partial meniscectomy which is typically a 4-6 week recovery to return to baseline. During a partial meniscectomy, an orthopedic surgeon goes in arthroscopically via two small holes in the knee. Once inside, the surgeon inserts a camera to observe the affected areas. From there, other tools are introduced to grab at the offending area and cut out the frayed portion of the meniscus. A shaver is introduced to smooth down the area to remodel and prevent any any future fraying or breakdown of the tissue.

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Credit: https://nydnrehab.com/what-we-treat/knee-pain/meniscal-tears/

After the surgical procedure is completed, rehab is introduced to restore the knee to full function. Immediately after any surgery, the body enters an inflammatory phase which can last up to 48 hours after the insult to the area. Typically pain and swelling are addressed first through the time tested RICE method. This includes rest, ice, compression, and elevation. This helps alleviate post surgical swelling and pain as if the leg is in a dependent position, the excess fluid builds up in the knee and lower leg, causing extra pressure on the surrounding tissues. Other ways to manage the pain include the use of a TENS unit which provide superficial electrical stimulation over the skin to assist in desensitizing the area to reduce pain.

Once pain and swelling have improved, range of motion and strengthening is implemented to focus on returning the knee to normal function. Range of motion exercises include alternating between bending and straightening the knee through stretching to normalize function. This can be accomplished through heel slides in lying or sitting, stretching with the use of a towel or belt to pull the knee into flexion, or assistance from a physical therapist through passive motion to increase range.

There are countless strengthening exercises that can be performed but simple exercises after surgery include quad sets which encourage knee straightening, short arc quads to improve quadriceps strength, hip flexion, abduction, and adduction strengthening for weight bearing and return to walking, and ankle pumps. Progression of strengthening include closed chain exercises which are where the foot is in contact with the ground include stationary bike, modified lunges, terminal knee extension, squats, etc. Further exercises included open chain exercises in where the foot is off the floor includes long arc quads, step ups, balance and proprioceptive exercises as knee function improves. Finally, running, cutting, plyometric activities are incorporated to increase towards return to sport. A general rehab protocol can be found here. Successful outcomes as high as 90% are reported and able to return to pre-injury level of activity.

Benjamin will return to full function without any complications barring infection in time for OTA’s. He will most likely work with medical staff to return to game form which will take several months. This is possibly why he did not have surgery during the season. With Benjamin’s previous history of knee injuries which include an ACL tear, knee sprain, and most recently, a meniscus tear, there is some concern for future injury. However, while he is at higher risk for injury due to the previous ACL tear, there is little evidence that I have found that supports increased risk of re-tearing the meniscus greater than normal rates.

As with other injuries, there is only so much that can be done for prevention. Strengthening, agility, and proprioceptive activities are key to reduce future injury. In the case of Benjamin’s injury, external forces through the joints can not be entirely prevented. Benjamin may be wearing a brace as he returns to his prior form to control any swelling. He may elect to play with a hard brace to prevent hyperextension, though this would reduce mobility leading to him declining this option.

Over the years, the Bills have witnessed rashes of injury, and the teams success this season in successfully rehabbing players like Kelvin very much assisted in 2017’s outcome. The Bills are primed with draft picks, free agency cap space, and what appears to be an the ability to bring players back healthy. This will allow them to address other needs this off season rather than having to plan for the unknown in terms of the return of injured contributors from 2017. Continue to check back for with me for Bills injury news, reviews by position and draft pick injury analysis. Follow me on Twitter @kyletrimble88, thank you for reading and GO BILLS!!

Week 15 Recap- Dolphins

Assessing the severity of E.J Gaines injury, Kelvin Benjamin’s eventual knee surgery, and discussing other player’s updates injury status.

The Bills continue to play with our emotions, winning their home finale against the Miami Dolphins 24-16 which brings their home record to 6-2. This is their best record at home since 1999 which everyone knows is the last time they made the playoffs. I have said on this site several times that I felt they had a playoff run in them; I have also stated that they are just about done. This is my fandom, living and dying week-to-week. I have been here once before as a fan in 2014 when the Bills lost to the Raiders after a rousing win against the Packers the week before. I also recall in 2004 when they played the Steelers at home and lost their chance at a playoff berth. These moments are fleeting during The Drought; as before, we must enjoy this and know that one day, they will make the playoffs again.

Before I let my emotions get the best of me, today’s post as always will be assessing injuries sustained in Sunday’s game. Thankfully, only CB E.J. Gaines was injured midway through the 3rd quarter during a tackle. Upon video review, he comes in low attempt to tackle TE Julius Thomas at which time Thomas turns to his right to absorb the blow, forcing Gaines down as he hits his left knee, rolls over and begins favoring it.

After multiple reviews, there is no planting or pivoting motions, there are no lateral movements, there is no specific mechanism of injury. I am initially stumped as to what his injury is; I suspect he hit it hard and just couldn’t play through it. At worst, he may have sustained a patellar fracture due to the direct hit on the knee, but that is an extreme case which I do not believe to have happened. More information may be released in the coming days, but there wasn’t anything that can indicate any specific injury. Losing him for any extended time will be costly as the team does suffer without his play in the secondary.

Other notes regarding injuries are RB LeSean McCoy, WR Kelvin Benjamin, QB Nathan Peterman, and OT Cordy Glenn. First up is Mccoy who appeared to be injured after reaching 10,000 yards and had to leave the game momentarily midway through the 2nd quarter. After seeing broadcast replay, he got the wind knocked out of him. Later in the 4th quarter, McCoy was hit in the backfield and twisted in the air, landing very hard on his right hip. He was able to get up but was in obvious pain as he walked off the field. He did not return to the game as the offense was no longer needed until victory formation. He may show up on the injury report with a hip injury but should be nothing that will keep him out for Sunday.

Benjamin will continue to show up on the injury report due to his meniscus tear sustained in the Chargers game but did not appear to be limited during this previous Sunday. It is worth mentioning that after the game Benjamin was asked about surgery on his knee after the season and he reported that he would require a procedure. He will most likely require a meniscectomy which involves shaving down the partially torn area to reduce pain, repeated swelling, and range of motion limitations. As he has already been cleared to play, he will most likely not sustain any further damage, but may limit his full abilities. Even injured, Benjamin brings big play abilities to the offense when given the ball.

Peterman has cleared the concussion protocol as of Monday. He appeared to be on track to clear before Sunday’s game, however he may still have been dealing with some dizziness or headaches during Friday’s practice which prevented full clearance. He will be valuable against the Patriots in case QB Tyrod Taylor goes down with an injury. Peterman has shown he can run the offense during the Colts game and can be a game manager.

Finally, Glenn has been placed on IR with his chronic foot/ankle issue which little information is known. I continue to believe he has some type of instability in that region which has prevented him from effectively producing. As has been the theme, specific information is limited which leaves a good portion to be guessed. I will be posting an article during the off-season on the type of procedure that I believe Glenn will be having and will be able to shed light on his availability for 2018.

After Wednesday’s injury report comes out, I expect more names to be added and more information known, specifically Gaines’ knee injury. As of right now, I’m still believing in this team for a playoff run. They still have to do their job, but they have to make the playoffs at some point; why not now? Like everything else, time will tell.

Continue to check back for updates regarding the injury report and any notable updates. Follow me on Twitter @kyletrimble88 for breaking news and my latest thoughts. As always, thank you for reading and GO BILLS!!