Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions
Publication Date: January 1, 2018
Last Updated: March 14, 2022
Summary of Recommendations (2018)
EXAMINATION – OUTCOME MEASURES: ACTIVITY LIMITATIONS/ SELF-REPORTED MEASURES
For knee-specific outcomes, clinicians should use the International Knee Documentation Committee 2000 Subjective Knee Evaluation Form (IKDC 2000) or Knee injury and Osteoarthritis Outcome Score (KOOS) (or a culturally appropriate version for patients whose primary language is not English) and may use the Lysholm scale (with removal of swelling item, and using unweighted scores). (B)
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Clinicians may use the Tegner scale or Marx activity rating scale to assess activity level before and after interventions intended to alleviate the physical impairments, activity limitations, and participation restrictions associated with meniscus or articular cartilage lesions; however, these have less evidence support about measurement properties. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) or the European Quality of Life-5 Dimensions (EQ-5D) are appropriate general health measures in this population. The Knee Quality of Life 26-item questionnaire (KQoL-26) may be used to assess knee-related quality of life. (C)
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EXAMINATION – PHYSICAL PERFORMANCE MEASURES
Clinicians may administer appropriate clinical or field tests, such as single-legged hop tests (eg, single hop for distance, crossover hop for distance, triple hop for distance, and 6-m timed hop), that can identify a patient’s baseline status relative to pain, function, and disability; detect side-to-side asymmetries; assess global knee function; determine a patient’s readiness to return to activities; and monitor changes in the patient’s status throughout the course of treatment. (C)
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EXAMINATION – PHYSICAL IMPAIRMENT MEASURES
Clinicians should administer appropriate physical impairment assessments of body structure and function, at least at baseline and at discharge or 1 other follow-up point, for all patients with meniscus tears to support standardization for quality improvement in clinical care and research, including the modified stroke test for effusion assessment, assessment of knee active range of motion, maximum voluntary isometric or isokinetic quadriceps strength testing, forced hyperextension, maximum passive knee flexion, McMurray’s maneuver, and palpation for joint-line tenderness. (B)
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Clinicians may administer the appropriate physical impairment assessments of body structure and function, at least at baseline and at discharge or 1 other follow-up point, for all patients with articular cartilage lesions to support standardization for quality improvement in clinical care and research, including the modified stroke test for effusion assessment, assessment of knee active range of motion, maximum voluntary isometric or isokinetic quadriceps strength testing, and palpation for joint-line tenderness. (D)
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INTERVENTIONS – PROGRESSIVE KNEE MOTION
Clinicians may use early progressive active and passive knee motion with patients after knee meniscal and articular cartilage surgery. (B)
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INTERVENTIONS – PROGRESSIVE WEIGHT BEARING
Clinicians may consider early progressive weight bearing in patients with meniscal repairs. (C)
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Clinicians should use a stepwise progression of weight bearing to reach full weight bearing by 6 to 8 weeks after matrixsupported autologous chondrocyte implantation (MACI) for articular cartilage lesions. (B)
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INTERVENTIONS – PROGRESSIVE RETURN TO ACTIVITY
Clinicians may utilize early progressive return to activity following knee meniscal repair surgery. (C)
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Clinicians may need to delay return to activity depending on the type of articular cartilage surgery. (E)
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INTERVENTIONS – SUPERVISED REHABILITATION
Clinicians should use exercises as part of the in-clinic supervised rehabilitation program after arthroscopic meniscectomy and should provide and supervise the progression of a home-based exercise program, providing education to ensure independent performance. (B)
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INTERVENTIONS – THERAPEUTIC EXERCISES
Clinicians should provide supervised, progressive range-ofmotion exercises, progressive strength training of the knee and hip muscles, and neuromuscular training to patients with knee meniscus tears and articular cartilage lesions and after meniscus or articular cartilage surgery. (B)
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INTERVENTIONS – NEUROMUSCULAR ELECTRICAL STIMULATION/BIOFEEDBACK
Clinicians should provide neuromuscular stimulation/ re-education to patients following meniscus procedures to increase quadriceps strength, functional performance, and knee function. (B)
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Recommendation Grading
Overview
Title
Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions
Authoring Organization
American Physical Therapy Association
Publication Month/Year
January 1, 2018
Last Updated Month/Year
August 7, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Review recent peer-reviewed literature and make recommendations related to meniscus and articular cartilage lesions.
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Home health, Hospital, Long term care, Outpatient
Intended Users
Physical therapist, occupational therapist, athletics coaching, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Rehabilitation, Management, Treatment
Diseases/Conditions (MeSH)
D007718 - Knee Injuries, D051346 - Mobility Limitation, D002358 - Cartilage, Articular
Keywords
acute knee pain, articular cartilage, Articular Cartilage Lesions, meniscus pain