Extension deficit

[ealifestyle]

Hi everyone.

Backstory - injured knee 8 years ago. MRI showed small later meniscus tear and osteochondral lesion of medial femoral condyle (believed to have been there for a long time). Rehabbed it/strength trIned and never had any other issues with it until 2 years ago after giving birth to my son. Again, managed to rehab it but after I had my daughter in April 2023 it reared its ugly head again but this time the MRI showed it had flipped into a bucket handle tear so my knee was in a locked position.

Had surgery August 17th and surgeon had to remove 80% as the meniscus was trashed. No other work done in the knee.

Since this, my walking has felt worse than prior to surgery. I apparently have full extension but I absolutely do not have terminal knee extension when walking which I feel is contributing to the slight limp/gait pattern. I am also doing strength training regularly.

Did anyone else experience this post op? How did you fix it? Could the lesion be the thing stopping the active extension? I am at a loss here at as 33 year old mum of 2 small kids I just want my functionality back.

Thanks in advance

[The_KNEEguru]

I think you have a typo when you say "small later meniscus tear " and I am presuming you mean "small lateral meniscus tear"?

The lateral meniscus is very different to the medial meniscus because it is more mobile partly due to the presence of the popliteus tendon which is not present in the less mobile medial meniscus - /KNEEnotes/knee-dictionary/lateral-meniscus - and an 80% excision is likely to have major consequences over time. I refer you to this article in the mediacal literature https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9747892/ involving several knee specialists where a consensus was reached that

Preservation of the lateral meniscus should be the first-line treatment whenever possible, because the long-term clinical and radiological outcomes are worse after partial meniscectomy.

I am not that sure that with only 20% of your lateral meniscus intact, that you can expect a natural return of the function you had before the partial meniscectomy. You may find yourself a candidate for meniscal allograft transplantation (MAT) - see in the same paper

The indication for lateral MAT is symptomatic meniscal deficiency without the presence of advanced degenerative changes

and they also say that

the decision for lateral MAT should be made according to a case-by-case basis, especially in young patients.

So this may be something that you discuss with a surgeon expert in this area....I personally doubt that this is something that a physiotherapist can rectify.

[ealifestyle]

Sorry yes lateral meniscus.

I assumed that due to the fact that the meniscus was flipped and locked it wasn’t providing much function anyway but having it removed seems to have made it worse.

I am aware of the long term implications of this removal I was more trying to enquire as to why this would result in me being unable to fully extend my leg/extend when walking?

[The_KNEEguru]

I cannot be sure. I wonder if the popliteus has become a bit incompetent?
See -

Stabilization: The popliteus muscle helps to stabilize the knee joint during weight-bearing activities.
Gait Cycle: The popliteus muscle also plays a crucial role in the gait cycle by controlling the internal and external rotation of the tibia during walking and running.

https://www.motionspecificrelease.com/p ... 20running.

I am not sure what you could do about that, though. Perhaps any of the MSK Physiotherapist readers could give us some insight here?