Case Study: Medial Meniscus Repair (Long Haul Truck Driver)

I recently completed an exercise rehabilitation programme with a client following a left knee injury sustained at work in June this year.  A tear was identified in the posterior root of the medial meniscus and a surgical repair was performed 2 weeks after the injury.  Surgical repair of the meniscus requires a greater recovery time but offers the patient a better long-term prognosis if successful.

The meniscus is a C-shaped piece of cartilage in the knee which is essential for optimal joint stability, load distribution and shock absorption.  There are two menisci within each knee, one medial and the other lateral.  A common cause of injury is twisting on a slightly flexed knee.  Imagine a football player attempting a rapid change in direction.

When the client first attended Absolute Balance he had commenced light alternative duties at work and recently completed physiotherapy treatment.  The client was extremely motivated to return to his pre-injury job role as a Long-Haul Truck Driver and return to his hobbies which include mountain biking and martial arts.

Goal: Return to pre-injury duties as a Long-Haul Truck Driver

Injury: Left knee injury (surgical repair of the posterior root of the medial meniscus)

History: Bilateral tibial tubercle transfers, Right knee arthroscopic release, Long standing patellofemoral arthritic changes

Assessment: Reduced left lower limb control during unilateral assessments, Reported mild anterior knee discomfort during squats (unrelated to present injury), Muscle wastage in left lower limb

Key physical demands: Repetitive knee flexion and extension to manipulate the truck clutch, Stepping/climbing in/out of truck, ushing, pulling, bending and squatting when conducting pre-start check and trailer hook up

Programme goals: Increase strength and stability of the supporting lower limb musculature to improve capacity for ascending and descending truck steps and performing repetitive manipulation of truck clutch

An individualised gym-based programme was devised following the assessment of the client’s physical capacity and consideration of the key physical job demands.  Weekly supervised sessions were conducted at a gym close to the client’s home, with the client also attending independently to facilitate his progress and promote self-management.

Due to the reduced control during step-ups, an initial focus was placed on developing the eccentric phase of this movement and single-leg stability.  Modifications were implemented to squat technique to prevent anterior knee discomfort in order to develop his capacity with this movement to facilitate a return to pre-injury duties.  After three weeks of the programme the client was cleared to trial pre-injury duties.  This involved being away for 5 days as part of the interstate commutes.  Due to these changes, the programme was adapted to provide exercises for the client to complete whilst away.

The client was extremely motivated to the programme which enabled the difficulty of the exercises to be progressively increased to facilitate the desired improvements.  The images below are an example of the work-specific exercises implemented in the programme.

  

 

At the conclusion of the programme the client had achieved all the functional goals set out in the programme.  A notable improvement was identified in single leg stability which is vital for climbing into/out of the truck which is occasionally onto uneven surfaces or slippery steps from rain.  The exercise rehabilitation programme has transitioned to self-management to maintain the strength, stability and endurance of the lower limb.

If you would like more information on exercise rehabilitation please contact Absolute Balance on 9244 5580 or at info@absolutebalance.com.au

 

Daniel D’Avoine (B.Sc.Ex.Phys)

Workers Compensation Specialist