Efficacy of therapeutic ultrasound treatment of a meniscus tear in a severely disabled patient: a case report.

Abstract

This report focuses on diagnosis and management of a meniscus tear of unknown etiology in a functionally impaired patient. The patient was a 21-year-old man diagnosed with viral meningoencephalitis and postvaccinal central pontine myelinolysis, who experienced respiratory failure and required prolonged mechanical ventilation. He was in a comatose state for approximately 1.5 months. He presented to our facility 3 weeks after coma complaining of left knee pain and limited range of motion (ROM). Diagnostic workup, including magnetic resonance imaging, showed a grade II posterior horn medial meniscus tear and lateral tibial stress injury of the left knee. Management of the meniscus tear included the RICE protocol (rest, ice, compression, elevation), therapeutic ultrasound, and physical therapy. The patient responded extremely well to initial ultrasound therapy, with decreased pain and increased ROM of the left knee, which allowed him to make significant functional gains and to make overall progress in our comprehensive acute rehabilitation program. To date, nonoperative care of acute meniscal injury is commonly considered to be unsatisfactory; however, in this patient it led to rapid functional gains. Thus, therapeutic ultrasound may be a beneficial modality to decrease pain and increase ROM of the knee in an acutely torn meniscus, which, in turn, would likely promote good functional progress in any rehabilitation program.