Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Meniscectomy and Meniscus Repair


Related Terms

  • Cartilage Surgery
  • Meniscus Shaving
  • Partial Meniscectomy

Specialists

  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist

Comorbid Conditions

Factors Influencing Duration

The type of procedure; the occurrence of complications; and the individual's job requirements, ability to modify work activities, and compliance with rehabilitation may affect duration of disability.

Medical Codes

ICD-9-CM:
80.6 - Excision of Semilunar Cartilage of Knee; Meniscectomy; Excision of Meniscus of Knee
81.42 - Five-in-one Repair of Knee; Medial Meniscectomy, Medial Collateral Ligament Repair, Vastus Medialis Advancement, Semitendinosus Advancement, and Pes Anserinus Transfer
81.43 - Triad Knee Repair; Medial Meniscectomy with Repair of the Anterior Cruciate Ligament and the Medial Collateral Ligament; ODonoghue Procedure
81.47 - Repair of Knee, Other

Overview

© Reed Group
Meniscectomy is the surgical removal or repair of either of two C-shaped bands of cartilage in a joint, most commonly the knee (knee meniscus). The meniscus forms a buffer between leg bones (the tibia, fibula, and femur); serves as a shock absorber; assists in lubrication of the joint; and limits the joint's flexion, extension, and rotation. Twisting or hyperflexion of the joint are the most common causes of meniscal tears. The location and type of tear determine how much of the meniscus needs to be removed. The entire meniscus is rarely removed due to the increased risk of knee instability and osteoarthritis.

Many meniscal injuries are sports-related. Although use of proper technique when exercising or playing sports is emphasized, many meniscus tears may not be preventable. A sign of meniscus injury is typically a "pop" noted at the time of injury. Joint tenderness, knee pain, and recurrent knee catching may follow. The knee may "lock," making it difficult or impossible to straighten the leg out.

Source: Medical Disability Advisor



Reason for Procedure

The meniscectomy procedure is used to remove injured or damaged cartilage from the knee joint. The procedure is also used to relieve symptoms (joint tenderness, knee pain, and recurrent knee catching). In contrast to partial meniscus excision, meniscus repair may slow down the inevitable post-traumatic arthritis that follows a meniscus tear, and also provide protection to the knee ligaments. The goal of a meniscectomy is to relieve symptoms.

Source: Medical Disability Advisor



How Procedure is Performed

Arthroscopic surgery is now the standard of care for meniscal surgery. It has the advantage of producing less pain and promises a quicker recovery. However, it may occasionally prove difficult, depending on the type and location of the tear and the presence of adhesions. In these cases, open or conventional meniscectomy may be preferable. In an arthroscopic meniscectomy or meniscus repair, after the individual is anesthetized, the surgeon inserts a viewing scope (arthroscope) and one or two tools into the knee joint through small incisions (cuts or portals). Fluid is injected into the knee to expand the joint so the structures and cartilage can be seen. The surgeon first examines the knee to find any tears or other damage.

Tears along the inner curve of the meniscus where the blood supply is poor, especially those that are of the ragged, degenerative type, are most commonly treated by removing the damaged part of the meniscus (partial meniscectomy). Tears near the outer rim of the meniscus where the blood supply is rich may be repaired with stitches (meniscus repair). With either procedure, any avascular fragments of cartilage are removed. The surgery concludes by removing the arthroscope and tools and closing the small incisions with sutures.

In a conventional meniscectomy or meniscus repair, after the individual is anesthetized, the affected area is approached by an open incision into the knee joint to examine and treat internal structures. If additional injuries are visualized, the injured structures are repaired. The surgery concludes with the closure of the skin with sutures or clips that can usually be removed about 1 week after surgery.

Source: Medical Disability Advisor



Prognosis

The predicted outcome of a meniscectomy procedure is good. Most individuals who undergo meniscectomy can expect significant improvement without complications, though some studies report a complication rate of as high as 30% for meniscus repair (Baker). In 5% to 10% of patients, meniscal repairs do not heal (Baker).

About 2 to 8 weeks should be allowed for recovery from surgery (Baker). A meniscal repair may take longer to heal (see Rehabilitation).

The prognosis is worse if both menisci in the same knee are injured and require meniscectomy (as opposed to repair). The prognosis is also worse if the knee has other injuries (for example, instability from ligament injury) or if the knee has significant pre-existing arthritis.

Source: Medical Disability Advisor



Rehabilitation

The primary focus of rehabilitation following a meniscectomy or meniscus repair is to control pain and restore function. The rehabilitation program will be dependent on the surgical procedure and the protocol of the treating physician.

The first goal of rehabilitation is independent ambulation. Gait training with an assistive device may be necessary, with weight bearing as indicated by the physician. If, at the beginning, pain is an issue, modalities such as heat and cold may be used. After the early postoperative period, it is common to begin physical therapy with a heat treatment in order to relax the tissues around the knee and to conclude with a cold treatment in order to control the pain and swelling that may follow exercise. The physician will determine use of compressive wraps or devices.

The next goal is to restore motion and strength to the involved knee. Passive range of motion exercises are usually begun immediately to help restore full mobility to the joint. If a meniscus repair has been performed, particularly one involving the posterior meniscus, knee flexion may be restricted to 90 degrees for the first 6 weeks to avoid displacement (Brockmeier). During the first 4 to 6 weeks after repair, the joint should be protected by a knee brace during ambulation, with weight bearing progression dictated by the type of repair performed (Brockmeier). Initial strengthening exercises are non-aggressive and typically static (isometric) (Lento).

Exercise may be progressed based on the recommendations of the physician. It may be necessary to strengthen the adjacent joints if limited weight bearing was necessary pre- or post-operatively. Therapy should progress to strengthening exercises as tolerated, and should include flexibility exercises throughout the period of strengthening. While strong muscles around the joint are critical, flexibility of the same muscle groups must be considered. It is important to emphasize closed chain exercises, in which the foot is stabilized, as well as open chain exercises, in which the foot is free to move, when appropriate (Lento). Therapy may continue to include the use modalities as needed to control pain and swelling. Individuals can be instructed in a home exercise program to be performed independently to complement the supervised exercise regimen.

When full, pain-free motion is regained and the individual has sufficient strength for all activities of daily living, the individual may be progressed to balance and proprioceptive exercises. The physician, individual, and physical therapist will determine the extent of these exercises.

Before discharge from physical therapy, individuals should understand both the need for continued exercise to maintain the stability of the knee joint and ways to protect the joint during work and leisure activities. Although a meniscus can heal within approximately 12 weeks, the joint may still need to be protected from heavy loading until the meniscus has regained its full strength. If a meniscectomy were performed, the degree of knee loading during work and leisure activities must be considered and discussed with the physician prior to return to work. After meniscus repair, full heavy work and athletic activities may be delayed for 16 to 24 weeks (Brockmeier; Lento).

FREQUENCY OF REHABILITATION VISITS
Surgical (meniscectomy)
SpecialistMeniscectomy and Meniscus Repair
Physical TherapistUp to 12 visits within 6 weeks
Surgical (meniscus repair)
SpecialistMeniscectomy and Meniscus Repair
Physical TherapistUp to 24 visits within 12 weeks
Note on Surgical (Meniscus Repair) Guidelines: In a meniscal repair it can take the tissue up to 4 months to heal, and the final exercises cannot be started until the tissues are healed. Individuals can likely return to certain work before full healing has occurred but may need continued rehabilitation.
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

The complication rates for arthroscopic meniscectomy range from 0.5% to 1.7%. Complication rates reported for meniscus repair range from 1% to 30% (Baker). Complications of either procedure may include nerve or blood vessel damage, bleeding, infection, stiffening of the knee joint, and failure of the procedure.

Complete meniscectomy may increase the rate of degenerative changes to the articular surface and often leads to increased instability of the knee. In addition, blood vessels and nerves around the knee may be injured and cause numbness or weakness in the leg below the knee. Besides the usual surgical complications of anesthesia, chronic pain, infection, and bleeding, the individual may experience the formation of blood clots within a deep-lying vein (deep vein thrombosis) and changes in sensation around the incision.

Some individuals develop a postsurgical inflammation aggravated by physical therapy that slows recovery. It is important to note that even though arthroscopic meniscectomy and repair are now the standard of care, having the procedure performed arthroscopically does not automatically mean recovery will be short and/or easy.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Strenuous activities should be restricted for several weeks. Other restrictions include no kneeling, squatting, crawling, climbing, or prolonged standing during the early phase of recovery. Use of crutches and a knee brace will affect agility. Frequent rest periods with facilities that allow the individual to elevate the lower extremity may enable earlier return to work. Use of prescribed medications for pain and swelling may require review of any drug policies.

Both increased awareness of the knee’s position while twisting, turning, or lifting and reestablishing knee fitness, emphasizing strength and flexibility, will help prevent recurrent problems. Some individuals may have permanent restrictions on kneeling, jumping, and squatting based on findings during surgery.

Source: Medical Disability Advisor



References

Cited

Baker, Bradley S., and James Lubowitz. "Meniscus Injuries." eMedicine. Eds. Leslie Milne, et al. 5 Jun. 2008. Medscape. 18 Feb. 2009 <http://www.emedicine.com/sports/topic160.htm>.

Brockmeier, Stephen F., and Scott A. Rodeo. "Section B: Meniscal Injuries." DeLee and Drez’s Orthopaedic Sports Medicine. Eds. Jesse C. DeLee, David Drez, and Mark D. Miller. 3rd ed. Saunders Elsevier, 2009. MD Consult. Elsevier, Inc. 18 Nov. 2009 <http://www.mdconsult.com/das/book/body/172237772-5/0/2079/52.html?tocnode=57568499&fromURL=52.html#4-u1.0-B978-1-4160-3143-7..00023-3--sc2_3557>.

Lento, Paul, and Venu Akuthota. "Chapter 63 -Meniscal Injuries." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

General

Levy, David, Howard Dickey-White, and June Sanson. "Knee Injury, Soft Tissue." eMedicine. Eds. Eric Kardon, et al. 12 Dec. 2008. Medscape. 18 Feb. 2009 <http://emedicine.medscape.com/article/826792-overview>.

Source: Medical Disability Advisor






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