a half inch diameter of the cleat tip, and at most, a three-eighths inch of cleat length. stretches the second way to prevent a meniscus tear is to strengthen and stretch the major leg muscles. those muscles include the hamstrings, quadriceps, and calf muscles. one popular exercise used to strengthen the hamstrings is the leg curl. it is also important to properly stretch the hamstrings; doing standing toe touches can do this. seated leg extensions strengthen the quadriceps and doing the quadriceps stretch will help loosen the muscles. toe raises are used to strengthen and stretch the calves. adequate muscle mass and strength may also aid in maintaining healthy knees. the use of the parallel squat increases much needed stability in the knee if executed properly. execution of the parallel squat will develop the lower body muscles that will strengthen the hips, knees, and ankles. proper parallel squat form to improve knee stability technique the last major way to prevent a tear in the meniscus is learning proper technique for the movement that is taking place. for the sports involving quick powerful movements it is important to learn how to cut, turn, land from a jump, and stop correctly. it is important to take the time out to perfect these techniques when used. these three major techniques will significantly prevent and reduce the risk of a meniscus tear. treatment tear of medial meniscus presently, treatments make it possible for quicker recovery. if the tear is not serious, physical therapy, compression, elevation and icing the knee can heal the meniscus. meniscus tears are more likely to heal on their own if they are in what physicians call the "red zone," or the outer edge of the meniscus where blood supply is present. more serious tears may require surgical procedures. surgery, however, does not appear to be better than non-surgical care. in the long term, degenerative meniscal tears are often associated with osteoarthritis. this leads to poor outcomes regardless of treatment type. in the short term, studies have shown arthroscopic partial meniscectomy (apm) is a more effective treatment with regards to function and pain management. conservative treatments initial treatment may include physical therapy, bracing, anti-inflammatory drugs, or corticosteroid injections to increase flexibility, endurance, and strength. common anti-inflammatory drugs and painkillers prescribed for meniscus tears include acetaminophen, non-steroidal inflammatory drugs, and corticosteroids. exercises can strengthen the muscles around the knee, especially the quadriceps. stronger and bigger muscles will protect the meniscus cartilage by absorbing a part of the weight. the patient may be given paracetamol or anti-inflammatory medications. for patients selecting non-surgical treatment, physical therapy may reduce symptoms of pain and swelling. this type of rehabilitation focuses on maintenance of full range of motion and functional progression without aggravating symptoms. physical therapists can employ electric stimulation, cold therapy, and ultrasonography. accelerated rehabilitation programs can be as successful as the conservative program. the program reduces the time the patient spends using crutches and allows weight bearing activities. the less conservative approach allows the patient to apply a small amount of stress while protecting range of motion. it is likely that a patient with a peripheral tear can pursue the accelerated program, while a patient with a larger tear adopts the conservative program. the use of platelet rich plasma (prp) to aid in the healing process has become widely accepted among us athletes. although the procedure has grown in popularity, studies assessing the efficacy of prp treatment have yielded contradictory results. surgery arthroscopy is a surgical technique in which a joint is operated on using an endoscopic camera as opposed to open surgery on the joint. the meniscus can either be repaired or completely removed. surgery is not appropriate for a degenerative meniscus tear, absent locking or catching of the knee, recurrent effusion or persistent pain. evidence suggests that it is no better than conservative management in those with and without osteoarthritis. surgery appears to offer no benefit to adults who have mild arthritis. an independent international guideline panel recommended against arthroscopy for degenerative meniscus tears; this conclusion derived from evidence of no lasting benefit and that less than 15% of patients experience even a short-term benefit. disadvantages include a two to six week recovery time and rare but serious adverse effects that can occur, including blood clots in the legs, surgical site infections, and nerve damage. the bmj rapid recommendation includes infographics and shared decision-making tools to facilitate a conversation between doctors and patients about the risks and benefits of arthroscopic surgery. if the injury is isolated, then the knee would be relatively stable. however, if an injury such as an anterior cruciate ligament injury (torn acl) is coupled with a torn meniscus, then an arthroscopy is recommended. a meniscal repair has a higher success rate given an adequate blood supply to the peripheral rim. the interior of the meniscus is avascular, but the blood supply can penetrate up to about 6 millimetres (0.24 in). therefore, meniscus tears that occur near the peripheral rim are able to heal after a meniscal repair. one study found that repair is better than removal (meniscectomy). the amount of rehabilitation time required for a repair is longer, but removing the meniscus can induce osteoarthritis. meniscectomy rehab requires four to six weeks. repair requires four to six months. if conservative treatment is ineffective, surgical intervention may be required. younger patients are typically more resilient and respond well to this treatment, while older, more sedentary patients do not have a favorable outcome after a repair. transplants meniscus transplants are regularly successful, although the procedure is not common and many questions surrounding its use remain. side effects of meniscectomy include: the knee loses its ability to transmit and distribute load and absorb mechanical shock. persistent and significant swelling and stiffness in the knee. the knee may be not be fully mobile; there may be the sensation of knee locking or buckling in the knee. the full knee may be in full motion after tear of meniscus. increases progression of arthritis and time to knee replacement. implants another treatment approach in development is a meniscus implant or "artificial meniscus." while many artificial joints and bionic body parts are available, including arms, legs, joints and other body parts, a prosthetic meniscus replacement. the first to be implanted in humans is called the nusurface meniscus implant. the implant is made from medical grade plastic and is designed not to require fixation to bone or soft tissue. the implant could be a good option for younger, active patients who are considered too young for knee replacement because that surgery lasts only about 10 years. the implant has been used in clinical trials in europe since 2008. the first surgery as part of us clinical trials took place in january 2015 at ohio state university's wexner medical center. two fda-approved clinical trials evaluating the implant completed enrollment in june 2018. in september 2019, the manufacturer received breakthrough designation from the u.s. food and drug administration, and the company expected to file for regulatory approval within the following year. in november 2019, the implant became commercially available in israel. other implants include trammpolin and orthonika. scientists are working to grow an artificial meniscus in the lab. scientists from cornell and columbia universities grew a meniscus inside the knee joint of a sheep using a 3-d printer and the sheep's stem cells. similarly, researchers at scripps research shiley center for orthopaedic research and education reported growing a meniscus. post-surgical rehabilitation typical locations of arthroscopic surgery incisions in a knee joint following surgery for a tear in the meniscus after a successful surgery for treating the destroyed part of the meniscus, patients must follow a rehabilitation program to have the best result. the rehabilitation following a meniscus surgery depends on whether the entire meniscus was removed or repaired. if the damaged part of the meniscus was removed, patients can usually start walking using a crutch a day or two after surgery. although each case is different, patients return to their normal activities on average after a few weeks (2 or 3). still, a completely normal walk will resume gradually, and it's not unusual to take 2–3 months for the recovery to reach a level where a patient will walk totally smoothly. many meniscectomy patients don't ever feel a 100% functional recovery, but even years after the procedure they sometimes feel tugging or tension in a part of their knee. there is little medical follow-up after meniscectomy and official medical documentation tends to ignore the imperfections and side-effects of this procedure. if the meniscus was repaired, the rehabilitation program that follows is a lot more intensive. after the surgery, a hinged knee brace is sometimes placed on the patient. this brace allows controlled movement of the knee. the patient is encouraged to walk using crutches from the first day, and most of the times can put partial weight on the knee. improving symptoms, restoring function, and preventing further injuries are the main goals when rehabilitating. by the end of rehabilitation, normal range of motion, function of muscles and coordination of the body are restored. personalized rehabilitation programs are designed considering the patient's surgery type, location repaired (medial or lateral), simultaneous knee injuries, type of meniscal tear, age of patient, condition of the knee, loss of strength and rom, and the expectations and motivations of the patient. day one through ten of arthroscopy surgical recovery. phase i there are three phases that follow meniscal surgery. each phase consists of rehabilitation goals, exercises, and criteria to move on to the next phase. phase i starts immediately following surgery to 4–6 weeks or until the patient is able meet progression criteria. the goals are to restore normal knee extension, reduce and eliminate swelling, regain leg control, and protect the knee (fowler, pj and d. pompan, 1993). during the first 5 days following the surgery, a passive continuous motion machine is used to prevent a prolonged period of immobilization which leads to muscular atrophy and delays functional recovery. during the 4–6 weeks post-surgical, active and passive non-weight bearing motions which flex the knee up to 90° are recommended. for patients with meniscal transplantation, further knee flexion can damage the allograft because of the increased shear forces and stresses. if any weight-bearing exercises are applied, a controlled brace should be worn on the knee to keep the knee at near (<10°) or full extension. the suggested exercises target increasing the patient's rom, muscular and neuromuscular strength, and cardiovascular endurance. aquatic therapy, or swimming, can be used to rehab patients because it encompasses rom, strength, and cardiovascular exercises while relieving stress on the body. it has also been shown to significantly improve dependent edema and pain symptoms. no pain gait without crutches, swelling and 4–6 weeks after surgery are the criteria to begin the next phase (ulrich g.s., and s aroncyzk, 1993). phase ii this phase of the rehabilitation program is 6 to 14 weeks after the surgery. the goals for phase ii include being able to restore full rom, normalized gait, and performing functional movements with control and no pain (fowler, pj and d. pompan, 1993). also, muscular strengthening and neuromuscular training are emphasized using progressive weight bearing and balance exercises. exercises in this phase can increase knee flexion for more than 90°. advised exercises include stationary bicycle, standing on foam surface with two and one leg, abdominal and back strengthening, and quadriceps strengthening. the proposed criteria include normal gait on all surfaces and single leg balance longer than 15 seconds (ulrich g.s., and s aroncyzk, 1993). balance exercises on a foam surface in phase 2. the patient tries to maintain balance first with both legs, then with only the affected leg. phase iii patients begin exercises in phase iii 14 to 22 weeks after surgery. phase iii's goal and final criterion is to perform sport/work specific movements with no pain or swelling (fowler, pj and d. pompan, 1993). drills for maximal muscle control, strength, flexibility, movements specific to patient's work/sport, low to high rate exercises, and abdominal and back strengthening exercises are all recommended exercises (ulrich g.s., and s aroncyzk, 1993). exercises to increase cardiovascular fitness are also applied to fully prepare the patients to return to their desired activities. if the progression criteria are met, the patient can gradually return to