Mechanical Diagnosis and Therapy and Directional Preference as an Adjunct to Lower Extremity Strengthening in Meniscus Tear Treatment: A Case Report

Background: Meniscal tears remain a highly prevalent injury with 61/100,000 people seeking treatment and 35% of people over the age of 50 having a positive meniscal tear finding on MRI.^1,2 Partial meniscectomies are one treatment option for meniscal tears, but 71.4% of surgical patients show signs of osteoarthritis at a 7-year follow-up.⁶ With this high prevalence, conservative treatment provides another possible treatment. Thus, the purpose of this case report is to present the conservative treatment option of Mechanical Diagnosis and Therapy (MDT) and directional preference as adjunct therapies to lower extremity strengthening in a patient with a meniscus tear. Case Description: A 56-year-old female with a history of knee osteoarthritis, injured the medial meniscus of her right knee when attempting to stop a fall on her steps at home. Intervention: Mechanical Diagnosis and Therapy (MDT) and directional preference was used as an adjunct to lower extremity strengthening. Treatments included repeated knee flexion and extension and strengthening exercises such as step ups, squats, and manual therapy. Outcomes: The Lower Extremity Functional Scale (LEFS), manual muscle testing, and subjective percentages of improvement were used to assess progress throughout the treatment episode. The patient improved by 10 points on the LEFS with a MDC and MCID of 9 points.²¹ This correlates with an increase of 12.5% in function while the patient reported 70% improvement. Her right lower extremity strength improved from 3+/5 to 4+/5 in all myotomes with initial deficits. Discussion: The results were inconclusive for MDT and directional preference as an adjunct to lower extremity strengthening as our patient had similar functional and self-reported outcomes when compared to a study using similar strengthening exercises.