Rehabilitation Following Meniscus Repair


Phase 1: Postop phase

Goals

• Protect healing of repair

• Decrease pain

• Manage effusion

• Increase weight-bearing tolerance per procedure

• Gradually improve knee ROM to 0–90° by week 2 and 0–120° by week 4

• Restore quadriceps control

Weeks 1–2

Brace

Long-leg postoperative brace

ROM goals

0–90°

Weight-bearing

Peripheral: TTWB—50 % WB

Complex: TTWB—25 % WB

Interventions

Patella mobilizations
 
LE flexibility
 
Quad set/SLR/knee extension AROM
 
NMES
 
Ankle pumps
 
Ice/compression/elevation

Weeks 3–4

Brace

Long-leg postoperative brace

ROM goals

0–120°

Weight-bearing

Peripheral, 75 % FWB; complex, 50–75 % WB

Interventions

Patella mobilizations
 
LE flexibility
 
Quad set/SLR/knee extension AROM
 
NMES
 
Ankle pumps
 
HR/wall sits (peripheral)
 
Ice/compression/elevation

Phase 2: Early rehab phase

Goals

• Gradually improve knee ROM to full

• Minimal to no effusion

• Decrease pain

• Progress weight-bearing tolerance per procedure

• Increase strength

• Improve balance and proprioception

• Minimal to no gait deviations

Weeks 5–6

Brace

Long-leg postoperative brace

ROM goals

0–135°

Weight-bearing

Peripheral, FWB; Complex, 75 % FWB

Interventions

Patella mobilizations
 
LE flexibility
 
Quad set/SLR
 
NMES
 
Knee extension 90–30°
 
Leg press 70–10° (peripheral)
 
Mini squats/HR/wall sits
 
Ice/compression/elevation

Phase 2: Early rehab phase

Weeks 7–8

ROM goals

Full ROM

Weight-bearing

FWB

Interventions

LE flexibility
 
Quad set/SLR
 
Knee extension 90–30°
 
Multi-hip (Flex/ABD/ADD/Ext)
 
Ham curls
 
Leg press 70–10° (peripheral)
 
Mini squats/HR/wall sits
 
Lateral step-ups
 
Proprioception
 
Stationary bike
 
Ice/compression/elevation

Phase 3: Functional progression

Goals

• Improve lower extremity strength

• Enhance proprioception, balance, and neuromuscular control

• Improve muscular endurance

• Restore limb confidence and function

Weeks 9–12+

Interventions

LE flexibility
 
Quad set/SLR
 
Knee extension 90–30°
 
Multi-hip (Flex/ABD/ADD/Ext)
 
Ham curls
 
Leg press 70–10°
 
Mini squats/HR/wall sits
 
Lunges
 
Sports cord/band walks
 
Proprioception
 
Perturbation training
 
Stationary bike
 
Swimming
 
Stair climber
 
Ice/compression/elevation

Phase 4: Return to activity

• Normalize lower extremity strength

• Enhance muscular power and endurance

• Improve neuromuscular control

• Completion of running program

• Perform selected sport-specific drills

• Gradual return to full unrestricted sports

4–6+ months

Interventions

LE flexibility
 
Knee extension 90–30°
 
Multi-hip (Flex/ABD/ADD/Ext)
 
Ham curls
 
Leg press 70–10°
 
Mini squats/HR/wall sits

Phase 4: Return to activity
 
Proprioception
 
Stationary bike
 
Swimming
 
Stair climber
 
Running program
 
 4 months peripheral
 
 6 months complex
 
Plyometrics (peripheral tears 4–6 months/complex tears 6–9 months)





Phase 1: Postoperative (Weeks 1–4)


The immediate postoperative phase begins following surgery and lasts approximately 1 month. Initially, patients ambulate with bilateral axillary crutches in a postoperative long-leg brace locked in full extension. Limited weight-bearing for the first 4 weeks may protect the repair and increase the healing potential. Generally, for a peripheral repair, patients will be toe-touch weight-bearing to 50 % weight-bearing during this time interval. For complex and radial tears, patients will be toe-touch weight-bearing to 25 % weight-bearing. For radial tears, it has been reported that weight-bearing may place a displacing force across the repair of a radial meniscus tear; thus weight-bearing precautions will be similar to a complex tear [3]. However, early physiological loading can be beneficial to the menisci in a manner similar to fractures and may help overall healing [4]. The knee brace is opened from 0° to 90° for ROM exercises and kept locked in extension for all other activities. Flexion beyond 90° is discouraged for the first month since motion beyond this leads to “femoral rollback” and therefore increased tensile forces across the repair site. Ice, compression, and elevation are important for controlling knee effusion and pain control. Patients are instructed to utilize ice for 10–15 min every 1–2 h during the first 10–14 days postoperatively.

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Mar 25, 2017 | Posted by in ORTHOPEDIC | Comments Off on Rehabilitation Following Meniscus Repair

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