Chapter 30 Rehabilitation of Meniscus Repair and Transplantation Procedures
CLINICAL CONCEPTS
The postoperative program for meniscus repair and transplantation is shown in Table 30-1. The initial goal is to prevent excessive weight-bearing, because high compressive and shear forces can disrupt healing meniscus repair sites (especially radial repairs) and transplants. Variations are built into the protocol according to the type, location, and size of the meniscus repair and whether concomitant procedures (such as ligament reconstructions) are performed. The surgeon has the responsibility to inform the physical therapy team of details regarding the type of tear and the repair that was performed. Meniscus repairs with all-inside fixators have inferior holding strength, and commonly, only a few sutures are used. These repairs require more protection to allow for healing during the first 6 postoperative weeks. Inside-out meniscus repair techniques involve multiple vertical divergent sutures (see Chapter 28, Meniscus Tears: Diagnosis, Operative Techniques, and Clinical Outcomes) and have superior holding strength.
Critical Points CLINICAL CONCEPTS
Clinicians should be aware that meniscus repairs located in the periphery (outer third region) heal rapidly, whereas complex repairs that extend into the central third region tend to heal more slowly and require greater caution. In addition, modifications to the postoperative exercise program may be required if noteworthy articular cartilage deterioration is found during the arthroscopic procedure. This rehabilitation program has been used at the authors’ institution in hundreds of meniscus transplant and repair recipients, and the results of clinical investigations3-5,7 demonstrate its safety and effectiveness in restoring normal knee motion, muscle, and gait characteristics.
IMMEDIATE POSTOPERATIVE MANAGEMENT
TABLE 30-2 Postoperative Signs and Symptoms Requiring Prompt Treatment
Postoperative Sign and/or Symptom | Treatment Recommendations |
---|---|
Continued pain in the medial or lateral tibiofemoral compartment of the meniscus repair or transplant | Physician examination, assess need for refixation or re-repair |
Tibiofemoral compartment clicking, or a subjective sensation by the patient of “something being loose” within the tibiofemoral joint | Physician examination, assess need for refixation or re-repair |
Failure to meet knee extension and flexion goals (see text) | Overpressure program, early gentle manipulation under anesthesia if 0°–135° not met by 6 wk postoperatively |
Decreased patellar mobility (indicative of early arthrofibrosis) | Aggressive knee flexion, extension overpressure program, or gentle manipulation under anesthesia to regain full ROM and normal patellar mobility |
Decrease in voluntary quadriceps contraction and muscle tone, advancing muscle atrophy | Aggressive quadriceps muscle strengthening program, EMS |
Persistent joint effusion, joint inflammation | Aspiration, rule out infection, close physician observation |
EMS, electrical muscle stimulation; ROM, range of knee motion.
From Heckmann, T.; Barber-Westin, S. D.; Noyes, F. R.: Meniscal repair and transplantation: Indications, techniques, rehabilitation, and clinical outcome. J Orthop Sports Phys Ther 36:795–814, 2006.
BRACE AND CRUTCH SUPPORT
Critical Points BRACE AND CRUTCH SUPPORT
Brace Used 6 Wk in Complex Meniscus Repairs and Transplants
Brace not required in simple meniscus repairs in periphery (outer third region).
Crutch support for 4 wk postoperative. Patients weaned when normal gait demonstrated.
Crutches with partial weight-bearing are recommended for the first 4 wk in all cases.
RANGE OF KNEE MOTION AND FLEXIBILITY
TABLE 30-3 Range of Motion, Flexibility, and Modality Usage after Meniscus Repair and Transplantation
