Rehabilitation guidelines for meniscal repair uw health. Rehabilitation guidelines for meniscal root repair the intent of this protocol is to provide the clinician with a general guideline of the postoperative course of the patient that has undergone the above stated procedure. The success of a meniscus repair is most dependent on two factors. Click here to download pdf rehabilitation after knee meniscus repair. Rehabilitation following a meniscus repair is more significant than if the torn piece of meniscus is simply removed through a procedure called a partial meniscectomy. Longleg postoperative c, a, t c, a, t c, t range of motion minimum goals 090 0120 05 x x x weightbearing toe touch to 50% body weight 75% to 100% body weight toe touch to 25% body weight. Rehabilitation exercises a meniscus tear is a common knee joint injury. Find out when it helps, what to expect, and how long youll need to do it for. Surgical knee will be in a hinged rehab brace locked in full extension for 4 weeks postop. Op r ehabilitation protocol the following is a protocol for postoperative patients following an isolated meniscus repair. Once the dressing is removed on the third postoperative day, ice is applied for 20minute periods 3. As tolerated should be understood to include with safety for the reconstructionrepair.
If an acl reconstruction and meniscus repair are performed, follow the meniscus repair program for. Nl rom with return to adls work sport nl strength and proprioception nwb status per md, see below post op restrictions return to sports 1012 weeks control pain and swelling. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. Op rehabilitation protocol the following is a protocol for postoperative patients following an isolated meniscus repair.
Meniscus repair rehabilitation the following protocol is a guideline for rehabilitation following meniscus repair. If you have any questions, please speak to your physiotherapist. This handout describes details of the postoperative care of your knee. Your physiotherapist has diagnosed you with a degenerative meniscal tear. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. As tolerated should be understood to include with safety for the reconstruction repair. Anterior cruciate ligament acl and meniscus repair.
We have remained at the forefront of medicine by fostering a culture of collaboration, pushing the boundaries of medical research, educating the brightest medical minds and maintaining an unwavering commitment to the diverse communities we serve. Lowe this rehabilitation protocol was developed for patients who have isolated meniscal repairs. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a patient that has undergone a meniscal repair. Postoperative rehabilitation aims to foster healing after meniscal repair and. There are two types of cartilage in the knee, articular cartilage and meniscus cartilage. Regular manual mobilizations to surgical wounds and associated soft tissue to. Meniscal repair rehabilitation protocol rom brace, wbat in extension only, limit rom 090 x 6 wks phase 1 02wks. Knee immobilizer used for four weeks, ted hose to be worn until. Rehabilitation guidelines for meniscal repair of root and.
If a surgeon removes the torn part of the meniscus, the pain is relieved for a whileuntil. Meniscal repairs located in the vascular zones of the periphery or outer third of the meniscus are progressed more rapidly than those repairs that are more complex and located in that avascular zone of the meniscus. Regular assessment of gait to avoid compensatory patterns. How well the knee will heal and whether surgery will be needed depends in large part on the type of tear see figure in appendix and how bad the tear is. The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a meniscal repair. Acl reconstruction with meniscal repair rehabilitation.
Rehabilitation guidelines for meniscal root repair please note that these instructions are general guidelines to be followed. If you have surgery to repair your meniscus, it may take more like 3 months. Re 17 chris ales m 7 rtho ln rownsbur i 6112 317263632 rthoindcom acl reconstruction with meniscal repair rehabilitation protocol basic acl protocol but no passive range of motion prom greater than 90 degrees for four weeks. Dependent upon the location of the repair, weight bearing status postoperatively as well as. Nov 16, 2016 below is an example of a rehabilitation program suitable for both conservative treatment and following surgery for partial removal of torn knee cartilage meniscus.
Meniscus repair rehabilitation protocol the following is a protocol for postoperative patients following meniscus repair. Articular cartilage is made up of collagen, proteoglycans and water which lines the end of the bones that meet to form a joint. Knee arthroscopy meniscus root repair day of surgery a. Rehabilitation following meniscus repair memorial hermann. Conclusions there is a lack of consensus regarding the optimal postoperative protocol. Regain knee motion, limiting knee flexion to 90 degrees 3. Meniscal repair guidelines postoperative phase 3 week 1422 the focus of the final phase of rehabilitation following meniscal repair is directed at optimizing functional capabilities and preparing the patientathlete for a safe return to sport activities. Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older. Lie on your back with a rolled up towel under your heel or sit in a chair with the heel on a stool as shown in the figure. Rehabilitation and return to play following meniscal repair. For this reason, rehabilitation following a meniscal repair is particularly conservative in an effort to protect the repaired meniscus. Meniscus repair and transplant protocol the noyes knee. Meniscus root repairs nonweight bearing with brace locked at 0 degrees okay to unlock brace while nonweight bearing i.
Meniscal repairs located in the vascular zones of the periphery or outer third of the meniscus are progressed more rapidly than those repairs that are more complex and located in the avascular zone of the meniscus. The torn meniscus rehabilitation program is split into 4. Postoperative instructions knee arthroscopy meniscus root. Repair can be achieved by a transtibial tunnel repair, a suture anchor repair or a side to side repair.
Meniscal repairs located in the vascular zones of the periphery or outer third of the meniscus are progressed more rapidly than those repairs that are. Brace knee immobilizer used for four weeks, ted hose to be worn until ambulation has returned to normal presurgery level or two weeks. The following is a protocol for postoperative patients following an isolated meniscus repair. If it doesnt work, then it may be time for surgery.
Factors affecting success include tear age, location and pattern, age of the patient, as well as any associated injuries. Precautions and related issues the decision to repair a tear in the meniscus is based largely on the location of. The authors have reported the efficacy of the rehabilitation programs and the results of meniscus repair and transplantation in many studies. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Postoperative rehabilitation aims to foster healing after meniscal repair and facilitate the patients return to full function. Jan 21, 20 he highlights the importance of walking with crutches in a longleg brace for about 6 weeks after meniscal transplant and complex meniscus repairs extending into central onethird region but not routinely after repair of a peripheral meniscus tear.
Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet to form a joint. The orthopedic surgeon may modify the time frames and weight bearing status, as necessary, to allow adequate healing time. Specific changes in the program will be made by the. Some meniscus tears can be repaired by suturing stitching the torn pieces together. Pull the heel toward the buttocks, flexing the knee. Meniscus repair rehabilitation northeast orthopedics and. Meniscus repairs located in the periphery heal rapidly, whereas complex multiplanar repairs tend to heal more slowly and require greater caution. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a patient that has undergone. Meniscal repair postoperative rehabilitation protocol orthoindy. While the postop dressing is in place, icing should be done continuously. It is a minimally invasive procedure often undergone as an outpatient. Meniscal repair postoperative rehabilitation protocol. Verma or either physician assistant supersede the instructions below and should be followed. Noyes knee institute rehabilitation protocol for meniscus repairs and transplants 12 34 56 78 912 4 5 6 712 brace.
The purpose of this clinical commentary is to provide a brief background on meniscal root anatomy, biomechanics, tear pathology, and surgical technique, and to provide an indepth discussion of current concepts of meniscal root repair rehabilitation based on anatomic and biomechanical principles. Because the meniscus must heal back together, recovery time for a repair is much longer than from a. Meniscus repair guidelines vanderbilt university medical. Physical therapy pt and exercises for a meniscus tear rehab. Table 1 rehabilitation principles for the meniscal patient 1.
In his epidemiological study conducted on 17,397 patients in germany and switzerland, soccer, followed by skiing, are the sport with an increased risk of meniscal injuries. The menisci occupy 60% of the contact area between the tibial and femoral cartilage surfaces and transmit over 50% of joint. Noyes, md3 the purpose of this paper is to provide current knowledge regarding the indications, operative. Common tears include longitudinal, parrotbeak, flap, bucket handle, and mixedcomplex. Frisbie memorial hospital marsh brook rehabilitation service wentworthdouglass hospital durham. Rehabilitation of meniscal injury and surgery john t. No loaded knee flexion beyond 450 for 4 weeks no loaded knee flexion beyond 900 for 8 weeks. The treatment chosen will depend on the location of the tear, the athletes sport, ligamentous stability of the. It is by no means intended to substitute for ones clinical decision making regarding the progression of a patients post. Articular cartilage is made up of collagen, proteoglycans and water and lines. Rehabilitation guidelines for meniscal repair of root and complex tears. If the knee will not straighten fully, you can place a weight 2 to 5 pounds on the thigh, just above the kneecap.
We recommend seeking professional advice before beginning rehabilitation. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much. Madison, wi 53718 rehabilitation guidelines for meniscal repair there are two types of cartilage in the knee, articular cartilage and meniscus cartilage. Acl reconstruction rehabilitation protocol 6 3 heel slides are used to gain final degrees of flexion. If the torn meniscus is removed, the patient is usually up and walking within a day or two of surgery, and back to normal activities within several weeks. Meniscus repair rehabilitation meniscus repair rehabilitation this rehabilitation protocol was developed for patients who have isolated meniscal repairs. The primary goal of this protocol is to protect the reconstruction while. Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction. Pdf rehabilitation and return to play following meniscal repair. If an athlete suffers a meniscal root tear, the three options for treatment include.
This booklet gives information on the different types of meniscus problems, the evidencebased management options, and how physiotherapy can help. If you have questions, contact the referring physician. Indications, techniques, rehabilitation, and clinical outcome timothy p. Acl reconstruction with meniscus repair postoperative physical therapy protocol. For most tears, some simple exercises can help maintain muscle strength in the front of the thigh quadriceps, back of the thigh hamstr. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear.
Rehabilitation protocol for meniscus repair this protocol is intended to guide clinicians and patients through the postoperative course for a meniscus repair. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair. Below is an example of a rehabilitation program suitable for both conservative treatment and following surgery for partial removal of torn knee cartilage meniscus. It is no means intended to be a substitute for ones clinical decision making regarding the. As reported by majewski, injuries to the menisci are the second most common injury to the knee, with an incidence of 12% to 14% and a prevalence of 61 cases per 100,000 persons6. The protocol may be modified depending on the location and extent of the meniscal tear and subsequent repair. Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet. Meniscus repair rehabilitation program gundersen health system. Surgeons may elect to delay weight bearing andor place these individuals in an unloader brace. Be sure to rotate your leg outward laterally slightly to gain a better activation of the medial inner side of the quadriceps. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving. Try to hold this position for 5 minutes, three times a day.
Second, patients must be compliant with the postoperative rehabilitation after a meniscus repair. One high standard, three local partners for more information go to. Oct 28, 2019 rehabilitation following a meniscus repair is more significant than if the torn piece of meniscus is simply removed through a procedure called a partial meniscectomy. Root tears are repaired whenever possible based on their importance in limiting future knee arthritis. Pwb with crutches and brace locked at 00 prom 0 900 gradual increase in flexion rom based on symptoms ice, compression and elevation patellarscar tissue mobilization exercises. Mar 23, 2012 medial meniscus repair patients with a varus deformity and lateral meniscus repair patients with a valgus deformity may need a more conservative approach in their rehabilitation as the compressive loads in the respective involved compartment are higher. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Meniscal repair protocol brigham and womens hospital. If you have surgery to remove part of the meniscus, it may take 3 to 6 weeks before you get back to normal activities.
A meniscal repair is a surgical procedure to repair a torn meniscus via keyhole surgery. Anterior cruciate ligament acl and meniscus repair rehabilitation protocol general notes. Dependent upon the location and size of the repair, weight bearing. Meniscus rehab exercises the physical therapy advisor. Knee arthroscopy with meniscus repair rehab protocol. First, if the meniscus repair is attempted on a tear in the central portion of cartilage where the blood supply is poor, it is likely to fail. Acl reconstruction, pcl reconstruction, chondroplasty precautions. Rehabilitation and return to play following meniscal repair article pdf available in operative techniques in sports medicine 253 july 2017 with 7,034 reads how we measure reads. Knee arthroscopy with meniscus repair rehab protocol longitudinal bucket handle tears this protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Protect the knee from overstress and allow healing 2. Physical therapy pt can be useful for a torn meniscus whether or not you have surgery.
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