Brace six weeks, locked in extension while ambulating for 6 weeks. Meniscal repair postoperative protocol rosenberg cooley metcalf. Pdf the outcome of meniscal repair has been good to excellent with regard to. Partial weightbearing status meniscus is the key force distributor of the. Ambulation o crutches x 6 weeks o 02 weeks ttwb, brace locked in extension o 24 weeks 50% wb, brace locked in extension. Define the protocol to be followed for all patients. Acl autograft reconstruction with meniscus repair 20191021t16. The primary function of the articular cartilage is to. Hospital has accepted this protocol as our standard protocol for the management of patients sp meniscal repair. Common tears include longitudinal, parrotbeak, flap, bucket handle, and mixedcomplex. The decision to repair a tear in the meniscus is based largely on the location of the tear.
If the knee will not straighten fully, you can place a weight 2 to 5 pounds on the thigh, just above the kneecap. Knee arthroscopy with meniscus repair rehab protocol. Discontinue crutches and brace when gait in nonantalgic about 6 weeks post op and patient has adequate quad control. Small clinical studies support rehabilitation protocols that. Partial weightbearing status meniscus repair rehabilitation dr. Download pdf, 36kb 5 acl with meniscus repair protocol. So if were going to talk 90s protocols, take a look at these studies from way back when from shelbourne and barber that showed excellent results in patients undergoing a combined aclmeniscus repair procedure and utilizing no limitations in weightbearing or range of motion, similar to a protocol for an isolated acl reconstruction. Define the protocol to be followed for all patients referred from northwestern orthopedics after the above procedure has been performed.
The physician reserves the right to either advance or delay this protocol as deemed necessary. The outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play rtp. Lowe this rehabilitation protocol was developed for patients who have isolated meniscal repairs. Harold schock iii, md meniscus repair protocol 1160 kepler drive 1 p a g e green bay, wi 54311 9202885555 if an acl reconstruction is performed in conjunction with a meniscus repair, please follow meniscus repair protocol. A complete radial tear of the meniscus can lead to extrusion, rendering it nonfunctional and resulting in deleterious arthritic changes to the lateral compartment. Here we report on a technique of mmprt repair using suture anchor combined with arthroscopic meniscal centralization and open wedge high tibial osteotomy owhto. Next steps tips to help you get the most from a visit to your healthcare provider. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol. Rehabilitation of meniscal root repairs follows a linear periodization protocol based on progressive loading of the repair. Phase 1 maximum protection phase 06 weeks goals for phase 1 protect anatomic repair. Alaia, md assistant professor of orthopaedics division of sports medicine tel. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear. Meniscus repair protocol mr gilbert and mr coupe sports knee clinic, wrightington hospital phase 1 week 12 week exercise goals 12 rom 090 rom exs patellar mobs ankle pumps gastrocsoleus stretch hamstringitb stretch prone hangsheel props strength static qs slrs hip strengthening weight bearing pwb control pain and inflammation ice. Chief, division of sports medicine associate professor of orthopaedic surgery tel.
For the final 3 phases, consisting of muscle endurance, strength, and power and returntosport. Meniscal root repairs and radial tear repairs should be progressed slowly because the tear involves complete disruption of the circumferential fibers of the meniscus. Discuss frequency and duration of treatment 23xwk is expected for the first 8 weeks, followed by intermittent appointments over another 68 weeks. A torn meniscus causes pain, locking or clicking, and weakness of the knee. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving pre. The knee menisci medial and lateral are wedgeshaped semilunar disks made of fibrocartilage interposed between the. 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. Acl reconstruction w meniscus repair mizzou sports doc. Phase i maximum protection weeks 0 to 4 0 to 1 week.
Resection overview based on the type and location of the meniscus tear, the torn meniscus can either be repaired or resected. Capstone orthopedics provides a full spectrum of sports. Suture anchor repair for a medial meniscus posterior root tear combined with arthroscopic meniscal centralization and open wedge high tibial osteotomy. Begin flexion rom beyond 90 degrees as tolerated at 5 weeks. If medial meniscus repair no hamstring pres until four weeks.
The first 6 weeks are focused on nonweight bearing nwb protection, followed by 2 to 3 weeks of gradual progressive wb. Dependent upon the location and size of the repair, weight bearing. Acl with meniscus postoperative protocol rosenberg cooley. Suture anchor repair for a medial meniscus posterior root. It is important to recognize that all times are approximate and that progression should be based on careful monitoring of the patients functional status. For most tears, some simple exercises can help maintain muscle strength in the front of the thigh quadriceps, back of the thigh hamstr. Try to hold this position for 5 minutes, three times a day. Pdf rehabilitation and return to play following meniscal repair. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. This protocol is intended to provide the user with instruction, direction, rehabilitative guidelines and functional goals.
Meniscus repair physical therapy protocol orthoindy. It is not intended to serve as a substitute for clinical decision making. Treatment will follow the defined protocol below and be carried. Phase 1weeks 12 meniscus repair goal is pain control, reduce inflammation and effusion, adequate quadvmo contraction, independent in hep, and tdwb week exercise goal rom 0. Athletes represent the most demanding subgroup of patients as they have high expectations to return to their preinjury level of activity and in doing so they place maximum stress on any meniscal repair. In order for the meniscus repair to heal, the tear must be near this outer edge in an area of good blood supply nutrients from the blood vessels are necessary for healingthis is the socalled red vascularwhite nonvascular region of the meniscus. The meniscus is a circular piece of cartilage with its blood supply coming from the outer rim. Meniscal root or radial repair meniscal repair protocol this rehabilitation protocol was developed for patients who have isolated meniscal root or radial tear repairs. Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet to form a joint. Torn meniscus is caused by a twisting movement of the knee while bearing weight. 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. Rehabilitation protocol for meniscus repair this protocol is intended to guide clinicians and patients through the postoperative course for a meniscus repair. Small clinical studies support rehabilitation protocols that allow early motion.
Based on these findings along with magnetic imaging. Acl reconstruction with meniscus repair brian bjerke, md postoperative protocol phase i maximum protection weeks 0 to 6. 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. Post operatively these patients will need to avoid combined. 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.
Rehabilitation protocols help patients most in noting the specific timing of activities and exercises relevant to their condition. Acl reconstruction and meniscus repair physical therapy. Meniscal cartilage plays a crucial role in the function and biomechanics of the knee joint. Articular cartilage is made up of collagen, proteoglycans and water which lines the end of the bones that meet to form a joint. Arthroscopic repair of a complete radial tear of the lateral meniscus poses a challenge to orthopaedic surgeons. 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.
Conclusions there is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Acl reconstruction with meniscus repair adopted mar1998, revised jan2017 1 general principles. Surgeons may elect to delay weight bearing andor place these individuals in an unloader brace. Rehabilitation guidelines for meniscal repair of root and complex tears there are two types of cartilage in the knee. Turek stone research foundation san francisco xxiv congress of the spanish arthroscopy association 2. This protocol was designed to provide the rehabilitation professional with a guideline of postoperative care. Figure 1 meniscus cartilage shown here from above the knee, without the femur.
Rehabilitation following meniscus repair memorial hermann. The postoperative program for meniscus repair and transplantation is shown in table 3 and has been described elsewhere in detail. Exercises, medicine and arthroscopy may be used to treat a torn meniscus. Phase 1weeks 12 meniscus repair goal is pain control, reduce inflammation and effusion, adequate quadvmo contraction, independent in hep, and tdwb week exercise goal rom 060, patellar mobs, ankle pumps, gastrocsoleus. Rehabilitation guidelines for meniscal repair uw health. Physical therapy rehabilitation protocols and rtp decisionmaking remains controversial in the setting of meniscal repair. Early emphasis on achieving full hyperextension equal to the opposite side. Use crutches for 7 to 10 days to reduce swelling, the patient may discontinue with crutches when they can ambulate without a limp. 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. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Meniscal repair protocol1 northwestern medical center. Rehabilitation guidelines for meniscal repair of root and. Outsidein repair technique for a complete radial tear of.
The lateral meniscus is vital in dissipating the force in the lateral compartment of the knee. January 1, 1993 to july 1, 2014 were queried with use of the terms meniscus orand repair and rehabilitation. Meniscus repair rehabilitation meniscus repair rehabilitation this rehabilitation protocol was developed for patients who have isolated meniscal repairs. Rehabilitation exercises a meniscus tear is a common knee joint injury. Maximum protection weeks 1 to 6 goals control inflammationeffusion allow early healing full passive knee extension gradually increase flexion to 90 degree independent quadriceps control weight bearing non weight bearing for six weeks unless noted by dr. Meniscus repair guidelines vanderbilt university medical. Meniscus repair rehabilitation northeast orthopedics and. Rehabilitation and return to play following meniscal repair. Rehabilitation exercises appendix topic images meniscus tears quad sets straightleg raise to the front straightleg raise to the back hamstring curls heel raises heel dig bridging shallow standing knee bends meniscus tear. The meniscus functions in load bearing, load transmission, shock absorption, joint stability, joint lubrication, and joint congruity 11. Meniscus root repairs nonweight bearing with brace locked at 0 degrees okay to unlock brace while nonweight bearing i. This protocol should be used with combined a acl reconstruction and meniscus repair the intent of this protocol is to provide guidelines for progression of rehabilitation. Acl reconstruction with meniscus repair postoperative physical therapy protocol. 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.
It should be stressed that this is only a protocol and should not be a substitute for clinical decision making. Outsidein repair technique for a complete radial tear of the. Jan 16, 2017 so if were going to talk 90s protocols, take a look at these studies from way back when from shelbourne and barber that showed excellent results in patients undergoing a combined aclmeniscus repair procedure and utilizing no limitations in weightbearing or range of motion, similar to a protocol for an isolated acl reconstruction. Acl reconstruction wmeniscal repair protocol missouri orthopaedic institute weeks 612. The primary function of the articular cartilage is to provide. Meniscus repair rehabilitation northeast orthopedics and sports. Acl with meniscus postoperative protocol rosenberg. Patients will be in a hinged knee brace for 4 weeks postop locked in full. These tears will typically be repaired in younger, active patients. Specific changes in the program will be made by the. This rehabilitation protocol was developed for patients who have isolated meniscal repairs.
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