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 Meniscal Repair Surgical Rehabilitation

Progression to the next phase based on Clinical Criteria and/or Time Frames as

Appropriate.

Key Factors in determining progression of rehabilitation after Meniscal repair include:

  • Anatomic site of tear

  • Suture fixation (failure can be caused by too vigorous rehabilitation)

  • Location of tear (anterior or posterior)

  • Other pathology (ligamentous injury)

     

Phase I –Maximum Protection- Weeks 1-6: Goals:

  • Diminish inflammation and swelling

  • Restore ROM

  • Reestablish quadriceps muscle activity

    Stage 1: Immediate Postoperative Day 1- Week 3

  • Ice, compression, elevation

  • Electrical muscle stimulation

  • Brace locked at 0 degrees

  • ROM 0-90

    o Motion is limited for the first 7-21 days, depending on the development of scar tissue around the repair site. Gradual increase in flexion ROM is based on assessment of pain and site of repair (0-90 degrees).

  • Patellar mobilization

  • Scar tissue mobilization

  • Passive ROM

  • Exercises

    o Quadriceps isometrics
    o Hamstring isometrics (if posterior horn repair, no hamstring exercises for 6

    weeks)
    o Hip abduction and adduction

• Weight-bearing as tolerated with crutches and brace locked at 0 degrees

• Proprioception training with brace locked at 0 degrees

Stage 2: Weeks 4-6

  • Progressive resistance exercises (PREs) 1-5 pounds.

  • Limited range knee extension (in range less likely to impinge or pull on repair)

  • Toe raises

  • Mini-squats - less than 90 degrees flexion

  • Cycling (no resistance)

  • PNF with resistance

  • Unloaded flexibility exercises

     

Phase II: Moderate Protection- Weeks 6-10

Criteria for progression to phase II:

  • ROM 0-90 degrees

  • No change in pain or effusion

  • Quadriceps control (MMT 4/5)

 

Goals:

  • Increased strength, power, endurance

  • Normalize ROM of knee

  • Prepare patients for advanced exercises

    Exercises:

  • Strength progression

  • Flexibility exercises

  • Lateral step-ups

  • Mini-squats

    Endurance Program:

  • Swimming (no frog kick), pool running- if available

  • Cycling

  • Stair machine

    Coordination Program:

  • Balance board

  • Pool sprinting- if pool available

  • Backward walking

  • Plyometrics

     

Phase III: Advanced Phase- Weeks 11-15

Criteria for progression to phase III:

  • Full, pain free ROM

  • No pain or tenderness

  • Satisfactory clinical examination

  • SLR without lag

  • Gait without device, brace unlocked

Goals:

  • Increase power and endurance

  • Emphasize return to skill activities

  • Prepare for return to full unrestricted activities

    Exercises:

  • Continue all exercises

  • Increase plyometrics, pool program

  • Initiate running program

    Return to Activity: Criteria

  • Full, pain free ROM

  • Satisfactory clinical examination

    Criteria for discharge from skilled therapy: 1) Non-antalgic gait

    2) Pain free /full ROM
    3) LE strength at least 4/5
    4) Independent with home program
    5) Normal age appropriate balance and proprioception 6) Resolved palpable edema

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