Orthopaedic Surgeon
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:
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Anatomic site of tear
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Suture fixation (failure can be caused by too vigorous rehabilitation)
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Location of tear (anterior or posterior)
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Other pathology (ligamentous injury)
Phase I –Maximum Protection- Weeks 1-6: Goals:
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Diminish inflammation and swelling
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Restore ROM
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Reestablish quadriceps muscle activity
Stage 1: Immediate Postoperative Day 1- Week 3
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Ice, compression, elevation
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Electrical muscle stimulation
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Brace locked at 0 degrees
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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).
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Patellar mobilization
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Scar tissue mobilization
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Passive ROM
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Exercises
o Quadriceps isometrics
o Hamstring isometrics (if posterior horn repair, no hamstring exercises for 6weeks)
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
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Progressive resistance exercises (PREs) 1-5 pounds.
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Limited range knee extension (in range less likely to impinge or pull on repair)
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Toe raises
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Mini-squats - less than 90 degrees flexion
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Cycling (no resistance)
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PNF with resistance
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Unloaded flexibility exercises
Phase II: Moderate Protection- Weeks 6-10
Criteria for progression to phase II:
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ROM 0-90 degrees
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No change in pain or effusion
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Quadriceps control (MMT 4/5)
Goals:
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Increased strength, power, endurance
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Normalize ROM of knee
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Prepare patients for advanced exercises
Exercises:
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Strength progression
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Flexibility exercises
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Lateral step-ups
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Mini-squats
Endurance Program:
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Swimming (no frog kick), pool running- if available
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Cycling
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Stair machine
Coordination Program:
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Balance board
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Pool sprinting- if pool available
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Backward walking
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Plyometrics
Phase III: Advanced Phase- Weeks 11-15
Criteria for progression to phase III:
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Full, pain free ROM
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No pain or tenderness
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Satisfactory clinical examination
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SLR without lag
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Gait without device, brace unlocked
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Goals:
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Increase power and endurance
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Emphasize return to skill activities
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Prepare for return to full unrestricted activities
Exercises:
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Continue all exercises
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Increase plyometrics, pool program
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Initiate running program
Return to Activity: Criteria
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Full, pain free ROM
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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