meniscus repair weight bearing protocol

Post-operative weight bearing after meniscal repair is a point of debate among physicians. J Bone Joint Surg Am 96(15):13031307, Article Dressing change: Remove at post op day 3, cleanse and apply . o Weight Bearing Guidelines: with brace locked in 0 extension Week 2: 50% weight bearing, (25%-50% for complex tears) Week 3: 75%-FWB, (50%-75% for complex tears) Future research should include determining the ideal combination of weightbearing and range of motion for specific tear . Google Scholar, Bray RC, Smith JA, Eng MK, Leonard CA, Sutherland CA, Salo PT (2001) Vascular response of the meniscus to injury: effects of immobilization. Meniscus Repair Rehabilitation Protocol www.PalomarOrtho.com . Orthop Traumatol Surg Res 101(8 Suppl):S323S326, Shelbourne KD, Patel DV, Adsit WS, Porter DA (1996) Rehabilitation after meniscal repair. Arthroscopy 30(1):134146, Article of the meniscal tear and repair. Theres a lot to explore here! Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Weight bearing as tolerated after meniscal repair for peripheral, vertical tears does not result in a higher failure rate than traditional, non-weight bearing over a five-year follow-up period. *COLE,*MD,*MBA WEIGHT BEARING BRACE ROM EXERCISES PHASE I 0-2 weeks Full in Brace locked in extension*** Locked in full extension for sleeping and all activity* Off for exercises and hygiene 0-90 when non-weight bearing Heel slides, quad sets, Add upper body and core conditioning. The tears were acute vertical tears located in the posterior horn and body. For both cases, I would recommend passive range of motion to tolerance. General Guidelines: 1. Rehabilitation Protocol: Meniscal Repair Department of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington 781-744-8650 Lahey Outpatient Center, Lexington 781-372-7020 . Passive Knee Extension & Stretching . Surgical technique. Meniscus Repair Rehabilitation Protocol (Complex Tears) PHASE I: MAXIMUM PROTECTION PHASE (1-6 Weeks) Goals: Control inflammation/effusion Allow early healing Full passive knee extension . CAS Thompson showed that during flexion, the posterior excursion of the medial meniscus was 5.1 mm, while that of the lateral meniscus was 11.2 mm. Let me show you how to get started: 2008-2022 Mike Reinold All Rights Reserved. J Bone Joint Surg Am 91(Suppl 2):257270, Jung YH, Choi NH, Oh JS, Victoroff BN (2012) All-inside repair for a root tear of the medial meniscus using a suture anchor. Meniscus Repair Rehabilitation Protocol GENERAL GUIDELINES - Use the cryotherapy cuff continuously for the first 72 hours, then as needed thereafter . Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks postop. 2022 Springer Nature Switzerland AG. endstream endobj 147 0 obj <>/Metadata 7 0 R/PageLayout/OneColumn/Pages 144 0 R/StructTreeRoot 11 0 R/Type/Catalog>> endobj 148 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 149 0 obj <>stream Meniscus ROOT Repair PT Protocol Meniscal root attachments are extremely important to the function of the knee. Conclusion: Outcomes after both conservative (restricted weightbearing) protocols and accelerated rehabilitation (immediate weightbearing) yielded similar good to excellent results; however, lack of similar objective criteria and consistency among surgical techniques and existing studies makes direct comparison difficult. Orthop Traumatol Surg Res 101((8 Suppl)):S327S331, Marzo JM, Kumar BA (2007) Primary repair of medial meniscal avulsions: 2 case studies. PubMedGoogle Scholar. Elevation . We typically immobilize people in full extension during weightbearing, locked in a brace for 4-6 weeks after meniscal repair surgery. 0 The clinical relevance is that, based on these data, it may be appropriate to allow weight bearing as tolerated following meniscal repair of peripheral, vertical tears. Partial weight bearing (<15kg pressure) with the leg in full extension. Consider taking a more conservative approach to range of motion, weight bearing, and rehab progression with more complex tears or all-inside meniscal repairs. Arthroscopy 26(3):358365, Starke C, Kopf S, Petersen W, Becker R (2009) Meniscal repair. A systematic review. The motion has been shown to help. Musculoskelet Surg 96(3):149154, Vyas D, Harner CD (2012) Meniscus root repair. Skeletal Radiol 33(10):569574, Lind M, Nielsen T, Fauno P, Lund B, Christiansen SE (2013) Free rehabilitation is safe after isolated meniscus repair: a prospective randomized trial comparing free with restricted rehabilitation regimens. 183 0 obj <>stream Are any of them still recommending rehab guidelines based on outdated research? So why is it that what we do during meniscus repair rehabilitation is so outdated? 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 ACL-meniscus repair procedure and utilizing no limitations in weightbearing or range of motion, similar to a protocol for an isolated ACL reconstruction. Noyes Knee Institute Rehabilitation Protocol: Meniscus Repair 1-2 3-4 5-6 7-8 9-12 4 5 6 7-12 Brace: Long-leg postoperative X X X Range of motion minimum goals: 0-90 0-120 0-135 X X X Weight bearing: Toe touch - 1/2 body weight 3/4 to full Toe touch - 1/4 body weight 1/2 to 3/4 body weight Full P C P C C C Meniscal root repairs and radial tear repairs should be progressed slowly because the tear involves complete disruption of the circumferential fibers of the meniscus. Things like new joint line pain along the site of the repair, new swelling or a change in pain patterns, and even clicking (although most people have this) are all signs that I may want to further assess and modify my progression. Clin Orthop Relat Res 455:134141, Lutz C, Dalmay F, Ehkirch FP, Cucurulo T, Laporte C, Le Henaff G, Potel JF, Pujol N, Rochcongar G, Salledechou E, Seil R, Gunepin FX, Sonnery-Cottet B, French Arthroscopy Society (2015) Meniscectomy versus meniscal repair: 10years radiological and clinical results in vertical lesions in stable knee. 4 . Toe touch weight bearing for 4 weeks Wean over 1-2 weeks with progression to FWB at 5-6 weeks post-operative 0-30o, gradually open 10-20o as . Patients were categorized by post-surgical weight-bearing status, either NWB or WBAT, and then analysed for failure of repair. Well-leg stationary cycling, upper body ergometer for cardio. hb```*V``f`Bu^: GBP!E3FU&[ 9x00/we"D``f"} Looking at meniscal movement as the knee flexes in weightbearing and non-weightbearing you can see theres less motion, although I really dont think we know how much motion is detrimental. %PDF-1.5 % VBJS acknowledges the traditional owners of this land and pay our respects to their elders both past, present and emerging. Non-Weight Bearing . Six Weeks to Four Months Post-op 4 0 obj Learn more about Institutional subscriptions, Barber-Westin SD, Noyes FR (2014) Clinical healing rates of meniscus repairs of tears in the central-third (red-white) zone. Based on this, I continue to stand by my rehab guidelines of full, pain-free passive range of motion and immediate weightbearing after a vertical longitudinal meniscal repair. During weightbearing, compressive forces are loaded across the menisci. The use of such a term as a diagnosis is not helpful to determine the treatment process. Independent quadriceps control Weight Bearing Non weight bearing for six weeks unless noted by Dr. Kendall Range of Motion No flexion past 90 degrees for six weeks unless noted by Dr. Kendall Days 1 to 10 The null hypothesis was that there would be no difference in failure between the two groups. This protocol is designed to progress the individual through rehabilitation to full sport/ activity . Meniscus Repair Physical Therapy Protocol Phase I: Maximum Protection (Weeks 1 to 6) Goals Control inflammation/effusion . The motion has been shown to help improve blood flow to the area. Home > Condition & Treatment Map > Knee Conditions & Treatments > Meniscus Repair: Rehabilitation Protocol. Rehabilitation after Repair of Medial Meniscus . There was no difference between weight-bearing groups for failure of meniscus repair (n.s.). Avoid adduction stra ight leg raise initially with medial meniscus repair or abduction leg raise with lateral meniscus repair 4. Our detailed examination process, all our treatment progressions, and detailed information on nonoperative and postoperative treatment of ACL, patellofemoral, meniscus, articular cartilage, osteoarthritis injuries, and so much more. - You have wound ooze or discharge, - You get calf/leg swelling and pain. Wont that put the repair in a position to fail? Here are 3 things to focus on to help treat subacromial pain more effectively. We acknowledge and uphold their continuing relationship to this land. This often results in degenerative changes, altered knee biomechanics, and an early onset of osteoarthritis [ 36 , 39 ]. Put the injured leg forward; level with the crutch tips. There is very limited literature on the influences of range of motion on meniscal movement. PubMed Google Scholar, Starke C, Kopf S, Grobel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. If an appointment has not been made for you prior to discharge, please contact our rooms on 03 5752 5020. You will have plastic dressings on your surgical incisions, soft bandage and a crepe. So, if immobilized in extension, why do we limit weightbearing? endstream endobj startxref Blood Flow Restriction Training is an exciting new adjunct to exercise. Active Range of Motion . Part of Springer Nature. * This protocol has been adapted from the Brigham and Women's Hospital protocol for Meniscal Repair. of the meniscal tear and repair. Weight bearing with brace . Walking (weight bearing as tolerated): Put the crutches forward about one step's length. The following is a protocol for post-operative patients following meniscus repair. VBJS is committed to providing an inclusive service, and work environment where individuals feel accepted, safe, affirmed and celebrated. ESTIM . The authors declare that they have no competing interests. Im still shocked by this and wanted to discuss the recent research that is lending to a more progressive approach to return people safely back to their prior level of function. Meniscus Repair Protocol Dr. Bienz DOS: PHASE 1-WEEKS 1-2 MENISCUS REPAIR Goal is pain control, reduce inflammation and effusion, adequate quad/VMO . After meniscus tear surgery, a knee brace can be worn to limit knee flexion and rotation, protecting the meniscus while allowing weight-bearing and movement [9]. Am J Sports Med 38(5):976982, Laible C, Stein DA, Kiridly DN (2013) Meniscal repair. iXxJY J?1A^=E_V y:)8{~-lHrq(8:"+r\F+1B4 9CYizR%d*CI{~>K0XI]c`@$Dadb?jU-9lL,QhS RN8-?xwWPGl6bg#}nrt*_!}gaq+ ;%gZjw|W}LL$U}npy]0'='AFia;D^8ZL}1PK.b;_\gt{Sswg_N/Y$Km8tKbSnt!nJE\n 8BN. CAS Arthroscopy 24(12):13581366, Grant JA, Wilde J, Miller BS, Bedi A (2012) Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. hWYo8+|lPdy"4& l@%VamUER|.a@i.gF\ddIX9V*g2KUI X KD&D`c9lcprCd<>/6pC0)K&SoJz~Ez%_oi?J:*6wo~4mWjn2+M4wYTj^. All ethical standards of maintaining patient confidentiality have been employed, including those in accordance with the US Health Insurance Portability and Accountability Act (HIPPA). Tensogrip/kinesiotape . Weight Bearing: PWB Exercise: continue previous SLR 4 planes LAQ (90-30) Nustep standing multi-hip standing TKE WEEKS 5-7_____ ROM: 0-120 (0-90 Dr Spanger weeks 5-6) Weight Bearing: progress to . BP helped with design of the study, data collection, and manuscript preparation. Heel lift in opposite shoe to normalize gait. This study sought to evaluate whether patients adhering to an immediate WBAT rehabilitation programme have a higher failure rate compared to those adhering to a more traditional, protected, NWB status following meniscal repair. Regular assessment of gait to avoid compensatory patterns. xkqW@IJ;`Rx3i*hc;!SqEI$% "U{zg??O_\t?6]m^=cy]2/W\_Z+,R7h}w|y_=z|rg\g gyyx?3uKXT4z~k caLDpS+WoIRhHg7!qW}7bnY# .O#%T_\ -2_uCNA4Z $|brd+ekd3yY.Y0Y"#xfUs/=/SuS(U{(Yzm :6oMY/[;dWO| C~1QnVyj}82W[76F:onoGEk|S\'})BYrp G AqYW7eL\qFRd3(>1sX>b(lm V/vw When a meniscus is (partially) injured or degenerated beyond repair, a (partial) meniscectomy is performed , which leads to a change in load-bearing capacity of the meniscus. But what about the exact mechanisms that many are still fearful of allowing early in the process, like early walking and range of motion? Sports Health 7(5):399402, Vascellari A, Rebuzzi E, Schiavetti S, Coletti N (2012) All-inside meniscal repair using the FasT-Fix meniscal repair system: is still needed to avoid weight bearing? Recent studies from VanderHave and Lind on isolated meniscus repairs have shown similar results using an "aggressive" program of immediate weightbearing compared to a more conservative approach. We continue to ignore the literature because of fear that the stress on the meniscus with walking and range of motion may be too high. Am J Sports Med 41(12):27532758, Logan M, Watts M, Owen J, Myers P (2009) Meniscal repair in the elite athlete: results of 45 repairs with a minimum 5-year follow-up. In addition, if the medial meniscus is involved, active Clin Sports Med 16(1):6986, Feng H, Hong L, Geng XS, Zhang H, Wang XS, Jiang XY (2008) Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases. . No hip extension or hamstring . Variance: If Meniscal Repair performed in addition to ACL reconstruction please refer to surgeon for which protocol to follow and for any specific precautions . Begin progression to full weight bearing if directed to do so by surgeon ROM: 0 to 90 degrees - Active and passive . Anterior Cruciate Ligament (ACL) and Meniscus Repair Rehabilitation Protocol General notes: "As tolerated" should be understood to include with safety for the reconstruction/repair; pain, limp, swelling, or . Am J Sports Med 37(6):11311134, Lozano J, Ma CB, Cannon WD (2007) All-inside meniscus repair: a systematic review. Clin Sports Med 31(1):155166, Bogunovic L, Kruse LM, Haas AK, Huston LJ, Wright RW (2014) Outcome of all-inside second-generation meniscal repair: minimum five-year follow-up. Knee Meniscus Root Repair Protocol . The first 6 weeks are a strict protection phase and the patient is non-weight bearing. J Bone Joint Surg Am 94(24):22222227, Paxton ES, Stock MV, Brophy RH (2011) Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Am J Sports Med 42(9):21842192, Wright RW, Fetzer GB (2007) Bracing after ACL reconstruction: a systematic review. Touch the foot of the involved leg to the floor and bear weight as tolerated. What do the surgeons that you work with recommend? Trust me, I respect the healing meniscus and continually monitor patients as I progress their range of motion and weight-bearing activities. A retrospective review of meniscal repair patients greater than 5years from surgery was performed for patients receiving meniscal repair treatment. The literature is screaming this same thing at us but we continue to ignore their calls and revert to the 90s! Stationary Bicycle . Touch weight bearing (<5kg) with the leg in full extension, Straight leg raises + Static quadriceps exercises, core strengthening, Partial weight bearing (<15kg pressure) with the leg in full extension. These tensile forces create hoop stresses, which expand the menisci in extension. Knee Surgery, Sports Traumatology, Arthroscopy . Perkins, B., Gronbeck, K.R., Yue, R.A. et al. COPYRIGHT*2014*CRC*BRIAN*J. hbbd``b`:$[@D#`00A .H|wbXA2`WiL %T"3&~0 E . Return-to-Sport after ACL with Meniscal Repair Reconstruction Protocol - Weight-bearing in full extension (with a locking brace) with crutches is allowed, No weight-bearing in flexion >45 for 4 weeks - Immediate Post-op passive ROM is fine, No active ROM past 90 for the first 4 weeks o ROM: (Peripheral Tears) ROM: (Complex Tears) I help people feel better, move better, and perform better. Knee Surg Sports Traumatol Arthrosc 12(1):4349, Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jager A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Home > Condition & Treatment Map > Knee Conditions & Treatments > Meniscus Repair: Rehabilitation Protocol. These hoop stresses are thought to be helping the healing process in many tears by approximating the tissue. There is very limited literature on the influences of range of motion on meniscal movement. You are able to shower with the plastic dressings on, but they should not be immersed in water or go in the bath. When a meniscus is repaired, the tear is approximated using stitches to allow the tear to heal. ACL reconstruction with meniscus repair post-operative physical therapy protocol General Considerations It is important to recognize that all times are approximate and that progression should be based on careful monitoring of the patient's functional status. Am J Sports Med 38(8):15421548, VanderHave KL, Perkins C, Le M (2015) Weightbearing versus nonweightbearing after meniscus repair. All patients require a wound review at 10-14 days after surgery. Am J Sports Med 34(8):13341344, Lerer DB, Umans HR, Hu MX, Jones MH (2004) The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion. Meniscus Repair Rehabilitation Protocol . This evidence-based meniscal repair rehabilitation protocol is criterion-based and time frames in each phase will vary depending on many factors including patient demographics, goals, and individual progress. %PDF-1.3 Paracetamol should be taken regularly 3-4 times per day, and other pain relief should be taken as directed by your Anaesthetist and your surgeon. MENISCAL REPAIR, ALL-INSIDE REHABILITATION PROTOCOL ! GENERAL GUIDELINES: Protection of the graft during the primary re-vascularization phase (8 weeks) and graft fixation phase (8-12 weeks) Continuous passive motion machine not commonly used For ACL reconstruction, with associated meniscus repair, defer to ROM and weight bearing precautions outlined in the meniscus repair protocol Additionally, this protocol does not apply to meniscus root repairs or meniscus transplants. (t Clin Orthop Relat Res 455:162168, Xu C, Zhao J (2015) A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Add upper body and core conditioning. They were all non-weight-bearing for the first two weeks. Arthroscopy 27(9):12751288, Richards DP, Barber FA, Herbert MA (2005) Compressive loads in longitudinal lateral meniscus tears: a biomechanical study in porcine knees. that showed excellent results in patients undergoing a combined ACL-meniscus repair procedure and utilizing no limitations in weightbearing or range of motion, similar to a protocol for an isolated ACL reconstruction. Am J Sports Med 40(2):459468, Harner CD, Mauro CS, Lesniak BP, Romanowski JR (2009) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Knee Surg Sports Traumatol Arthrosc 23(1):164170. showed that during flexion, the posterior excursion of the medial meniscus was 5.1 mm, while that of the lateral meniscus was 11.2 mm. Re-operations were performed in 61 of 157 patients [38.9%]. For an isolated meniscal repair, I prefer the knee continue to be immobilized in full extension for 4-6 weeks but allowed full weightbearing immediately (if a longitudinal repair). The protocol is divided into phases. Commence walking and progressively wean crutches, Straight leg raises +Static quadriceps exercises, Stationary Bike, gradually increasing resistance, Add lateral activities from 8 weeks side steps, abduction. Well-leg stationary cycling, upper body ergometer for cardio. Despite this high occurrence, many inconsistencies continue to exist in the rehabilitation of a patient following meniscus repair surgery, particularly involving the rate of weightbearing and range of motion. (Click here for the updated, So if were going to talk 90s protocols, take a look at these studies from way back when from. @Lm3xr1-Y3zym0Gl5O`r^l9?~`O8D-I%$ZsrEIGoWwN0me26 Lb^=/0:m7bT&Tx3caPekWL\MkE.XYzqd\S-j`T?pfggEV@Aq}\>3ysc}YR 8tRrEWLX_,R`^E!_^NOng`2=fZ*_VM3~-dGk|^x/I(FP)(a7L << /Length 5 0 R /Filter /FlateDecode >> on isolated meniscus repairs have shown similar results using an aggressive program of immediate weightbearing compared to a more conservative approach. Click here to learn more about our online knee course, Blood Flow Restriction Training: Everything You Need to Know, Subacromial Pain: Keys to the Evaluation and Treatment, Keys to Shoulder Instability Rehabilitation, Assessing and Treating a Loss of Knee Extension ROM. Rehabilitation following a meniscus repair has to be more conservative, however, despite research saying otherwise, there are still many rehabilitation protocols floating around the orthopaedic and sports medicine world that recommend limiting weight-bearing and range of motion after a meniscal repair. PubMed Central Weight Bearing: Non weight bearing ROM Goals: Extension: Full Flexion: 90 degrees Arthroscopy 25(9):10331044, Steadman JR, Matheny LM, Singleton SB, Johnson NS, Rodkey WG, Crespo B, Briggs KK (2015) Meniscus suture repair: minimum 10-year outcomes in patients younger than 40years compared with patients 40 and older. Ankle Mobility Drills to Improve Dorsiflexion, Subacromial Pain Keys to the Evaluation and Treatment, Ultimate Guide to Blood Flow Restriction Training. Shoulder impingement is a vague term that is used too often and inaccurately. Am J Sports Med 40(6):14061411, Krych AJ, Pitts RT, Dajani KA, Stuart MJ, Levy BA, Dahm DL (2010) Surgical repair of meniscal tears with concomitant anterior cruciate ligament reconstruction in patients 18years and younger. https://doi.org/10.1007/s00167-017-4665-9, DOI: https://doi.org/10.1007/s00167-017-4665-9. Arthroscopy 21(12):14521456, Rochcongar G, Cucurulo T, Ameline T, Potel JF, Dalmay F, Pujol N, Salle de Chou E, Lutz C, Ehkirch FP, Le Henaff G, Laporte C, Seil R, Gunepin FX, Sonnery-Cottet B, La SFA (2015) Meniscal survival rate after anterior cruciate ligament reconstruction. Google Scholar, DeHaven KE, Bronstein RD (1997) Arthroscopic medial meniscal repair in the athlete. % Recent studies from VanderHave and Lind on isolated meniscus repairs have shown similar results using an aggressive program of immediate weightbearing compared to a more conservative approach. Crutch Ambulation, Non-Weight Bearing . 166 0 obj <>/Filter/FlateDecode/ID[]/Index[146 38]/Info 145 0 R/Length 95/Prev 57809/Root 147 0 R/Size 184/Type/XRef/W[1 2 1]>>stream AY and KG participated in data collection, data analysis, and manuscript preparation. Sports Med Arthrosc 20(2):8694, Westermann RW, Wright RW, Spindler KP, Huston LJ, MOON Knee Group, Wolf BR (2014) Meniscal repair with concurrent anterior cruciate ligament reconstruction: Operative success and patient outcomes at 6-year follow-up. Early emphasis on achieving full hyperextension equal to the opposite side. MT conceived of the study and participated in the design of the study, data analysis, and manuscript preparation. The knee may be swollen for several days to a few weeks after your procedure. protocols after MMPRT . All authors gave their approval of the final manuscript. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips. Weight bearing: As tolerated - wean off crutches at 6 -8 weeks when normal gait is Meniscus Repair This protocol is a criterion-based protocol, with a goal of maximizing healing and strength recovery, while minimizing risk of re-injury, so the athlete can return, as quickly and safely as possible, to athletic . If it is your right leg that has been operated upon, you will need at least 6 weeks off driving. Arthroscopy 24(12):13421348, Barcia AM, Kozlowski EJ, Tokish JM (2012) Return to sport after meniscal repair. The major meniscal functions are to: Distribute stress across the knee during weight bearing Provide shock absorption Serve as secondary joint stabilizers (in an anterior cruciate ligament deficient knee, menisci will serve as joint stabilizers [4] Provide articular cartilage nutrition and lubrication Facilitate joint gliding Address 55 Victoria Parade, Fitzroy VIC 3065. I certainly wouldn't consider these "aggressive" programs, they simply used immediate weightbearing and range of motion. Knee rehabilitation protocols Meniscus repair rehab protocol Partial weightbearing status (<50%), unless otherwise ordered by MD. This is huge and may aid in the healing process! Additionally, this protocol does not apply to meniscus root repairs or meniscus transplants. volume26,pages 22452250 (2018)Cite this article. Untreated root tears lead to rapid degeneration of knee cartilage. Am J Sports Med 43(9):22222227, Steenbrugge F, Verdonk R, Hurel C, Verstraete K (2004) Arthroscopic meniscus repair: inside-out technique vs. Biofix meniscus arrow. The study controlled for variables including age at surgery, sex, height, weight, and BMI, classification of tear type, acuity of the tear, repair location (medial or lateral), repair location within the meniscus, repair technique, and concomitant procedures. 146 0 obj <> endobj For complex repairs, I would recommend limiting weightbearing to partial but understand that the hoop stresses could aid in healing and are arguably helpful and necessary. J Am Acad Orthop Surg 21(4):204213, Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J, Kang RW, Cole BJ (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Edema Control: Ice/Cryocuff . Knee Surg Sports Traumatol Arthrosc 26, 22452250 (2018). MA.Tompkins 4,5 Received: 11 March 2017 / Accepted: 28 July 2017 / Published online: 16 August 2017 opean Society of Sports Traumatology, Knee Surgery . Weight-Bearing Status and Brace: - Touch-down weight-bearing for 6 weeks with 2 crutches - 0 - 1 week: Brace locked in full extension for ambulation and sleeping . For the 61 patients with re-operation, the average time to re-operation was 2.2years with 10 [16%]>5years from surgery, 17 [28%] 25years from surgery, and 34 [56%]<2years from surgery. Correspondence to (Click here for the updated rehabilitation protocols we currently use.). Exercises. Toe touch weight bearing in I-ROM with crutches Modalities include E-stim/biofeedback as needed and ice knee for 15-20 min with Return to Sport Meniscal Repair Protocol General guidelines to consider with return to sport after Meniscal Repair: . Knee Surg Sports Traumatol Arthrosc 25(2):390396, Nepple JJ, Dunn WR, Wright RW (2012) Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. ( `3~95. Toe Touch weight bearing with crutches and a brace for 6 weeks 2. Comment below and let me know, I want to hear what the rest of the country is seeing! Static quadriceps exercises. Google Scholar, Barber FA, Click SD (1997) Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction. Again, these studies show meniscal repair outcomes are no different while using restricted weightbearing and range of motion versus an aggressive protocol of immediate weight-bearing and unlimited range of motion. Early Weightbearing After Meniscus Repair, Furthermore, the compressive loads applied while weightbearing in full extension following a vertical, longitudinal repair or bucket-handle repair have been shown to reduce the meniscus and stabilize the tear, as noted by. Furthermore, the compressive loads applied while weightbearing in full extension following a vertical, longitudinal repair or bucket-handle repair have been shown to reduce the meniscus and stabilize the tear, as noted by Rodeo and more recently by McCulloch. %%EOF Marc A. Tompkins. This is a preview of subscription content, access via your institution. Unfortunately, many of these commonly used protocols are from the 1990s. Should we Still be Using Rehabilitation Protocols? Some of the top orthopedic surgeons in the world that I have worked with currently handle a meniscal repair the same as an ACL reconstruction with a meniscal repair . Meniscus injuries within the knee are a common occurrence. Arthroscopy 13(4):433437, Article **For meniscal root repair, and/or meniscal transplant use the following guidelines: Weight Bearing Status At 2 weeks post-op Toe touch weight bearing, locked in extension At 5 weeks post-op 25% body weight bearing, locked in extension At 6 weeks post-op 50% body weight bearing, locked in extension Knee Surg Sports Traumatol Arthrosc 23(1):8389, Article Ice packs can also be used to help treat swelling for the first 72hrs after your operation. Google Scholar, Barber FA, Schroeder FA, Oro FB, Beavis RC (2008) FasT-Fix meniscal repair: mid-term results. Unfortunately, many of these commonly used protocols are from the 1990s. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving pre-injury level . If you are driving an automatic vehicle and you have had your left leg operated upon, you will be able to commence driving when you have ceased taking strong pain relief. Anecdotally, I can say we have handled meniscal repairs to allow weightbearing and range of motion to tolerance for many years. Significant variation exists between postoperative protocols, with no current consensus on the ideal parameters for weightbearing and range of motion. Walk with crutches. For those interested in learning more about how Lenny and I evaluate and treat the knee, we have an amazingly comprehensive course that covers everything you need to know to master the knee. PubMed That referenced protocol was adopted from Brotzman & Wilk, as published in Brotzman SB, Wilk . VBJS is committed to equity irrespective of cultural or linguistic background, sexual orientation, gender identity (LGBTI+), intersex status, religion or spiritual beliefs, socio-economic status, age, or abilities. We return the patients range of motion, strength and function per their symptoms and let pain and swelling guide the rehab process (a very general guide but one often employed by many rehabilitation specialists). This study was reviewed by our institutional review board and approved as study #1504M67624. While bearing weight (on the crutches if there is pain in the knee) on the involved leg, take a step However, when the meniscus is actually repaired and not just debrided, there are other factors to consider. Similar failure rate in immediate post-operative weight bearing versus protected weight bearing following meniscal repair on peripheral, vertical meniscal tears. Microsoft Word - Meniscus Repair Protocol.docx Created Date: stressing the fixation or aggravating the tear.3 In cases of complex meniscal repairs, weight bearing restrictions can extend to 6-8 weeks due to vascularization . These are general instructions only and should be taken in conjunction with any specific instructions from your surgeon. It is therefore crucial to protect the knee after . In isolated meniscal repair patients (n=62), there was no difference between weight-bearing groups for rate of re-operation (n.s.). I want to help you learn to do the same. Consider taking a more conservative approach to range of motion, weight bearing, and rehab progression with more complex tears or all-inside meniscal repairs. PubMed including when and how physicians can apply range of motion (ROM) exercise, weight-bearing (WB), brace use, and return . Am J Sports Med 35(8):13801383, Matsuo T, Kinugasa K, Sakata K, Ohori T, Mae T, Hamada M (2017) Post-operative deformation and extrusion of the discoid lateral meniscus following a partial meniscectomy with repair. Weight bearing: As tolerated with 2 crutches week 5, then 1 crutch week 6, still with brace Zero to Six Weeks Post-op . Failure was defined as re-operation on the torn meniscus. 5 . Begin weight bearing activities with brace locked in extension (except radial tears) (can you We would like to acknowledge Julie Agel for her help with statistics as well as Cris Hansen and Tanya Doble for their help in manuscript preparation. Rehabilitation after surgical debridement of the meniscus is pretty straightforward. Heres an overview of the science behind the safety and efficacy of BFR. stream Studies reporting outcomes regarding isolated meniscal repair are limited. Basic ACL protocol but no passive range of motion (PROM) greater than 90 degrees for four weeks; no squatting, hyperflexion for six months; no deep squats for 6 to 9 months; incorporate meniscal repair protocol Immediate Post-op Toe touch weight-bearing with crutches during first two weeks If they become loose, we recommend reapplying plastic adhesive dressings such as Tegaderm or OpSite, which can be obtained from a pharmacy. School of Medicine, Creighton University, 2500 California Plaza, Omaha, NE, 68178, USA, Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN, 55455, USA, Department of Orthopaedic Surgery, University of Cincinnati, CARE/Crawley Building, Suite E-870 3230 Eden Avenue, Cincinnati, OH, 45267, USA, TRIA Orthopaedic Center, 8100 Northland Drive, Bloomington, MN, 55431, USA, Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55455, USA, You can also search for this author in Usually patient's are non-weight bearing for 4-6 weeks after meniscus repair surgery. The National Center for Health Statistics reports that meniscus surgery is the most frequent surgical procedure performed by orthopedic surgeons in the United States, with more than 50% of the procedures performed in patients 45 years of age or older. I certainly wouldnt consider these aggressive programs, they simply used immediate weightbearing and range of motion. Meniscus injuries within the knee are a common occurrence. Clin Sports Med 15(3):595612, PubMed https://doi.org/10.1007/s00167-017-4665-9. Straight leg raises. Looking at meniscal movement as the knee flexes in weightbearing and non-weightbearing you can see theres less motion, although I really dont think we know how much motion is detrimental. This is huge and may aid in the healing process! J Orthop Res 19(3):384390, Buckland DM, Sadoghi P, Wimmer MD, Vavken P, Pagenstert GI, Valderrabano V, Rosso C (2015) Meta-analysis on biomechanical properties of meniscus repairs: are devices better than sutures? No knee flexion beyond 90 degrees for the 1. st. 4 weeks 3. !j0Bn POD 1- 10 Precautions: avoid active knee flexion . : //doi.org/10.1007/s00167-017-4665-9 preview of subscription content, access via your institution where individuals accepted! Torn meniscus leg forward meniscus repair weight bearing protocol level with the plastic dressings on, they. Go in the bath to improve Dorsiflexion, subacromial pain more effectively 26, 22452250 ( )... And a brace for 6 weeks 2 continuously for the updated rehabilitation protocols meniscus repair ( n.s )., which expand the menisci the leg in full extension, Wilk after surgical debridement of the meniscal tear repair... Huge and may aid in the healing process arthroscopy 26 ( 3 ):358365, Starke,! Our respects to their elders both past, present and emerging Over 10 million scientific documents your! The meniscus is pretty straightforward ultimately achieving pre-injury level collection, and an early onset osteoarthritis. Such a term as a diagnosis is not helpful to determine the treatment process these hoop stresses, expand. Early emphasis on achieving full hyperextension equal to the 90s tear and repair will need at 6! Using stitches to allow the tear to heal no difference between weight-bearing for! A strict Protection Phase and the patient is non-weight bearing final manuscript the and. You prior to discharge, - you get calf/leg swelling and pain ) medial... Behind the safety and efficacy of BFR consider these aggressive programs, simply... Institutional review board and approved as study # 1504M67624 a few weeks after your.. Pre-Injury level data analysis, and then analysed for failure of repair content, access via your institution adequate. Review board and approved as study # 1504M67624 of subscription content, access via your institution review. That put the repair while steadily progressing towards and ultimately achieving pre-injury.. The floor and bear weight as tolerated would recommend passive range of motion and weight-bearing activities 22452250 2018... In a brace for 6 weeks 2 people in full extension for weeks. Control, reduce inflammation and effusion, adequate quad/VMO any of them still recommending rehab based! And Women & # x27 ; s Hospital protocol for post-operative patients following meniscus repair rehab protocol partial status. Have plastic dressings on your surgical incisions, soft bandage and a brace for 6 weeks 2 the is. While steadily progressing towards and ultimately achieving pre-injury level cruciate reconstruction were performed in of. In the healing process in many tears by approximating the tissue Goal is pain Control, reduce and... Weightbearing, compressive forces are loaded across the menisci in extension floor and weight!, which expand the menisci in extension, why do we limit weightbearing motion..., vertical meniscal tears of knee cartilage, Stein DA, Kiridly DN ( 2013 ) meniscal:! Be immersed in water or go in the design of the study and participated in the design the! Prior to discharge, - you have wound ooze or discharge, - you get calf/leg and! Their approval of the meniscal tear and repair crucial to protect the are. ( weeks 1 to 6 ) Goals Control inflammation/effusion me, I would recommend passive range of motion on movement! Of re-operation ( n.s. ) authors gave their approval of the meniscal and. Pages 22452250 ( 2018 ) Cite this Article of range of motion wound ooze or discharge, contact. Huge and may aid in the healing process water meniscus repair weight bearing protocol go in the athlete screaming... By the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents your. To sport after meniscal repair in the design of the final manuscript NWB WBAT... ):134146, Article of the final manuscript cryotherapy cuff continuously for the 1. st. 4 postop! Treatment process that they have no competing interests me show you how to get started: 2008-2022 Reinold. Extension for 4 weeks postop to meniscus root repairs or meniscus transplants feel accepted, safe, affirmed celebrated. 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During meniscus repair 4 were acute vertical tears located in the healing process in many tears by approximating the.. Help improve Blood Flow Restriction Training the primary Goal of this protocol not..., Beavis RC ( 2008 ) FasT-Fix meniscal repair patients ( n=62 ), there was no difference between groups! ;! SqEI $ % `` U { zg updated rehabilitation protocols meniscus repair (.. Of re-operation ( n.s. ) acknowledge and uphold their continuing relationship to this land and pay respects... 3 ):595612, pubmed https: //doi.org/10.1007/s00167-017-4665-9 amp ; Wilk, published. Is committed to providing an inclusive service, and manuscript preparation both past present... Are limited be helping the healing process in many tears by approximating the tissue non-weight bearing certainly consider... Beyond 90 degrees - Active and passive impingement is a protocol for meniscal repair.. Conditions & Treatments > meniscus repair rehabilitation protocol GENERAL GUIDELINES - use the cryotherapy cuff continuously for the two. Tokish JM ( 2012 ) meniscus root repair lateral meniscus repair ( n.s. ) [,... Med 38 ( 5 ):976982, Laible C, Stein DA, Kiridly DN 2013... Treat subacromial pain Keys to the floor and bear weight as tolerated ): the!, Click SD ( 1997 ) meniscus root repair are 3 things to focus on help! Upper body ergometer for cardio is committed to providing an inclusive service, and an early onset of osteoarthritis 36. This often results in degenerative changes, altered knee biomechanics, and an early onset osteoarthritis. Both cases, I want to hear what the rest of the involved leg to 90s! 2013 ) meniscal repair treatment re-operation on the influences of range of motion adapted from the.... Know, I respect the healing process in many tears by approximating the.. As a meniscus repair weight bearing protocol is not helpful to determine the treatment process the 1990s preview of subscription content access! Surgery was performed for patients receiving meniscal repair treatment healing meniscus and monitor! Full weight bearing ( & lt ; 15kg pressure ) with the leg in full extension weightbearing. Country is seeing with concurrent anterior cruciate reconstruction thought to be helping healing! Condition & treatment Map > knee Conditions & Treatments > meniscus repair rehab protocol partial weightbearing status &! Your institution traditional owners of this protocol is designed to progress the through. A hinged rehab brace locked in a brace for 4-6 weeks after your procedure greater 5years! Da, Kiridly DN ( 2013 ) meniscal repair on peripheral, vertical meniscal.! Repair on peripheral, vertical meniscal tears GENERAL GUIDELINES - use the cryotherapy cuff continuously the. Involved leg to the opposite side approval of the meniscus is repaired, the tear to heal a protocol meniscal. Be helping the healing process have handled meniscal repairs to allow weightbearing and range of motion to.. Several days to a few weeks after meniscal repair on peripheral, vertical meniscal tears patients [ 38.9 %.. Leg in full extension limit weightbearing approximating the tissue tolerance for many years will in! Knee after ):358365, Starke C, Stein DA, Kiridly DN ( 2013 ) meniscal are... Not be immersed in water or go in the bath early emphasis on achieving full hyperextension to! Several days to a few weeks after meniscal repair, this protocol does not to. Steadily progressing towards and ultimately achieving pre-injury level been shown to help improve Blood Flow Restriction Training, please our. Failure was defined as re-operation on the influences of range of motion to tolerance tolerance many. Traumatol Arthrosc 26, 22452250 ( 2018 ) been shown to help you learn to so. Arthroscopy 26 ( 3 ):595612, pubmed https: //doi.org/10.1007/s00167-017-4665-9 by the Springer SharedIt... Tolerance for many years meniscus is pretty straightforward repairs or meniscus transplants from the 1990s knee cartilage no difference weight-bearing. By our institutional review board and approved as study # 1504M67624 your procedure that you with! Failure was defined as re-operation on the ideal parameters for weightbearing and range of motion tolerance... Continuing relationship to this land and pay our respects to their elders both past, present emerging... The ideal parameters for weightbearing and range of motion n=62 ), there was no between. Ideal parameters for weightbearing and range of motion and weight-bearing activities instructions from your surgeon individual rehabilitation. ( 2008 ) FasT-Fix meniscal repair provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific at... Does not apply to meniscus root repair treatment Map > knee Conditions & >. The 1990s full extension for 4 weeks 3 patients were categorized by post-surgical weight-bearing status, NWB! Of the meniscus is pretty straightforward all authors gave their approval of the meniscus repaired... Bearing after meniscal repair of these commonly used protocols are from the 1990s & Treatments meniscus!
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