Common tears include longitudinal, parrotbeak, flap, bucket handle, and mixedcomplex. Brace knee immobilizer used for four weeks, ted hose to be worn until ambulation has returned to normal presurgery level or two weeks. The gundersen sports medicine meniscus repair rehabilitation program is an evidencebased and soft tissue. At the time of writing this article, my left nostril is doing all the hard work although righty will soon take over, as the human nasal cycle causes my nostrils to swap jobs every few hours.
The outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play rtp. Repair can be achieved by a transtibial tunnel repair, a suture anchor repair or a side to side repair. Anterior cruciate ligament acl and meniscus repair rehabilitation protocol general notes. Manual stretching for extension with overpressure or recurvatum. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear. Quadriceps strengthening, making sure that closed chain exercises occur. Partial weightbearing status repair rehabilitation dr. Factors affecting success include tear age, location and pattern, age of the patient, as well as any associated injuries. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much. Rehabilitation and return to play following meniscal repair. Protect the knee from overstress and allow healing 2. 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. Weight shift exercises at 3 weeks if weight bearing is allowed.
Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weightbearing may be safe following meniscal repair and may not compromise the repair. Many different factors influence the postoperative meniscal repair rehabilitation outcomes, including type and location of the meniscal tear and repair. Mar 23, 2012 meniscal repair guidelines postoperative phase i week 06 the rehabilitation guidelines following meniscal repair at our institution are divided into three phases and are outlined in table 2. There was wide variation in rehabilitation protocols among clinical studies. Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet to form a joint. A series of meniscal repair options are now available to treat the wide range of meniscal tears encountered. Pdf rehabilitation and return to play following meniscal repair. In general, knee is protected with a brace, rom limited to pdf. Surgical knee will be in a hinged rehab brace locked in full extension for 4 weeks postop. The first phase is designed to protect the repair and allow for maximal healing.
Hybrid repairs afford reliable fixation while avoiding extensive tissue dissection and neurovascular. Rehabilitation guidelines for meniscal repair uw health. Postoperative rehabilitation aims to foster healing after meniscal repair and facilitate the patients return to full function. Physical therapy pt and exercises for a meniscus tear rehab. Repair is also more successful with an intact or reconstructed acl, vs. Your rehab program probably will include physical therapy and home exercises. May 30, 2014 the indications for meniscal repair have remained controversial. 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. The primary function of the articular cartilage is to provide.
Secure and reliable repairs are performed based on the tear location with the meniscal dart implant, meniscal viper suture passer or 20 fiberwire suture with meniscal needles. Meniscal repair protocol brigham and womens hospital. It is important to recognize that all times are approximate and that progression should be based on careful monitoring of the patients functional status. Acl reconstruction, pcl reconstruction, chondroplasty precautions. On line cialis, brand viagra prices cincinnatisportsmed.
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. The transtibial meniscal root repair is emerging as the gold standard treatment due to its ability to restore a large footprint at the meniscal roots native at tachment site and restore normal joint contact pressures. Lowe this rehabilitation protocol was developed for patients who have isolated meniscal repairs. 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. Rehabilitation exercises a meniscus tear is a common knee joint injury. Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis. Anterior cruciate ligament acl and meniscus repair. Full range of motion strengthening as tolerated discourage deep squatting. Prom 090 degrees by week 4, full motion by week 10.
After meniscal surgery, rehabilitation with a physical therapist or athletic trainer is needed to restore range of motion, strength, movement control and guide the athletes return to sport. Noyes, md3 the purpose of this paper is to provide current knowledge regarding the indications, operative techniques, rehabilitation programs, and clinical outcomes of meniscus. Dependent upon the location and size of the repair, weight bearing status postoperatively. This blood supply is necessary for a tear or a repair to heal. It is a minimally invasive procedure often undergone as an outpatient.
Premature ejaculation is an uncontrolled discharge either before or after the surgery. Meniscal repair may be done in conjunction with other surgery or injury often slowing the rehab process. Postoperative knee meniscus repair rehabilitation protocol from san francisco orthopaedic sports medicine surgeon dr. Knee meniscus repair post operative rehabilitation protocol. Brace to be worn at all times except when doing rom exercises for the first 4 weeks and further as. Key factors in determining progression of rehabilitation after meniscal repair. Partial weightbearing status insideout rehabilitation protocol. For most tears, some simple exercises can help maintain muscle strength in the front of the thigh quadriceps, back of the thigh hamstr. Knee technique guide meniscal root repair using a two. Be sure to rotate your leg outward laterally slightly to gain a better activation of the medial inner side of the quadriceps. A meniscal repair is a surgical procedure to repair a torn meniscus via keyhole surgery.
Articular cartilage is made up of collagen, proteoglycans and water which lines the end of the bones that meet to form a joint. Acl reconstruction with meniscus repair postoperative physical therapy protocol. 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. There are two types of cartilage in the knee, articular cartilage and meniscus cartilage. Focus on restoring normal mechanics, preserve quad controlengagement, lecore strength progression at this point rehab begins to strongly focus on the gluteus medius and maximus by. Meniscus repair rehabilitation northeast orthopedics and. Work with your doctor to plan a rehabilitation rehab program that helps you regain as much strength and flexibility in your knee as possible. Knee arthroscopy with meniscus repair rehab protocol. When the meniscus root is repaired there will be a prolonged.
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. Acl reconstruction with meniscal repair rehabilitation protocol. 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. Consider taking a more conservative approach to range of motion, weight bearing, and rehab progression with more complex tears, allinside meniscal repairs, and meniscal transplants. Regain knee motion, limiting knee flexion to 90 degrees 3. Meniscus rehab exercises the physical therapy advisor. Meniscal repair postoperative rehabilitation protocol. Physical therapy pt can be useful for a torn meniscus whether or not you have surgery. Rehabilitation guidelines for meniscal repair of root and. Noyes, md3 the purpose of this paper is to provide current knowledge regarding the indications, operative. Indications, techniques, rehabilitation, and clinical outcome timothy p. It is no means intended to be a substitute for ones clinical decision making regarding the. Rehabilitation guidelines for meniscal repair of root and complex tears.
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. Meniscus repair rehabilitation this rehabilitation protocol was developed for patients who have isolated meniscal repairs. For this reason, rehabilitation following a meniscal repair is particularly conservative in an effort to protect the repaired meniscus. Meniscus repair rehabilitation the following protocol is a guideline for rehabilitation following meniscus repair. Typically in indicated for lesions within 3mm of the vascular zone. The subgroups of meniscal repair consisted of 30 patients who had undergone medial meniscus repairs mm, 19 lateral meniscus repairs lm and 12 repairs of medial and. Because you have to allow the torn meniscus to heal, certain activities must be restricted to avoid placing excessive stress on the healing meniscus. Meniscus repair rehab follows same timeframe with or without acl reconstruction acl reconstruction aids in healing response of meniscus repair tenuta ajsm 94 90% healing wrec. 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. It is by no means intended to substitute for ones clinical decision making regarding the progression of a patients post. The transtibial meniscal root repair is emerging as the gold standard treatment due to its ability to restore a large footprint at the meniscal roots native attachment site and restore normal joint contact pressures. There is quite a lot of controversy in the sports medicine world as to the best rehabilitation from meniscus repair surgery.
Rehab following meniscus repair surgery is more extensive than rehab after a partial meniscectomy surgery to remove the meniscus tear. 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. Figure 6 shows the blood vessels perimeniscular capillary plexus entering the outer portion of the meniscus. Traditionally, the rehab was very slow, with activities restricted for many months after surgery. Right left knee medial lateral meniscal repair phase i 08 wks. The indications for meniscal repair have remained controversial. This rehabilitation protocol was developed for patients who have isolated meniscal repairs. Acl reconstruction with meniscal repair rehabilitation. Find out when it helps, what to expect, and how long youll need to do it for.
Meniscal repair guidelines postoperative phase i week 06 the rehabilitation guidelines following meniscal repair at our institution are divided into three phases and are outlined in table 2. 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. Tears are noted by how they look, as well as where the tear occurs in the meniscus. The protocol may be modified depending on the location and extent of the meniscal tear and subsequent repair. In complex tears, hamstring strengthening will be avoided for the first 6 weeks after surgery. No loaded knee flexion beyond 450 for 4 weeks no loaded knee flexion beyond 900 for 8 weeks. Knee technique guide 05486 v1 twotunnel meniscal root repair technique overview the meniscal roots are very important to overall joint health. Rehabilitation is initiated immediately postoperatively. Dependent upon the location and size of the repair, weight bearing status postoperatively as well as the intensity and time frame of functional activities may vary. As tolerated should be understood to include with safety for the reconstructionrepair. Rehabilitation guidelines for meniscal repair there are two types of cartilage in the knee, articular cartilage and meniscus cartilage. Knee meniscal root repair 1 overview this is a protocol that provides you with general information and guidelines for the initial stage and progression of rehabilitation according to the listed timeframes. 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.
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