Meniscus Repair Rehabilitation
Meniscus Repair Rehabilitation
This rehabilitation protocol was developed for patients who have isolated meniscal repairs. 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. Dependent upon the location of the repair, weight bearing status postoperatively as well as the intensity and time frame of initiation of functional activities will vary. The protocol is divided into phases. Each phase is adaptable based on the individual patients and special circumstances.
The overall goals of the repair and rehabilitation are to:
- Control pain, swelling, and hemarthrosis
- Regain normal knee range of motion
- Regain a normal gait pattern and neuromuscular stability for ambulation
- Regain normal lower extremity strength
- Regain normal proprioception, balance, and coordination for daily activities
- Achieve the level of function based on the orthopedic and patient goals
Important post-op signs to monitor:
The physical therapy should be initiated within 3 to 5 days post-op. It is extremely important for the supervised rehabilitation to be supplemented by a home fitness program where the patient performs the given exercises at home or at a gym facility.
- Swelling of the knee or surrounding soft tissue
- Abnormal pain response, hypersensitive
- Abnormal gait pattern, with or without assistive device
- Limited range of motion
- Weakness in the lower extremity musculature (quadriceps, hamstring)
- Insufficient lower extremity flexibility
Return to activity requires both time and clinic evaluation. To safely and most efficiently return to normal or high level functional activity, the patient requires adequate strength, flexibility, and endurance. Isokinetic testing and functional evaluation are both methods of evaluating a patient’s readiness to return to activity. Return to intense activities such as impact loading, jogging, deep knee flexion, or pivoting and shifting early post-operatively may increase the overall chance of a repeat meniscal tear and symptoms of pain, swelling, or instability should be closely monitored by the patient.
Rehabilitation Protocols
Phase 1: Week 1-2 Meniscal Repair
1ROM
- Passive, 0-90°
- Patellar mobilizations
- Ankle pumps
- Gastoc/soleus stretch
- Hamstring/ITB stretch
- Prone hangs to facilitate extension
2STRENGTH
- Quad sets with E-stim/biofeedback
- SLR in 4 planes
- SAQ
- Multi-hip machine in 4 planes
- Hip flexion-seated
- Multi-angle isometrics (0-60°)
3WEIGHT BEARING
- Toe touch weight bearing in post-op brace with crutches unless otherwise instructed
4MODALITIES
- E-stim/biofeedback as needed
- Ice 15-20 minutes with 0° knee ext
5BRACE
- Remove brace to perform ROM activities
- Post-op brace with crutches
- Brace locked at 0° ext to protect repair
GOALS OF PHASE:
- Control pain, inflammation, and effusion
- Adequate quad/VMO contraction
- Independent in HEP
- TDWB to PWB as instructed
Phase 2: Week 2-4 Meniscal Repair
1ROM
- Passive, 0-120°
- Patellar mobs
- Gastoc/soleus stretch
- Hamstring/quad/ITB stretch
- Prone hang as needed
- Heel/wall slides to reach goal
2STRENGTH
- Quad sets with biofeedback
- SLR in 4 planes with ankle weight
- Multi-angle isometrics (0-60°)
- Knee extension (90-30°)
- Heel raises/Toe raises
- Leg Press (110-40°)
- Wall squats
3BRACE
- Weight shift (side/side, fwd/bkwd)
- Single leg balance
- Cup walk/Hesitation walk
4WEIGHT BEARING PWB to FWB
- PWB to FWB with crutches as tolerated
- As instructed (case-dependent)
5BICYCLE
- May initiate bike when 110° flex is reached
- DO NOT use bike to increase flexion
6MODALITIES
- Biofeedback as needed
- Ice 15-20 minutes
7BRACE
- Post-op brace with crutches as indicated
- Opened to 90° at wk 2
- Opened to full ROM at wk 3-4
- Discontinue week 4
GOALS OF PHASE:
- ROM 0-120°
- Adequate quad/VMO contraction
- Control pain, inflammation, and effusion
- PWB to FWB with quad control
Phase 3: Week 4-12 Meniscal Repair
1ROM
- Passive, 0-135° (full)
- Gastroc/soleus stretch
- Hamstring/quad/ITB stretch
- Prone hang to reach goal as needed
- Patellar mobs
2STRENGTH
- Bicycle/EFX
- SLR in 4 planes with ankle weight/tubing
- Mini-squats/Wall squats
- Knee extension (90-30°)
- Hamstring curl (0-90°)
- Leg Press-single legged eccentric
- Smith Press-double legged
- Isokinetic training at high speeds (180-360°/sec)
- Multi-hip machine in 4 planes
- Lateral/Forward step-up/down
- Heel raise/Toe raise
- Lunges-knee not to migrate over toe
3BALANCE TRAINING
- Single leg balance with plyotoss
- Sports cord agility work
- Wobble board work
- ½ Foam roller work
4MODALITIES
- Ice 15-20 minutes as needed
5BRACE
- Discontinue
GOALS OF PHASE:
- ROM 0-135°
- Full weight bearing
- Control pain, inflammation, effusion
- Increase lower extremity strength and endurance
- Enhance proprioception, balance, and coordination
- Complete readiness for sport specific activity
Phase 4: Week 12-36 Meniscal Repair
1ROM
- Continue all stretching activities
2STRENGTH
- Continue all exercises from previous phases
3RUNNING PROGRAM
- Water walking
- Swimming (kicking)
- Backward run
4RUNNING PROGRAM
- Lateral shuffle
- Carioca, figure 8’s
5FUNCTIONAL TRAINING
- Initiate light plyometric program
- Box hops, level, double-leg
- Sport specific drills
6MODALITIES
- Ice 15-20 minutes as needed
GOALS OF PHASE:
- Enhance neuromuscular control
- Progress skill training
- Perform selected sports specific activity-unrestricted sporting activity
- Achieve maximal strength and endurance
Advanced weight training and sports specific drills are advised to maintain a higher level of competition. Isokinetic testing at 6 and 12 months may be recommended to guarantee maintenance of strength and endurance.
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