David Menche M.D.
Meniscal Repair Rehabilitation Protocol | Print |
Patients who have undergone an isolated meniscal repair need to understand the biological healing that is taking place in there knee after surgery. Initially, the repair is being held by sutures and/or devices until the body heals the tissue. During that time period protective exercise needs to be performed in order not to damage the repair. Many times for the first 2-3 weeks, I will have patients wear a knee immobilizer (removable brace) in order to protect the repair. Return to full sport usually will occur at 5-6 months post-operatively.

Until you have full range of motion (FROM) and no swelling do not think that more walking, standing or stair climbing will ultimately enhance the function of your knee. That is a myth. The above activities early on have a potential for overloading your knee and causing more pain and swelling.

For the first 4-8 weeks after surgery limit the above activities until you have achieved full range of motion and no swelling in the knee. Focus on your therapy program which initially will encourage range of motion and strengthening in a controlled, supervised manner. As you progress, I will encourage return to full activity as tolerated.

Stretching should be provided by one-on-one supervision in the therapy center and done on a daily basis at home. The therapist should instruct you on a home program before you attempt to perform these exercises at home.

Strengthening should only be performed in a very slow manner. Initially, one should start with a multi-angle isometric program (tightening the muscles) and progress to a PRE (progressive resistive exercise program i.e. lifting weights). When lifting weights, lift the weight over a 10 second time period and lower the weight over 5 seconds. If pain develops during any part of the range of motion, inform the therapist. The therapist will have 3 options.

1) To lower the weight and continue the exercise through a full range of motion.
2) To avoid the range of motion which is painful
3) To stop the exercise totally.

The exercises should initially be performed for one set and 12-15 repetitions. Patients may progress as tolerated. Ideally, one should perform one set of 6-8 repetitions. Upon the last repetition the patient will have total muscle fatigue but absolutely no pain in the joint i.e. in an open knee extension exercise the patient will attempt to raise his leg but it just won’t go. There is no pain but the muscle is totally fatigued. Exercises should be performed for all muscle groups of both lower extremities.

PRIMARY GOALS PRECAUTIONS
1. Achieve FROM
2. No swelling
3. Obtain full strength
Knee immobilizer worn full time
For the first 2-3 weeks, limit aerobic activity only for warm-up and cool down until full ROM, no swelling and adequate strength is achieved.

ADVERSE SIGNS AND SYMPTOMS

  1. Increased knee pain >24 hours
  2. Increased knee swelling that is not reduced with ice and elevation
  3. Increased redness, localized skin temperature and/or drainage or bleeding from surgical site.

PHASE 1- ACUTE PHASE- LIMITED ROM AND SWELLING

 

WEIGHT BEARING ROM BRACE EXERCISE
Progress weight bearing as tolerated. Obtain ROM 90-110 degrees @4-6 weeks
FROM @ 8 weeks
Immobilizer
1. multi-angle isometrics
progress to pre’s
2.  patellar mobility

PHASE 2 - RETURN TO FULL FUNCTION

CRITERIA TO ENTER PHASE 2
1) FROM
2) No pain or effusion
3) Satisfactory clinical exam

EXERCISE
1) Continue stretching and strenthening exercises
2) Increase functional aerobic activity level specific to the patient’s functional goals i.e. do not aggressively utilize the elliptical if the patient’s goals are to increase their everyday walking
3) Progress to sport-specific skill training as required @4-6 months
4) Avoid plyometrics that are not sport-specific