Rehabilitation protocols ohio state sports medicine. This process of tissue degeneration makes it very unlikely that a surgical repair will heal or that the surrounding meniscus will be strong enough to hold the sutures used to repair it. In general, knee is protected with a brace, rom limited to repair. Variations are built into the rehabilitation protocol according to the type, location, and size of the meniscus repair, if concomitant procedures are performed, and if articular cartilage damage is present. As tolerated should be understood to include with safety for the reconstruction repair. Anterior cruciate reconstruction with meniscal repair. Meniscal repair protocol the following is a patient guide to rehabilitation after a meniscal repair procedure.
Meniscus repair guidelines vanderbilt university medical. Specific changes in the program will be made by the physician as appropriate for the individual patient. Acl reconstruction rehabilitation protocol one of the most common complications following acl reconstruction is loss of motion, especially loss of extension. Even if an exercise or activity is listed at a particular time frame, some patients may not be ready to perform it. Meniscus debridement protocol meniscectomy weeks 12 ice massage pain modalities as indicated weight bearing as tolerated use crutches until can walk without a limp edema control therapy range of motion exercise goal. The sports physical therapy service is an integral part of the sports medicine center and the department of. Immediate knee motion and muscle strengthening are initiated the day after surgery.
Do not do resisted long or short arc quads, to avoid adversely stressing the graft. Meniscal repair protocol brigham and womens hospital. Common tears include longitudinal, parrotbeak, flap, bucket handle, and mixedcomplex. Regain knee motion, limiting knee flexion to 90 degrees 3. The menisci are wedge shaped, being thinner toward the center of the knee and thicker toward the outside of the knee joint figures. Right left knee medial lateral meniscal repair phase i 08 wks. Acl reconstruction with meniscus repair protocol dr bradley bruner 01012009 guidelines. Gentle strengthening protecting the healing meniscus. Noyes knee institute rehabilitation protocol for meniscus repairs and transplants 12 34 56 78 912 4 5 6 712 brace. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a patient that has undergone. Patients must demonstrate specific functional criteria at each physical therapy visit before progressing to more advanced interventions. Knee arthroscopy with meniscus repair rehab protocol.
The meniscus cartilage in the knee includes a medial inside meniscus and a lateral outside meniscus. Meniscal repair postoperative rehabilitation protocol. A tear in this red zone may heal on its own, or can often be repaired with surgery. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear. Ohio state physicians and physical therapists work collaboratively to develop best clinical practices for postsurgical rehabilitation. The menisci are wedge shaped, being thinner toward the center of the knee and thicker. The menisci are wedge shaped, being thinner toward the center of the knee. Pt protocol meniscus repair michael j rytel, md greater pittsburgh orthopaedic associates phase 1. 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 that avascular zone of the meniscus. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Rehabilitation guidelines for meniscal repair there are two types of cartilage in the knee, articular cartilage and meniscus cartilage. Specific changes in the program will be made by the.
Dependent upon the location of the repair, weight bearing status postoperatively as well as. If you have questions, contact the referring physician. Once the dressing is removed on the third postoperative day, ice is applied for 20minute periods 3. Manual stretching for extension with overpressure or recurvatum. The protocol may be modified depending on the location and extent of the meniscal tear and subsequent repair. Return to sport meniscal repair protocol general guidelines to consider with return to sport after meniscal repair. Meniscal root repair mensical radial tear repair this protocol provides general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. 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. Nwb weeks 02 pwb o 25% brace locked, bilateral crutches week 3 o 50% brace locked, bilateral crutches week 4. Altru advanced orthopedics knee meniscus repair rehabilitation protocol the intent of this protocol is to provide the therapist with a guideline for the postop rehab of a patient who has had a meniscus repair, meniscal root repair, or meniscal transplant.
Dependent upon the location and size of the repair, weight bearing. Microsoft word meniscus repair and transplant protocol. In general, knee is protected with a brace, rom limited to protocol for meniscus repair this protocol is intended to guide clinicians and patients through the postoperative course for a meniscus repair. Sports medicine physical therapy rehabilitation protocols. Lowe this rehabilitation protocol was developed for patients who have isolated meniscal repairs. Please follow individual physician guidelines on the referral.
Meniscal repair protocol this will delay the protocol for aclr 1. This blood supply is necessary for a tear or a repair to heal. Rehabilitation guidelines for meniscal repair uw health. The primary goal of this protocol is to protect the repair while steadily progressing towards and ultimately achieving preinjury level of activity. 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 w meniscal repair protocol missouri orthopaedic institute weeks 612. Knee arthroscopy meniscus root repair day of surgery a. The primary goal of this protocol is to protect the reconstruction while. The outer onethird of the meniscus has a rich blood supply. Throughout this protocol, time references in weeks since surgery represent the earliest that a. Microsoft word acl reconstruction w meniscus repair.
Hospital has accepted this protocol as our standard protocol for the management of patients sp meniscal repair. It is designed for rehabilitation following arthroscopic meniscal repair. Repair can be achieved by a transtibial tunnel repair, a suture anchor repair or a side to side repair. 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. Maximum protection weeks 1 to 6 goals control inflammationeffusion allow early healing full passive knee extension gradually increase flexion to 90 degree independent quadriceps control weight bearing non weight bearing for six weeks unless noted by dr. However, the large hematoma produced during the acl surgery is considered beneficial to the healing of the meniscal repair and some. While the postop dressing is in place, icing should be done continuously. Loss of knee extension has been shown to result in a limp, quadriceps muscle weakness, and anterior knee pain.
Brace knee immobilizer used for four weeks, ted hose to be worn until ambulation has returned to normal presurgery level or two weeks. The intent of this protocol is to provide the clinician with a guideline of the post operative rehabilitation course of a patient that has undergone a meniscal repair. Acl with meniscus repair 2 typically, after an anterior cruciate reconstruction surgery acl with meniscal repair there is a protected range of motion and weight bearing period that can last up to 6 weeks. Find pdfs of our most common rehabilitation protocols. Acl reconstruction, pcl reconstruction, chondroplasty precautions. This meniscus repair reconstruction protocol is criterion based. An athlete who returns to sport without functional stability being restored, is at a higher risk of failure and poor outcomes. Meniscal repair postoperative rehabilitation protocol orthoindy. Rest and elevate the knee when not doing your rehabilitation exercises. The path to regaining range of motion, strength and function can require a sustained and coordinated effort from the patient, his or her family, the ohio state sports medicine physical therapy team and sometimes, other healthcare providers. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. Acl reconstruction w meniscus repair mizzou sports doc. Stationary bike terminal knee extension in standing with tubing hamstring curls, aa, a, then resistive wall sits total gym, double leg, low level or leg press wall squats lateral and front stepups double leg balanceproprioception pool if available gait activation march sidestep backwards goals. Optimum return to sport does not mean to return as fast as possible.
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. Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet to form a joint. Many studies have reported encouraging results following repair of meniscus tears for both simple longitudinal tears located in the periphery and complex multiplanar tears that extend into the central third avascular region. Modifications to the protocol may be necessary dependent on location of repair, concomitant. No loaded knee flexion beyond 450 for 4 weeks no loaded knee flexion beyond 900 for 8 weeks. Anterior cruciate ligament acl and meniscus repair rehabilitation protocol general notes. Anterior cruciate ligament acl and meniscus repair. Acl reconstruction with patellar tendon autograft and. Meniscus repair rehabilitation protocol the following is a protocol for postoperative patients following meniscus repair. Discontinue crutches and brace when gait in nonantalgic about 6 weeks post op and patient has adequate quad control.
Aclr protocol with patellar tendon autograft and meniscal repair. Meniscus repair rehabilitation protocol general guidelines use the cryotherapy cuff continuously for the first 72 hours, then as needed thereafter ensure that the cuff never contacts the skin directly apply to the knee after performing rehabilitation exercises for the first 6 weeks. Figure 6 shows the blood vessels perimeniscular capillary plexus entering the outer portion of the meniscus. It is no means intended to be a substitute for ones clinical decision making regarding the. The following is a protocol for postoperative patients following an isolated meniscus repair. Microsoft word arthroscopic meniscal repair protocol.
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