MENISCAL POSTOPERATIVE REHABILITATION Dr Le Thi Ngoc Tuyet

Objectives List the factors influence speed & progressiveness in Rehab program of meniscal repair. Understand the treatment of each phase in postoperative Rehab program.

Meniscal repair

Size of tear Repair Stabilizatio n technique Suture (number, material) Location of repair Others Degeneration Ligaments Patella dysfunction…. Factors influence speed & progressiveness in Rehab Program

Rehab Program Phase I 0-6ws Phase II 6-14ws Phase III 14-22ws Protect healing tissue Improve ROM & Muscle Strength Functional Activities & Sport

Phase I (0-6ws) PROTECT HEALING TISSUE Problems Pain & swelling Lack of extension Limit of knee flexion

Pain & swelling PRICE

using-p-r-c-e-principle/

Lack of knee extension Quadriceps setting

KNEE FLEXION?

Meniscus movement with knee flexion

Active knee flexion pulls the medial & lateral meniscus posterior. This activity increased stress on the repaired and healing tissues

Meniscus zones Blood supply Lack of blood supply

Passive Knee Flexion based on assessment of pain (0, 30 o, 60 o, 70 o, 90 o ) 0-90 o 4-6ws 0-70 o :4ws 90 o : 4-6ws

WEIGHT BEARING?

The patient is non weight - bearing or partial weight - bearing to tolerance with crutches for a period of 4 to 6 weeks

Precautions Avoid ambulation without brace locked at 0 o before 4ws

Phase II (6-14ws) Full ROM & Muscle Strength Gait Balance

knee flexion Stretching extensor muscles (Quadriceps, iliospoas) Strengthening flexor muscles (Hamstrings)

Improve knee flexion Quadriceps & iliopsoas stretching Hamstrings strengthening

Partial weight bearing to full weight bearing Straight leg raise without quadriceps lag Partial squat Heel raise

Normal Gait

Balance & coordination

Cardiovascular activity based on patient response and tolerance Cycling exerciseTreadmill exercise

Phase II (14-22ws) Functional Activities Sport

be avoided early in the Phase III Full squatLunge

A gradual walking to running program

Hop test reconstruccion-de-lca-bp-457cfb26f1d446

Meniscectomy

Rehab Program Phase I 0-2ws Phase II 2-4ws Phase III 4-6ws No structure be protected Healing phase Improve ROM & Muscle Strength Functional Activities & sport

Rehab program Early control pain & swelling Immediate weight-bearing Maintain full ROM Regain muscle strength Return functional activities & sport

Take home messages A rehab program must be individually tailored base on scientific evidence, clinical signs and symptoms, and patient needs. Active knee flexion increases stress on the repaired and healing tissues. Full squat and lunge should be avoided until the end of the Phase III.

References 1. John Cavanaugh, Coleen T. Gately (2006). Meniscal Repair & Transplantation. Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician, Terry Gillette, Andrew A. Brooks (2007). Meniscectomy and meniscal repair. Rehabilitation for the postsurgical Orthopedic Patient, Micheal J. D’Amato, Bernard R. Bach (2007). Meniscal Injuries. Handbook of Orthopeadic Rehabilitation, second edition, Mosby Elservier, Philadelphia,

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