MENISCAL POSTOPERATIVE REHABILITATION Dr Le Thi Ngoc Tuyet.

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1 MENISCAL POSTOPERATIVE REHABILITATION Dr Le Thi Ngoc Tuyet

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

3 Meniscal repair

4 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

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

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

7 Pain & swelling PRICE

8 https://www.sportsmd.com/sports-injuries/injury-recovery/acute-sports-injury-treatment- using-p-r-c-e-principle/

9 Lack of knee extension Quadriceps setting

10 KNEE FLEXION?

11 Meniscus movement with knee flexion

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

13 Meniscus zones Blood supply Lack of blood supply

14 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

15 WEIGHT BEARING?

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

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

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

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

20 Improve knee flexion Quadriceps & iliopsoas stretching Hamstrings strengthening

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

22 Normal Gait

23 Balance & coordination

24 Cardiovascular activity based on patient response and tolerance Cycling exerciseTreadmill exercise

25 Phase II (14-22ws) Functional Activities Sport

26 be avoided early in the Phase III Full squatLunge

27 A gradual walking to running program

28 Hop test https://g-se.com/la-aplicacion-de-los-hop-test-dentro-de-la-rehabilitacion-post- reconstruccion-de-lca-bp-457cfb26f1d446

29

30 Meniscectomy

31 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

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

33 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.

34 References 1. John Cavanaugh, Coleen T. Gately (2006). Meniscal Repair & Transplantation. Postsurgical Rehabilitation Guidelines for the Orthopedic Clinician, 307-324. 2.Terry Gillette, Andrew A. Brooks (2007). Meniscectomy and meniscal repair. Rehabilitation for the postsurgical Orthopedic Patient, 367-380. 3.Micheal J. D’Amato, Bernard R. Bach (2007). Meniscal Injuries. Handbook of Orthopeadic Rehabilitation, second edition, Mosby Elservier, Philadelphia, 479-486.

35 THANK YOU FOR YOUR ATTENTIONS!