Meniscus Injuries Rehabilitation PDF

Considerations for Rehabilitation of Meniscal Injuries Mohammad Yabroudi, PT, PhD Jordan University of Science and Technology  Meniscal Injuries: Mechanisms Sudden changes in direction with foot fixed on ground (cutting, pivoting) Hyperflexion (landing, mi...

Considerations for Rehabilitation of Meniscal Injuries Mohammad Yabroudi, PT, PhD Jordan University of Science and Technology  Meniscal Injuries: Mechanisms Sudden changes in direction with foot fixed on ground (cutting, pivoting) Hyperflexion (landing, miners, plumbers, wrestlers) High impact compression loads MCL or ACL mechanisms Meniscal Injuries: Signs and Symptoms Severe pain on injury, effusion develops several hours later May have giving way on injury Later, intermittent pain, effusion, giving way Locking of knee Joint line tenderness + McMurray, Apley compression Limited ROM with premature end-feel Symptoms reproduced with deep squatting Quad inhibition Decision-making: Leave Alone Partial thickness tear, short peripheral tear that doesn’t disrupt joint mechanics Stable meniscus in unstable knee Degenerative meniscus in a degenerative knee  Partial Menisectomy If meniscal tear disrupts mechanics of knee and patient is not a good candidate for meniscal repair Debridement (remove as little as possible) Rehabilitation Following Arthroscopic Debridement Muscle Strengthening and Joint Mobility – Isometrics, AROM, PF mobilization immediately – Soft tissue manipulation of portal scars when incisions are healed – Progress to PREs when tolerated – Consider use of NMES Rehabilitation Following Arthroscopic Debridement Ambulation – PWBAT immediately – Progress to FWB when walking without a limp (usually within 1-2 weeks)  Rehabilitation Following Arthroscopic Debridement Return to Activity – Treadmill running at 3-4 weeks if quad strength >70% and no joint pain or effusion present – Progress to level surface running, straight sprinting, agility training as tolerated – Return to full activity usually in about 6 weeks. (quad strength should be >85%)  Meniscal Repair Considered when lesion is in area of good vascularization Lesion at least 1 cm in length Rehabilitation Following Meniscal Repair Muscle Strengthening and Joint Mobility – Limited range PROM and AROM for first 2-3 weeks (0-90), progress to full ROM within 6-8 weeks – Isometrics immediately – No resisted hamstring or Closed Chain ex for first 6 weeks – Progress to more aggressive strengthening at 6 weeks. May include CKC ex but should avoid resisted OKC hamstring ex. Rehabilitation Following Meniscal Repair Ambulation – WBAT, Brace Locked in Extension first 1-2 weeks – When brace unlocked, gradually wean from crutches to FWB ambulation Rehabilitation Following Meniscal Repair Return to Activity – Initiate graded running program (begin with treadmill) at 3-6 months, depending on quad strength, joint pain, effusion – Return to full activity usually not before 6 months and may be longer depending on progress with running and agility program – Failure usually related to too much activity to early post-op.  Meniscal Repair of Avascular, Central Region Becoming more common, due to importance of preserving meniscus when possible Modifications of surgical techniques to enhance healing in this area are used: – Fibrin Clot – Rasping of synovial fringe – Creating vascular access channels  Meniscal Repair of Avascular, Central Region Noyes, et al, Am J Sports Med, 2002 – 71 knees of individuals 19 years or less – 18 to 51 month follow-up – 75% had no symptoms and showed no sign of clinical failure at the time of follow- up  Meniscal Repair of Avascular, Central Region Noyes, et al, Arthroscopy, 2000 – 30 repairs in patients 40 years or older – 26 patients were asymptomatic and had not required further surgery after a mean of 34 months post-operatively Meniscal Repair of Avascular, Central Region: Rehab Described by Noyes, 2002 Immediate knee motion 0-90 Flexion to 120 by 3-4 weeks Flexion to 135 by 5-6 weeks Crutch ambulation for first 4 weeks, begin with touch weight bearing Gradual increase to FWB by 6 weeks No deep squatting, running, jumping, cutting, twisting for 6 months