Rehabilitation guidelines for acl reconstruction with. These findings suggest that acute repair of meniscal injury following traumatic fracture of the tibial plateau could produce functional results similar to those patients that did not sustain a meniscus tear. The first 6 weeks are a strict protection phase and the patient is nonweight bearing. Communication with the surgeon needs to continue during the rehabilitation process. Lowe this rehabilitation protocol was developed for patients who have isolated meniscal repairs. In addition, if the medial meniscus is involved, active hamstring contraction is contraindicated in this phase. Tdwb, brace locked at 0 degrees for ambulation and sleeping rom.
Meniscus root repairs nonweight bearing with brace locked at 0 degrees okay to unlock brace while nonweight bearing i. Patients must demonstrate specific functional criteria at each physical therapy visit before progressing to more advanced interventions. The direct attachment of the hamstring and popliteus tendons to the menisci requires limited knee flexor active contraction during the protection phase of recovery for the meniscus rootradial repair. Meniscal repair postoperative rehabilitation protocol. Acl reconstruction with meniscus repair protocol dr bradley bruner 01012009 guidelines. So if were going to talk 90s protocols, take a look at these studies from way back when from shelbourne and barber that showed excellent results in patients undergoing a combined aclmeniscus repair procedure and utilizing no limitations in weightbearing or range of motion, similar to a protocol for an isolated acl reconstruction. If you have questions, contact the referring physician. Meniscal repair guideline complex tears sanford health. In general, knee is protected with a brace, rom limited to protocol for meniscus repairs and transplants 12 34 56 78 912 4 5 6 712 brace. 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. Meniscal tissue is slow to heal and requires protection. Partialweight bearing meniscus repair protocol dr bradley bruner 01012009 guidelines. Each phase is adaptable based on the individual patient.
Acl reconstruction with meniscus repair brian bjerke, md postoperative protocol phase i maximum protection weeks 0 to 6. The gundersen sports medicine meniscus repair rehabilitation program is an. Meniscal repair guideline this rehabilitation program is designed to return the individual to their activities as quickly and safely as possible. The primary function of the articular cartilage is to provide. Anterior cruciate reconstruction with meniscal repair. Orthopaedic surgery, sports medicine and rehabilitation m e ni scus re pai r postoperative physical therapy protocol goals. The meniscus is a circular piece of cartilage with its blood supply coming from the outer rim. Dependent upon the location and size of the repair, weight bearing status postoperatively as well as the intensity and time frame of functional activities may vary. Figure 1 meniscus cartilage shown here from above the knee, without the femur. Acl reconstruction wmeniscal repair protocol missouri orthopaedic institute weeks 612. Tears in the peripheral third of the meniscus are more likely to heal due its vascular nature.
The decision to repair a tear in the meniscus is based largely on the location of the tear. Post operatively these patients will need to avoid combined. Meniscus repair protocol genomics diagnostic laboratory chop. T he knee is an anatomically complex joint, which is. Chief, division of sports medicine associate professor of orthopaedic surgery tel. Meniscus repair protocol mr gilbert and mr coupe sports knee clinic, wrightington hospital phase 1 week 12 week exercise goals 12 rom 090 rom exs patellar mobs ankle pumps gastrocsoleus stretch hamstringitb stretch prone hangsheel props strength static qs slrs hip strengthening weight bearing pwb control pain and inflammation ice. Jan 21, 20 manske claimed that meniscus transplants are under more stress in a joint with early degenerative processes, consequently a conservative rehabilitation protocol results more appropriate49. Acl reconstruction, pcl reconstruction, chondroplasty precautions. The primary goal of this protocol is to protect the reconstruction while steadily progressing towards and ultimately achieving pre. This meniscus repair reconstruction protocol is criterion based. Jan 16, 2017 so if were going to talk 90s protocols, take a look at these studies from way back when from shelbourne and barber that showed excellent results in patients undergoing a combined aclmeniscus repair procedure and utilizing no limitations in weightbearing or range of motion, similar to a protocol for an isolated acl reconstruction. Do not do resisted long or short arc quads, to avoid adversely stressing the graft. Acl reconstruction with meniscal repair rehabilitation protocol.
Basic acl protocol but no passive range of motion prom greater than 90 degrees for four. Formal physical therapy will be ordered by your orthopedic surgeon in the form of a written prescription upon discharge from surgery. Lie on your back with a rolled up towel under your heel or sit in a chair with the heel on a stool as shown in the figure. Define the protocol to be followed for all patients referred from northwestern. Manske claimed that meniscus transplants are under more stress in a joint with early degenerative processes, consequently a conservative rehabilitation protocol results more appropriate49. Acl reconstruction with patellar tendon autograft and. 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. Hospital has accepted this protocol as our standard protocol for the management of patients sp meniscal repair.
Even if an exercise or activity is listed at a particular time frame, some patients may not be ready to perform it. Knee immobilizer used for four weeks, ted hose to be worn until. In order for the meniscus repair to heal, the tear must be near this outer edge in an area of good blood supply nutrients from the blood vessels are necessary for healingthis is the socalled red vascularwhite nonvascular region of the meniscus. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. Acl reconstruction w meniscus repair mizzou sports doc. Brace knee immobilizer used for four weeks, ted hose to be worn until ambulation has returned to normal presurgery level or two weeks. Acl reconstruction with meniscus repair protocol kansas joint. Ramappas postoperative instructions meniscal repair sports medicine beth israel deaconess medical center 6176673940 physical therapy. Arthroscopic meniscal repair rehabilitation protocol i goals 1 manage inflammation iceman, nsaids, etc. Manual stretching for extension with overpressure or recurvatum. Right left knee medial lateral meniscal repair phase i 08 wks. This protocol was designed to provide the rehabilitation professional with a guideline of postoperative care. 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. It should be stressed that this is only a protocol and should not.
Re 17 chris ales m 7 rtho ln rownsbur i 6112 317263632 rthoindcom acl reconstruction with meniscal repair rehabilitation protocol basic acl protocol but no passive range of motion prom greater than 90 degrees for four weeks. No loaded knee flexion beyond 450 for 4 weeks no loaded knee flexion beyond 900 for 8 weeks. Focus on static double leg activation of gluteus mediusmaximus, normal stair climbing functional criteria full rom multiplanar le and core strength 55 with mmt subjective report of completing clam shell with blue band for 60 seconds 5x on right and. Partial weightbearing status mar 23, 2012 the goal of a meniscus repair is to allow the torn edges of the meniscus to heal once they have been fixated with sutures. Throughout this protocol, time references in weeks since surgery represent the earliest that a patient may. Meniscal repair postoperative rehabilitation protocol orthoindy. Tears are noted by how they look, as well as where the tear occurs in the meniscus. Rehabilitation guidelines for meniscal repair of root and. This rehabilitation protocol was developed for patients who have isolated meniscal repairs. Common tears include longitudinal, parrotbeak, flap, bucket handle, and mixedcomplex. Microsoft word meniscus repair rehabilitation protocol.
Modifications to the protocol may be necessary dependent on location of. 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. Brace six weeks, locked in extension while ambulating for 6 weeks. Rehabilitation guidelines for meniscal repair there are two types of cartilage in the knee, articular cartilage and meniscus cartilage. Microsoft word arthroscopic meniscal repair protocol. Rehabilitation guidelines for meniscal repair of root and complex tears there are two types of cartilage in the knee. If the knee will not straighten fully, you can place a weight 2 to 5 pounds on the thigh, just above the kneecap.
Rehabilitation guidelines for meniscal repair uw health. It is designed for rehabilitation following arthroscopic repair of a complex meniscal tear. These tears will typically be repaired in younger, active patients. It is advised to avoid returning to resisted knee extension exercises. It is not intended to serve as a substitute for clinical decision making. Acl reconstruction with meniscal repair this protocol provides guidelines for the rehabilitation for an acl reconstruction with a concordant meniscus repair. Meniscus repair rehabilitation protocol weight bearing range of motion bracesling therapeutic excercise phase 1 04 weeks 48 weeks 06 wks. Acl reconstruction with meniscal repair rehabilitation. The latter phases are adaptable based on the individual patients and special circumstances. Patients are not allowed to return to more aggressive physical activities. The most important factor in determining repairability is the location of the tear, as tears in the vascular periphery of the meniscus can produce a healing response.
Each plan of care should be individualized for each patient. Articular cartilage is made up of collagen, proteoglycans and water which lines the end of the bones that meet to form a joint. It is designed for rehabilitation following arthroscopic meniscal repair. Meniscal repair protocol this will delay the protocol for aclr 1. Nl rom with return to adls work sport nl strength and proprioception nwb status per md, see below post op restrictions return to sports 1012 weeks control pain and swelling. Meniscal repair protocol1 northwestern medical center. Meniscus repair guidelines vanderbilt university medical. The decision by the surgeon to repair or remove is based primarily on the location of the meniscal tear.
Articular cartilage is made up of collagen, proteoglycans and water and lines the end of the bones that meet to form a joint. Discontinue crutches and brace when gait in nonantalgic about 6 weeks post op and patient has adequate quad control. Isolated meniscus repair postop rehab protocol paragon. Rehabilitation protocol for meniscus repair this protocol is intended to guide clinicians and patients through the postoperative course for a meniscus repair. However, the large hematoma produced during the acl surgery is considered beneficial to the healing of the meniscal repair and some. Longleg postoperative c, a, t c, a, t c, t range of motion minimum goals 090 0120 05 x x x weightbearing toe touch to 50% body weight 75% to 100% body weight toe touch to 25% body weight.
Tibial plateau fractures with and without meniscus tear. This protocol should be used with combined a acl reconstruction and meniscus repair the intent of this protocol is to provide guidelines for progression of rehabilitation. Acl reconstruction with meniscus repair adopted mar1998, revised jan2017 1 general principles. 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. Gentle strengthening protecting the healing meniscus.
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