Rehabilitation after meniscal repair.
Meniscal repair as an isolated procedure should be considered for patients who present with clinically symptomatic meniscal tears and who have large, unstable, peripheral, bucket-handle meniscal tears at arthroscopy. Successful repair relieves meniscal symptoms and allows the patient to return to full function. In the authors' study population, patients with adequate repair of the meniscal tears followed a rehabilitation program that allowed immediate ROM and weight bearing as tolerated. They achieved a clinical result comparable to patients who followed a restrictive rehabilitation program. By using a less restrictive rehabilitation program, surgeons may offer patients who require meniscal repairs a program with a shorter interval between the surgical procedure and full return to the activities of daily living and athletics than was offered by previous regimens. From the evidence obtained from the study population using the authors' selection criteria and surgical technique, the accelerated rehabilitation program does not compromise the clinical result. The follow-up period is too short to determine if repair will be successful in protecting the knee joint from the known degenerative changes that follow meniscectomy. It is certain, however, that surgical repair that preserves meniscal tissue can relieve symptoms and allow patients to return to activities at their own pace. Many questions remain to be answered, all of which need to be addressed in the future: What is the natural history of an untreated meniscal tear in an ACL-stable and in an ACL-injured knee? Is suturing necessary for meniscal tears? If so, what type of suturing technique should be used? Is some type of meniscal abrasion or stimulation of the meniscal tear needed to obtain healing? What is the likelihood of a healed, repaired meniscus to retear in the future, even if the initial repair has been successful, especially on the medial side? At present, there is no universal agreement as to what rehabilitation protocol is best. For the past 8 years, the authors have undertaken an accelerated rehabilitation program following isolated meniscal repairs and also following repairs performed in conjunction with ACL reconstructions. With constant patient evaluation and follow-up, clinically successful results have been achieved. A well-designed, prospective, multicenter study of isolated meniscal repair comparing different rehabilitation protocols is desirable to resolve the existing controversial issue of rehabilitation after meniscal repair.
Shelbourne
K D
KD
Methodist Sports Medicine Center, Indianapolis, Indiana, USA.
Patel
D V
DV
Adsit
W S
WS
Porter
D A
DA
D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D004724:Endoscopy / Q000379:methods; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation*; D008592:Menisci, Tibial / Q000601:surgery*; D026741:Physical Therapy Modalities; D013536:Suture Techniques; D000070600:Tibial Meniscus Injuries