title: Free rehabilitation is safe after isolated meniscus repair: a prospective randomized trial comparing free with restricted rehabilitation regimens.
abstract: BACKGROUND
  The optimal rehabilitation program after meniscus repair has not been established. Numerous regimens have been suggested as beneficial for meniscus healing, but no controlled trials exist in the literature.
  
  
  OBJECTIVE
  The purpose of this prospective randomized trial was to investigate outcome with a free or a restricted rehabilitation regimen after isolated meniscus repair. The hypothesis was that free rehabilitation would result in increased failure of meniscus healing.
  
  
  METHODS
  Randomized controlled clinical trial; Level of evidence, 1.
  
  
  METHODS
  A total of 60 patients were included in this study within 2 to 3 days after meniscus repair. No patients with concomitant ligament reconstruction or cartilage repair surgery were included. Meniscus repair was performed with the all-inside technique; only vertical meniscus lesions close to the capsule were repaired. Patients were randomized to free (n = 32) or restricted (n = 28) rehabilitation. Free rehabilitation consisted of 2 weeks (range of motion [ROM], 0°-90°, no brace) and touch weightbearing, with unrestricted activity and free ROM allowed thereafter. Restricted rehabilitation consisted of 6 weeks of hinged brace use with a gradual increase ROM to 90° and only touch weightbearing during the 6 weeks. Patients were seen for follow-up at 3 months, 1 year, and 2 years. Those patients with joint line pain at the 3-month follow-up underwent MRI scanning to evaluate meniscus healing; a subsequent arthroscopy was performed for final evaluation meniscus healing if the MRI indicated lack of meniscus healing. At follow-up, the Knee Osteoarthritis Outcome Score (KOOS), Tegner function score, pain assessment, and patient satisfaction were used to evaluate outcomes.
  
  
  RESULTS
  Eleven patients were lost to follow-up. Repeat arthroscopy in patients with persistent symptoms demonstrated partial healing or lack of healing in 28% and 36% of patients in the free and the restricted rehabilitation groups, respectively (P = .53, nonsignificant). The KOOS and Tegner function scores were similar between groups at all follow-up times, as was patient satisfaction. Patients who underwent subsequent partial meniscectomy because of meniscus repair failure had lower KOOS score and Tegner function score than did patients without repair failure.
  
  
  CONCLUSIONS
  Free rehabilitation after meniscus repair is safe and does not entail increased failure rates compared with restricted rehabilitation. Subjective and functional outcomes at 1- and 2-year follow-up were not affected by rehabilitation regimen. Clinical outcomes in patients with repair failure who underwent subsequent partial meniscectomy were poorer than in those with healed meniscus repairs. A concern is the 30% overall lack of healing for patients with isolated meniscus lesions repaired with the all-inside technique.
authors.affiliation: Martin Lind, Division of Sports Trauma, Aarhus Sygehus, Tage Hansens Gade 2, DK 8000 Aarhus, Denmark. martinlind@dadlnet.dk.
authors.forename: Martin
authors.initials: M
authors.lastname: Lind
authors.forename: Torsten
authors.initials: T
authors.lastname: Nielsen
authors.forename: Peter
authors.initials: P
authors.lastname: Faunø
authors.forename: Bent
authors.initials: B
authors.lastname: Lund
authors.forename: Svend Erik
authors.initials: SE
authors.lastname: Christiansen
mesh_terms: D000293:Adolescent; D000328:Adult; D018771:Arthralgia / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods; D001915:Braces; D005260:Female; D050724:Fractures, Cartilage / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000209:etiology; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D016059:Range of Motion, Articular; D012421:Rupture / Q000601:surgery; D000070600:Tibial Meniscus Injuries; D016474:Weight-Bearing; D014945:Wound Healing; D055815:Young Adult
keywords: all-inside meniscus repair; meniscus repair; randomized clinical trial; rehabilitation