Free rehabilitation is safe after isolated meniscus repair: a prospective randomized trial comparing free with restricted rehabilitation regimens
Lind M, Neilsen T, Fauno P, Lund B, and Christansen SE. Am J Sports Med. 2013; (41) 12, 2753-2758.
Take Home Message: Following an isolated meniscal repair, it may be safe to permit patients to have early weight-bearing and less range of motion restrictions compared with more traditional restricted rehabilitation programs.
The rehabilitation that follows a meniscal repair is important because it can influence the structural integrity of the meniscus, which is particularly relevant because a healthy meniscus is crucial for the long-term health of a knee. Unfortunately, we still need to identify an optimal post-meniscal repair rehabilitation protocol that could expedite return to play while protecting the meniscus and promoting the long-term health of a knee. Therefore, Lind and colleagues completed a randomized controlled trial to investigate the outcome of an isolated meniscal repair followed by either a free or restricted rehabilitation program. The authors recruited a total of 60 young adults (19 female, 41 male, 18 to 50 years old), screened them for inclusion/exclusion criteria, and randomly assigned them to either a free or restricted rehabilitation group (32 free, 28 restricted). All of the participants presented with a repairable meniscal lesion and were excluded if they: (1) had a concomitant injury, (2) had previous meniscal or ligaments repair, or (3) expected an inability to follow the proposed rehabilitation protocol. The free rehabilitation group had limited knee flexion (0-90 degrees), did not wear a brace, and was permitted to be weight-bearing during the first two weeks. After the first two weeks, the free rehabilitation group had no restrictions. Conversely, participants in the restricted group were non-weight-bearing and limited to 30 degree of flexion during the first two weeks. At 3-4 weeks post-surgery the restricted participants were limited to 60 degree flexion and touch weight-bearing. Then during the next two weeks the restricted rehabilitation participants were limited to 60 degree of flexion but had no weight-bearing limitations. Patients in the free and restricted rehabilitation groups could return to running at 8 and 12 weeks; respectively. The participants attended follow-up evaluations at 3 months, 1 year, and 2 years post-surgery. Patient-reported outcomes included Knee Osteoarthritis Outcome Score (KOOS), Tegner function score, and joint line pain. The authors also assessed two objective outcomes: 1) failure of the meniscal repair (evaluated by arthroscopy) and 2) range of motion. Overall, there was no significant difference between the failure rates between the 2 groups at 1 or 2 year post-surgery. Further, there was no difference between the 2 groups at either time point for the KOOS or Tegner activity score.
Overall, this study suggests that less restrictive rehabilitation following an isolated meniscal repair does not have a detrimental effect on tissue healing, and does not impact patient-reported outcomes compared with more restrictive rehabilitation. These results may be of interest to clinicians as expedited weight-bearing, returning to full range of motion, and running may not be detrimental to the repaired meniscus. This in turn may then be beneficial to the patient because it will help him/her maintain muscle strength and endurance. While these results are encouraging they are only a step towards identifying a gold standard rehabilitation program following meniscal repair. The current study did not report the inclusion of any therapeutic exercises which could have an effect on further maintaining muscle tone. Furthermore, to increase applicability to clinicians, future research should look to include patients with concomitant injuries as this is a frequent occurrence. Ultimately, the data presented in the present study indicates that earlier weight-bearing and larger ranges of motion following an isolated meniscal repair may be safe for our patients.
Questions for Discussion: What restrictions do you place on your patients after an isolated meniscal repair? What therapeutic exercises or modalities do you use to treat patients after a meniscal repair?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
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