Free rehabilitation is safe after isolated meniscus repair: a
prospective randomized trial comparing free with restricted rehabilitation

Lind M, Neilsen T, Fauno P,
Lund B, and Christansen SE. Am J Sports Med. 2013; (41) 12, 2753-2758.

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

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

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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Lind M, Nielsen T, Faunø P, Lund B, & Christiansen SE (2013). Free rehabilitation is safe after isolated meniscus repair: a prospective randomized trial comparing free with restricted rehabilitation regimens. The American Journal of Sports Medicine, 41 (12), 2753-8 PMID: 24114748