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MENISCUS REPAIR

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The medial meniscus is more frequently injured than the lateral meniscus. Insult may occur when the foot is fixed on the ground and the femur is internally rotated, as when pivoting, getting out of a car etc. Lateral rotation of femur on fixed tibia may tear the lateral meniscus. Simple squatting or trauma may also cause a tear.

 

IMPAIRMENTS

BODY STRUCTURES​

1. Meniscus tear due to trauma

2. Locking of the knee

3. Break in the continuity of skin due to incision

4. Debridement of unstable tissue fragments

5. Fixed flexion deformity

 

BODY FUNCTIONS

1. Pain

2. Swelling

3. Tenderness

4. Reduced ROM of knee joint

5. Springy end feel

6. Difficulty in weight bearing on involved side

7. Reduced muscle strength

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GOALS

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  • Short term 

1. Patient and family education

2. Ergonomic advice

3. Reduce pain

4. Reduce swelling

5. Improve knee range of motion

6. Improve strength and endurance of knee musculature

7. Gait training

8. Prevent secondary complications

9. Achieve functional activities

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  • Long term

  1. Maintain knee range of motion

  2. Maintain strength and endurance of knee musculature

  3. Improve neuromuscular control/responses, proprioception and balance.

  4. Improve cardiopulmonary fitness

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MANAGEMENT

 

It is divided into 3 phases:
Maximum protection phase
Moderate protection phase
Minimum protection phase

 

MAXIMUM PROTECTION: 1-6 weeks

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Stage 1: Immediate postoperative Day 1- Week 3

  • Ice, compression, elevation.

  • Electrical muscle stimulation

  • Brace locked at 0 degrees.

  • ROM 0-90 degrees.

  • Patellar mobilization

  • Scar tissue mobilization

  • Passive ROM.

  • Exercises- quadriceps and hamstring isometrics, hip abduction & adduction.

  • Proprioceptive training.

 

Stage 2 Weeks 4-6

  • Progressive resistance exercises (PREs)

  • Knee extension within limits

  • Toe raises

  • Mini-squats

  • Cycling

  • Flexibility exercises

 

MODERATE PROTECTION PHASE : 6-10 weeks

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GOALS

  1. -Increase strength, power and endurance.

  2. -Normalize knee ROM.

  3. -Prepare patient for advanced exercises.

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Exercises

  • PRE progression

  • Flexibility exercises

  • Lateral step-ups

  • Mini squats

  • Isokinetic exercises

 

Endurance program

  • Swimming

  • Cycling

  • Stair machine

  • Pool running

 

Co-ordination program

  • Balance boards

  • Backward walking

 

MINIMUM PROTECTION PHASE: beyond 10 weeks

 

GOALS

  1. Increase power and endurance

  2. Emphasize return to skill activities

  3. Prepare for return to full unrestricted activities

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Exercises

  • Continue all exercises

  • Plyometrics

  • Initiate running program

 

Return to activity : Criteria

  • Full, non-painful ROM

  • Satisfactory clinical examination

  • Satisfactory isokinetic test.

 

REFERENCES

Carolyn kisner, Lynn Allen Colby, Terapeutic Exercise Foundations and Techniques, 6th edition.

S. Brent Brotzman, Kelvin E. Wilk, Clinical orthopaedicRehabilitaion , 2nd edition.

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