Rehabilitation after Repair of Medial Meniscus Posterior Root Tears: A Systematic Review of the Literature

Abstract

Background There is no consensus established on postoperative rehabilitation after medial meniscus posterior root tear (MMPRT) repair, including when and how physicians can apply range of motion (ROM) exercise, weight-bearing (WB), brace use, and return to sports (RTS). The purpose of this study was to systematically review the literature on postoperative rehabilitation characteristics of MMPRT repair regarding ROM, WB, brace use, and RTS. Methods A literature search was performed using the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase databases. The inclusion criteria were English language, human clinical studies, and studies describing rehabilitation protocols after MMPRT repair such as ROM, WB, brace use, and RTS. Abstracts, case reports, cohort studies, controlled laboratory studies, human cadaveric or animal studies, systematic reviews, and meta-analyses were excluded. Results Thirteen studies were included. Of the 12 ROM studies, ROM was started immediately within 1 or 2 days after operation in 6 studies and after 2 to 3 weeks of knee immobilization in the rest. Of the 13 WB studies, partial weight-bearing was initiated 1 to 4 weeks after operation in 8 studies and 6 weeks in the rest. Of the 9 brace studies, patients were immobilized by a splint for 2 weeks in 3 studies, and in the rest, a brace with full extension was applied for 3 to 6 weeks after several days of splint application. Of the 7 RTS studies, RTS was allowed at 6 months in 6 studies and 5 to 7 months in 1 study. Conclusions This systematic review revealed conservative rehabilitation protocols were more widely adapted as ROM and WB were restricted at certain degrees during postoperative periods in most protocols analyzed. However, it is impossible to identify a consensus on rehabilitation protocols as the protocols analyzed in this review were distinct each other and heterogeneous. In the future, a well-designed comparative study among different rehabilitation protocols is essential to establish a consensus.

Marrow stimulation procedures for high‐grade cartilage lesions during surgical repair of medial meniscus root tear yielded suboptimal outcomes, whilst small lesions showed surgical eligibility

“…non‐operative treatment, high tibial osteotomy). The details of surgical procedures for MMRT and MSP (microfracture and microdrilling), as well as postoperative rehabilitation methods, are provided in Supplementary material 1 [19, 29, 31, 32].…”

Medial Meniscus Posterior Root Tear: How Far Have We Come and What Remains?

“…As in severe varus alignment of the lower extremities, a high BMI may adversely affect the repaired MMRT by increasing its load [ 75 ]. In addition, given the relatively low failure load of suture fixation and the limited healing rate of MMRTs [ 70 , 72 , 73 ], patients should comply with strict postoperative rehabilitation programs to obtain an optimal healing environment [ 76 ]. Furthermore, the preoperative symptom duration was found to affect surgical outcomes [ 38 ].…”

“…Therefore, well organized postoperative rehabilitation programs are required to provide an optimal healing environment for the repaired MMRT by minimizing the potential effects of harmful stimuli. There are no standardized rehabilitation protocols yet, but most consist of protective strategies, such as limited weight-bearing, range of motion exercises, and brace application [ 76 , 90 ]. The details of the protocols varied greatly among studies.…”

“…The details of the protocols varied greatly among studies. According to a systematic study by Kim et al, range of motion exercises were initiated immediately after surgery or two to three weeks after surgery, and partial weight-bearing was started from one to six weeks after surgery [ 76 ]. A knee brace or splint was applied in a fully extended position two to six weeks after surgery [ 76 ].…”

“…According to a systematic study by Kim et al, range of motion exercises were initiated immediately after surgery or two to three weeks after surgery, and partial weight-bearing was started from one to six weeks after surgery [ 76 ]. A knee brace or splint was applied in a fully extended position two to six weeks after surgery [ 76 ]. This was followed by progressive muscle-strengthening exercises, and a return to sports is usually allowed six months after surgery [ 76 , 90 ].…”