Rehabilitation and return to sports after isolated meniscal repairs: a new evidence-based protocol

Abstract

Purpose Despite many protocols that have been proposed, there’s no consensus in the literature regarding the optimal rehabilitation program and return to sports (RTS) protocol following isolated meniscal repair. The aim of this current concept review is to look at the evidence of rehabilitation and RTS program after isolated meniscal repair, focusing on general and specific protocols per type of injury trying to give some guidelines based on the current state of knowledge. Methods A narrative literature review was performed searching PubMed database to identify relevant articles from January 1985 to October 2021 on rehabilitation and RTS after isolated meniscal repair. Randomized controlled trials (RCTs), prospective and retrospective cohort studies, case series, systematic reviews, meta-analyses, cadaveric studies and basic science studies were included. Results When the hoop tensile stress effect is preserved, an accelerated rehabilitation program may be suggested. Hence, partial weight bearing (20 kg) in association with ROM limited to 90° is allowed for the first four weeks, followed by weight bearing as tolerated. In contrast, when circumferential hoop fibers are disrupted, a restricted rehabilitation protocol may be recommended. In this scenario no weight bearing is allowed for the first six weeks after the surgery and range of motion (ROM) is limited to 90°. Conclusion Biomechanical evidence suggests that tailoring an individualized protocol based upon the type of lesion and meniscus stability is reasonable. Level of evidence Level V.

Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine

“…Taken in aggregate, recent systematic reviews have recommended employing accelerated rehabilitation protocols for tears with preserved hoop tensile stress. 9 , 27 , 33 , 41 The results of these studies are reflected in this survey of AOSSM members, a majority of whom allow immediate PWB and 90° of flexion postoperatively for tears with preserved hoop integrity. Both of these statements reached a consensus in this study.…”

“…Taken in aggregate, recent systematic reviews have recommended employing accelerated rehabilitation protocols for tears with preserved hoop tensile stress. 9,27,33,41 The results of these studies are reflected in this survey of AOSSM members, a majority of whom However, in tears with loss of hoop tensile stress, including radial and root tears, there remains concerns with accelerated protocols, particularly early weightbearing. Studies have demonstrated excellent outcomes in these tears with restricted protocols.…”

The Effect of Stem Cells on Meniscus Tear Injuries

“…A surgeon must regard the athlete and team training staff when it comes to the meniscal surgery outcomes and recovery. 7 to 9 weeks for meniscectomy and 5.6 months for a full repair of the meniscus are the typical number of times that an athlete has to sit out before they can return to play [1,27,30]. meniscectomy.…”

“…The psychological and mental status of the athlete also needs to be considered before they can RTP. The athlete must demonstrate usual running biomechanics and constant control of their neuromuscular system when participating in dynamic sport-specific activities before they can come back to play [1,9,13,16,27,28,32,34].…”

Aktuelles Vorgehen in der Nachbehandlung gelenkerhaltender Operationen am Kniegelenk im deutschsprachigen Raum

“…Auch ein gezieltes Vorbereiten auf die Operation im Rahmen einer Prähabilitation kann eine schnellere Rehabilitation bedeuten und Muskelatrophien verhindern [9]. Durch die Verwendung von Hartrahmenorthesen kann der Bewegungsradius begrenzt und ein muskuläres Defizit kompensiert werden, wo-bei klare Empfehlungen zu deren routinemäßiger Verwendung fehlen [9,13,14]. Sinnvoll ergänzt werden kann die physiotherapeutische Behandlung auch durch digitale Gesundheitsanwendungen (DIGA).…”