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Meniscus transplant rehab protocol

General considerations

  • Partial weight bearing for 4 weeks. Initiate at 10-20% for weeks 1-2, then progress up to 50% for weeks 3-4. Walk with crutches and a brace locked in extension. Consider a heel lift in opposite shoe to normalize gait.
  • Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks post-op.
  • Regular assessment of gait to avoid compensatory patterns.
  • Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis.
  • No direct palpation to surgical portals x 4 weeks. Consider the edge of the bandages as the “no touch zone” (approximately 2 inches in all directions). See wound care protocol for full details.
  • No resisted leg extension machines (isotonic or isokinetic).
  • No high impact or cutting / twisting activities for at least 6 months post-op.
  • No resisted lateral movement for 12 weeks.
  • M.D./nurse follow-up visits at Day 2, Day 14, 1 month, 3 months, 6 months, and 1 year post-op.
  • During the first 4 weeks: TWICE PER DAY: Without brace, allow GRAVITY ONLY (passive only) to bend knee back as tolerated BUT NO MORE THAN 90 DEGREES for a good knee stretch without increase in pain. Relax knee and stretch for 60 seconds.
  • DO NOT FORCE FLEXION >120 DEGREES FOR THE FIRST 6 MONTHS AFTER SURGERY

Week 1

  • Nurse visit day 2 post-op to change dressing and review home program.
  • Ice and elevation every 2 hours for 15-20 min each session.

Manual

  • Soft tissue treatments for edema / pain control and to posterior musculature, ITB, add, quad, calf. No direct palpation of surgical portals x 4 weeks.

Exercise

  • Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/ gluteal sets, ankle pumps.
  • Well-leg stationary cycling, upper body ergometer for cardio. Add upper body and core conditioning.
  • Daily edge of bed dangle for passive knee flexion (allow knee to hang in pain-free range with light stretch).

Goals

  • Decrease pain/edema.
  • Passive range of motion <90 degrees to avoid pulling on sutures.
  • Gait-partial weight bearing with brace locked in extension.

Weeks 2 - 4

  • Nurse visit at day 14 for suture removal and check-up.

Manual

  • Continue with soft tissue treatment for edema/pain, posterior musculature, iliotibial band, adductor, quadriceps, calf.

Exercises

  • Continue with previous, manual resisted exercises (i.e. PNF patterns) of the foot, ankle and hip. Trunk stabilization program, three limb plank. Single leg balance and proprioceptive exercises.
  • Aerobic exercises (i.e. unilateral cycling, upper body ergometer, Schwinn Air-Dyne with uninvolved leg and arms only, well body bike, single leg row machine).

Goals

  • Decrease pain/edema.
  • Passive range of motion 0-90 degrees.
  • Gait- partial weight bearing with brace locked in extension.

Weeks 4 - 6

  • M.D. visit at 4 weeks post-op, will wean off the use of rehab brace.

Manual

  • Stretching, exercises and manual treatments to improve range of motion (especially flexion). Initiate surgical portal scar mobilization if portals are completely closed.

Exercises

  • Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, proprioception).
  • Stationary bike low cadence, low resistance.
  • Slow walking on treadmill for gait training (preferably a low-impact treadmill).

Goals

  • Gait- unlock brace; wean off brace- increased gait mechanics.
  • Active range of motion 0-115 degrees.

Weeks 6 - 8

Manual

  • Continue as needed for ROM, decrease pain, muscle guarding.

Exercises

  • Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exercises., Shuttle/leg press). Do not overload closed or open-chain exercises.

Goals

  • Gait- no limp present, good mechanics.
  • Active range of motion 0-<120 degrees.
  • Tolerate 90/90 squat.

Weeks 8 - 12

Manual

  • Continue with soft tissue, joint mobilizations as needed.

Exercises

  • Add lateral training exercises (side-step ups, lateral stepping).
  • Introduce more progressive closed chain and agility leg exercises.
  • Patients should be pursuing a home program with emphasis on sport/activity-specific training.
  • Consider road cycling in saddle.

Goals

  • Active Range of Motion approx 120 degrees flexion (do NOT force flexion >120 degrees as per MD).
  • Initiate lateral training with no resistance.

Weeks 12 - 16

  • Complete 3 month sports test and initiate return to running program.
  • Increase intensity of low-impact cardio including bike, swimming, elliptical, etc.
  • Increase the intensity of strength and functional training for gradual return to activities.
  • Initiate resisted lateral training (theraband resisted side-stepping).

Goals

  • Complete and pass Sports Test.
  • No high impact activities for 1 year unless cleared by MD.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

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