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Tears of Meniscus Rehabilitation

Rehabilitation programs for patients with meniscus tears are highly individualized. A physical therapist can select a traditional

conservative rehabilitation protocol or an accelerated program. Barber’s research in 1994 reported that healing rates are the same between the two approaches. Factors that influence considerations for an appropriate rehabilitation program include the patient pre-injury status, patient’s expectation and tolerance for activity modification.

Other important factors are the types of treatment received (non-operative, meniscectomy, meniscal transplantation or implantation), the types and locations of tears, evaluation of patient current joint condition, age, etc.

Rehabilitation for non-operative treatment:

For patients with non-operative treatment, rehabilitation program is designed to reduce symptoms of pain and swelling at the affected joint. This type of rehabilitation focuses on maintenance of full range of motion and functional progression without aggravating the symptoms Physical therapists can utilize modalities such as electric stimulation (Figure 1), cold therapy and ultrasonography, etc.

Rehabilitation for operative treatment

For patients who underwent operative treatments such as meniscal repair, or recent advanced transplantation and implantation, a more conservative rehabilitation regimen is recommended for successful healing . Although the rehabilitation program is highly individualized, a general protocol can be derived. It consists of 3 main phases before the patients can come back to their desired normal activities and sports.

Phase 1: the initial first 4 to 6 weeks immediately after surgery treatment.

Balance exercises on a foam surface in phase 2. The patient tries to maintain balance first with both legs, then with only the affected leg.

The rehabilitation strategies in this phase involve using a passive continuous motion machine during the first 5 days following the surgery. Prolonged period of immobilization can lead to muscular atrophy and delay functional recovery During the 4-6 weeks post-surgical, they recommend active and passive non-weight bearing motions which flex the knee up to 90ᵒ. If any weight-bearing exercises are applied, a controlled brace should be worn on the knee to keep the knee at near (<10ᵒ) or full extension. Further knee flexion can damage the meniscal allograft because of the increased shear forces and stresses. Exercises such as stretching, straight leg raising, aquatic exercises (pool ambulation, swimming) are excellent in terms of reducing load stress and promoting range of motion.

Phase 2: the 6th to 14th week after surgery

The second phase is to focus on improving for full range of motion, restore normal gait. Also, muscular strengthening and neuromuscular training are emphasized using progressive weight bearing and balance exercises. Exercises in this phase includes increased knee flexion (>90ᵒ), stretching, squats, forward step up and down, stair master, standing on foam surface with one or two legs (Figure 2&3), etc.

Phase 3: the 14th to 22th after surgery

Forward step down exercise on an 8” step. This exercise improves quadriceps strength and control. It is introduced in phase 2 and continued in phase 3.

The third phase includes exercises for maximal strength and flexibility to meet the demands of the activities the patients desire to return to. Exercises in this phase improve limb symmetry, agility, and cardiovascular fitness. Examples are step exercise (Figure 4), hopping, squats, lunges, treadmill running, and sport/work specific movements, etc. This phase prepares patients to come back to full sport/work without restrictions.