| Note on research and authorship The primary focus of rehabilitation following a meniscectomy or meniscus repair is to control pain and restore function. The rehabilitation program will be dependent on the surgical procedure and the protocol of the treating physician.
The first goal of rehabilitation is independent ambulation. Gait training with an assistive device may be necessary, with weight bearing as indicated by the physician. If, at the beginning, pain is an issue, modalities such as heat and cold may be used. After the early post operative period, it is common to begin physical therapy with a heat treatment in order to relax the tissues around the knee and to conclude with a cold treatment in order to control the pain and swelling that may follow exercise. The physician will determine use of compressive wraps or devices.
The next goal is to restore motion and strength to the involved knee. No clear evidence exists regarding the ideal rehabilitation exercise protocol, and the following recommendations are based on common clinical practice (Kohn).
Exercise may be progressed based on the recommendations of the physician. If a meniscal repair has been performed, extreme flexion and rotation should be limited until the wound in the meniscus has had time to heal (8 to 12 weeks). It may be necessary to strengthen the adjacent joints if limited weight bearing was necessary pre- or post-operatively. Knee range of motion exercises can help to restore full mobility to the joint. Therapy should progress to strengthening exercises as tolerated, and it should include flexibility exercises throughout the period of strengthening. While strong muscles around the joint are critical, flexibility of the same muscle groups must be considered. It is important to emphasize closed chain exercises, in which the foot is stabilized, as well as open chain exercises, in which the foot is free to move, when appropriate (Witvrouw). Therapy may continue to include the use modalities as needed to control pain and swelling. Individuals can be instructed in a home exercise program to be performed independently to complement the supervised exercise regimen.
When full, pain-free motion is regained and the individual has sufficient strength for all activities of daily living, the individual may be progressed to balance and proprioceptive exercises. The physician, individual, and physical therapist will determine the extent of these exercises.
Before discharge from physical therapy, individuals should understand both the need for continued exercise to maintain the stability of the knee joint and ways to protect the joint during work and leisure activities. Although a meniscus can heal within approximately 12 weeks, the joint may still need to be protected from heavy loading until the meniscus has regained its full strength. If a meniscectomy were performed, the degree of knee loading during work and leisure activities must be considered and discussed with the physician prior to return to work.
Additional information may provide insight into the rehabilitation needs of these individuals (Thomson). |
| FREQUENCY OF REHABILITATION VISITS | | Surgical (Meniscectomy) | |
| Physical Therapist | | Up to 12 visits within 6 weeks | | | | | | | | Surgical (Meniscus Repair) ‡ | |
| Physical Therapist | | Up to 24 visits within 12 weeks | |
|
| ‡ Note on Surgical (Meniscus Repair) Guidelines: In a meniscal repair it can take the tissue up to 4 months to heal, and the final exercises cannot be started until the tissues are healed. Individuals can likely return to certain work before full healing has occurred but may need continued rehabilitation. |
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor