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The goal of this protocol is to provide a clinical guideline for the post-surgical course of physical therapy for a patient who has had a knee meniscal repair surgery. This is not intended to substitute clinical decision making regarding the patient’s proper progression based on evaluation findings, individual progress, and if/when post-operative complications arise. If a clinician requires assistance in the progression of a post-surgical patient the surgeon should be consulted.
GENERAL GUIDELINES:
- Partial weight-bearing (PWB) status (<50%) or Non-Weightbearing (NWB) per MD orders.
- Walk with crutches. 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 high impact or cutting / twisting activities for at least 6 months post-op.
- No resisted lateral movement for 12 weeks.
- 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.
- Pass VTFC Knee Functional Performance Test 1 at 3 months
- Pass VTFC Knee Functional Performance Test 2 at 6 months
- Return to work as directed by PT/MD based on work demands
Rehabilitation Progression
PHASE I: Week 0 – 4:
Goals:
- Protect meniscus and minimize effects of immobilization
- Decrease pain, promote an optimal healing environment, and control inflammation/swelling.
- Re-establish quadriceps control
- Full passive and active knee extension/hyperextension range of motion.
- Avoid hyperextension greater than 10 degrees.
- Week 1: Passive range of motion 0-70 degrees. Week 2-4: Passive range of motion 0-90 degrees.
- Gait: Partial-weight bearing (<50%) with brace locked in extension. Crutches used with gait.
- Educate patient on rehabilitation progression.
- Keep knee straight when sitting or lying down. Do not place a towel behind knee.
- Do not actively bend your knee; support surgical leg with transfers.
- Do not pivot on your surgical leg.
Brace:
- Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks post-op.
Weight Bearing Status:
- Non-weightbearing or partial weightbearing status (<50%), unless otherwise ordered by MD. Walk with crutches. Heel lift in opposite shoe to normalize gait.
Exercises:
- Game Ready / Ice and elevation every 2 hours for 15-20 min each session.
- Soft tissue treatments for edema/pain control and to posterior musculature, ITB, add, quad, calf.
- No direct palpation of surgical portals x 4 weeks.
- Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/ gluteal sets, ankle pumps.
- NMES supine knee extensions
- 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).
PHASE II: Weeks 4-8:
Criteria to advance to Phase II:
- Full extension
- Good quad set, SLR, without extension lag
- Flexion to 90°
- Minimal swelling/inflammation
- Normal gait on level surfaces
Goals:
- Gait- unlock brace; wean off brace and crutches. Emphasize proper gait mechanics.
- Passive range of motion 0-120 degrees.
Brace/Weight Bearing Status:
- Wean off the use of rehab brace.
Exercises:
- Stretching, exercises and manual treatments to improve range of motion (especially flexion).
- Initiate surgical portal scar mobilization if portals are completely closed.
- Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, proprioception).
- Stationary bike low cadence, low resistance.
- Aquatic Treadmill: Slow walking on treadmill for gait training
Phase III: Week 6 to 12:
Criteria to advance to Phase III:
- No patellofemoral pain
- Minimum of 90° of flexion
- Sufficient strength and proprioception to prepare for higher-level closed chain exercises(aquatic treadmill)
- Minimal swelling/inflammation
Exercises:
- Complete VTFC Knee Functional Performance Test 1
- Continue with soft tissue, joint mobilizations, as needed for ROM, decrease pain, muscle guarding.
- 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.
- 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.
- Week 8: Passive range of motion 0-135 degrees.
- Tolerate 90/90 squat.
- Week 12: Full range of motion.
- Initiate lateral training with no resistance.
Phase IV: Week 12 to 16:
Criteria for advancement to Phase IV:
- Gait- no limp present, good mechanics.
- Full range of motion.
Goals:
- Prepare for VTFC Knee Functional Performance Test 1 at 3 months post-surgery
- Complete and Pass VTFC Knee Functional Performance Test 1
- Return to sports clearance.
Exercises:
- Low-impact activities until 16 weeks.
- Increase the intensity of strength and functional training for gradual return to activities.
- Initiate resisted lateral training.