Rehab After Meniscus Repair Surgery

meniscus repair rehab
Physical therapy is an important part of meniscus repair rehab. Hero Images / Getty Images

Rehabilitation following a meniscus repair is more significant than if the torn piece of meniscus is simply removed through a procedure called a partial meniscectomy. If the torn meniscus is removed, the patient is usually up and walking within a day or two of surgery, and back to normal activities within several weeks. Following a meniscus repair, the rehab is more extensive.

Because your surgeon will not know with certainty if a meniscus repair can be performed prior to arthroscopic knee surgery, patients should understand that their rehabilitation will not be certain until the exact surgical procedure is known.

  Therefore, patients having meniscus surgery should be aware that rehab may be more extensive and restrictive if a meniscus repair is performed.

Exactly what rehabilitation is needed depends on several factors, and you should always check with your doctor prior to initiating or changing your post-operative rehab in any way. This is especially important because there are other procedures that may be performed at the same time as the meniscus repair that may alter the normal post-operative rehab schedule.

Typical Rehab Schedule

There is quite a lot of controversy in the sports medicine world as to "the best" rehabilitation from meniscus repair surgery. Traditionally, the rehab was very slow, with activities restricted for many months after surgery. More recently, a faster rehab has been attempted. However, there is still no consensus, and many surgeons vary in their recommendations. Always follow your doctor's specific instructions for post-operative rehab.

The most common rehab after meniscus repair is listed here. It is about 'middle of the road' between very conservative and very aggressive.

  • Immediately Post-Operative
    Upon awakening in the recovery room, patients are placed in a knee brace. The brace used may either be a knee immobilizer or a hinged knee brace. A knee immobilizer holds the knee fully extended, while a hinged knee brace can allow for controlled motion of the knee. If a hinged knee brace is used, it is locked with the knee fully straight.  Patients are given crutches, and instructed to walk with the crutches. Most often, patients will be allowed to place weight on the operated leg so long as the knee is held fully straight (either with a knee immobilizer or a hinged knee brace locked in extension).
  • The First Weeks
    Patients can remove the knee brace or immobilizer while not walking, and bend the knee. Your surgeon will typically restrict the amount you can bend your knee, since pressure on the meniscus increases as you bend your knee.  Often the brace will allow the knee to only bend a certain amount, such as 60 or 90 degrees, depending on your surgeon's recommendation.  Patients should continue to use a brace whenever walking, and only place weight on the leg if the knee is held fully straight by the brace.
  • The First Months
    After a month or so, emphasis is place on regaining more mobility. Patients can generally walk with the knee in the brace, but usually within 6 weeks the knee is allowed to bend while walking. Strenuous activities are still restricted as the meniscus continues to heal.
  • 3-4 Months
    By 3 to 4 months, most surgeons will allow return to full activities and no longer protect the knee. Patients must slowly return to sports and competition, but they no longer have restrictions on motion and do not require the use of a brace.

    As stated before, this is just an example of a possible rehab protocol after meniscus repair surgery. Many surgeons differ in their preference, and depending on other work that may have been done at the time of surgery the rehab can vary significantly. Some surgeons are pursuing a more aggressive rehab plan.  The reason for restrictions is that biomechanic studies demonstrate increased stress on the meniscus with bending (flexion) and twisting (rotation) of the knee.  However, it has not been clearly shown that these forces limit the healing of a repaired meniscus.  That said, most surgeons presume they can impact healing, and therefore have the aforementioned restrictions.  You should always follow your doctor's specific instructions, and if you have questions about your rehab ask your doctor's opinion.

    Sources:

    Laible C, et al. "Meniscal Repair" J Am Acad Orthop Surg April 2013 vol. 21 no. 4 204-213

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