Rehabilitation Guidelines for Meniscal Repair of Root and Complex Tears

Article Review by Evan Peterson PT, DPT

Knee Structure

The knee joint is composed of several parts. It contains bone, ligament, tendon, joint capsule, and different types of cartilage. The knee contains 2 distinct cartilages: articular and meniscus. Articular cartilage is at the ends of bones which come together to form the joint. The job of the articular cartilage is to provide a smooth surface that allows for proper gliding on the joint surfaces against one another. The meniscus cartilage on the other hand is designed to help decrease the load placed through the knee joint itself. The meniscus is horse shoe shaped and is comprised of a medial and lateral end. Because the femur and the tibia are both rounded, the meniscus is needed in order to spread out contact forces. This allows for improved shock absorption and knee stability. The menisci are composed of an anterior and a posterior which are attached to the tibia by strong roots. The roots help to provide increased knee stability and decrease amount of tibial rotation. These functions are important to protect the articular cartilage.

Meniscal Tears

A meniscal tear can be either acute traumatic or degenerative. An acute traumatic tear typically occurs in the athletic population and is caused by knee twisting with a planted foot. Degenerative tears are more commonly in middle aged people both male and female. The symptoms of an acute tear are swelling, pain along the knee joint line, and locking or catching.

Root Tear Rehab Options for the Athlete

One option the athlete has is to attempt rehabilitation without surgery. Another option is for the surgeon to trim out a portion of the torn meniscus. The last option is for the surgeon to repair the meniscus. Whenever it is possible, the surgeon will prefer to repair the meniscal root of an athlete, which is based upon the desire to limit future knee arthritis. After meniscal surgery, it is recommended to attend physical therapy in order to address knee range of motion, strength, and neuromuscular knee control. The therapist can also assist in guiding the patient back to performing normal sport activities. After a meniscus root repair, there is a prolonged period of non-weightbearing and restricted range of motion to allow proper healing.

Phase I of Rehab: Surgery until 8 weeks

• Typically begins 3-5 days after surgery
• Precautions
  • Toe touch weight bearing with brace
  • Gradually unlock brace for 6 weeks; after 6 weeks no brace
• Goal to restore range of motion from 0-90 degrees, decrease leg swelling, and restore control
• Perform
  • Knee extension on bolster, prone hangs, quadricep sets, hamstring sets, straight leg raises, heel slides to 90 degrees
• Progression to next phase
  • 8-10 weeks after surgery, pain free gait (no crutches), no swelling

Phase II of Rehab: 8 weeks post-surgery

• Goals are to improve single leg control, normalize gait, and improve functional control
• Precautions
  • No forced knee flexion past 60 degrees, no impact activities
• Perform
  • Hip and core exercises, stationary bike tasks, and balance or proprioceptive drills
• To Progress
  • Normal gait on all surfaces, functional tasks without unloading affected leg, and single limb stance greater than 15 seconds

Phase III of Rehab: Typically 12-16 weeks post-surgery

• Goals are good control while performing sport and work specific movements with impact
• Precautions
  • Avoid excessive post exercise swelling or posterior knee pain with flexion
• Perform
  • Low velocity agility drills, closed chain progressive strengthening including unilateral tasks, begin low amplitude landing drills to prevent excess frontal plane trunk lean and reduce hip adduction during stance

Phase IV of Rehab: 20-24 weeks post-surgery

• Goals
  • Normal multi planar motion performed at high velocities without compensation
  • Typical double leg landing mechanics
  • Demonstration of adherence and understanding of HEP
• Perform
  • Progressive agility drills with increased velocity from the last phase
  • Perform higher amplitude landing drills both bilateral and unilateral
  • Reactive drills including cutting and pivoting
  • Sport and work specific proprioceptive/ balance exercises
  • Continue core and hip strengthening exercises.
  • Progressive running program
• Returning to Sport/Work
  • The patient must be cleared by orthopedic surgeon as well as the therapist/athletic trainer.
  • The patient should be with a 15% deficit when performing all testing such as strength testing, hop tests, and force plate jumping.

Physical Therapy First

At Physical Therapy First, we have skilled therapists who are equipped to guide a patient through their recovery from a meniscal surgery. We take the time to examine the patient and help them to achieve their functional, recreational, and work-related goals. Please do not hesitate to reach out to us if you recently underwent or plan on having meniscal surgery.

Reference:

Rehabilitation Guidelines for Meniscal Repair of Root and Complex Tears – UW health. https://www.uwhealth.org/files/uwhealth/docs/pdf/Meniscus_Root_Rehab_final.pdf. Accessed February 10, 2022.