Rehabilitation of Knee Ligament and Meniscus Injuries

Meniscus:

Surgical options:

Complete meniscectomy

Partial meniscectomy

Meniscal repair

Post-op rehab:

Partial meniscectomy: 4 phases, progression depends on pain, swelling,

> patient's response to treatment

***Early protection:***

Goals: minimize joint effusion, initiate strengthening program

Treatment: Quad sets, progress to SLR, WBAT c AD

Time: 5-7 days post-op

***Moderate protection:***

Goals: ROM, quad strengthening

Treatment: AD: d/c when normal gait pattern; cont. SLR, add cuff

> weights when no ext. lag; multiple plane leg raises;
>
> isometric quads at varying ROM; stationary cycling for
>
> ROM, strength, endurance; use ice for swelling or pain

Time: begins \~ 1 week post-op

***Early functional:***

Goals: cont. strengthening

Treatment: isotonic quads; involved leg is stance leg as 'good' leg

> performs resisted multi-planar hip ROM; mini-squats; lateral step-ups;
> try to do more closed-chain, avoid full knee ext. in open chain (more
> patellofemoral stress)

Time: pt c no effusion, almost no pain, normal gait, 0-120 knee

flex, primary deficit is weakness

***Late functional:***

Goals: advanced functional exercise geared towards return to

pt's goals

Treatment: stair stepper, elliptical machine; start running when

> normal gait pattern; jumping rope; carioca running; cutting

Time: pt c full ROM, no effusion, quads 80% uninvolved side

Meniscal repair: inconsistent protocols, possibilities include:

1)  NWB x 6 weeks

2)  FWB, knee locked in extension

3)  FWB, no ROM restrictions

> Studies by Shelbourne et al and Barber show no difference in success
> or failure rates between unlimited rehabilitation programs and a
> restrictive program.
>
> Shelbourne et al accelerated program:
>
> Full WB, ROM as tolerated
>
> Closed-chain exercises at 2-4 weeks
>
> Progress to functional and sports activities as tolerated
>
> at 4-8 weeks

MCL and LCL rehab: article: The Physician and Sports Medicine, Vol. 24,
No.3,

March 1996; <http://www.physsportsmed.com/issues/1996/03_96/meislin.htm>

PCL rehab: nonoperative and post-operative

ACL post-operative rehab

Protocols for these can be found in the Orthopedic Section Home Study
Course

10.4.5 Injury and Rehabilitation of the Knee: Menisci, Ligaments, and

Fractures

ACL non-operative rehab:

***Initial goals:*** reduce joint effusion, restore joint ROM, begin
strengthening

program c goal of joint stability

***Treatment:*** ice; isometric HS at variety of ROM's; more parts of
ROM as

ROM increases; HS strengthening seated, prone, supine, standing;

Patellar mobs. if needed; need strong quad contraction -- use e-stim

if needed, progress to SLR

***Progress:*** as ROM and strength improve, add closed-chain exercise:
bilat. wall

> slides, partial squats, leg press; bridging supine on therapy ball
> with single leg (involved side)

Add proprioception and balance (early BAPS board / balance board)

Bike, stair stepper to improve strength and endurance

***Progress:*** unilateral exercise: single-leg press, step-ups,
bridging, wall slides,

Lunges

> ***Caution:*** monitor pt's response to treatment: pain, swelling,
> instability needs re-assessment and modification of program; pt
> progressing rapidly needs additional
>
> challenges to continue improving
>
> ***Return to activity:*** no joint effusion, full ROM;
> strength/endurance/balance comparable to uninvolved side; able to
> demonstrate functional stability of the knee in sport or occupation
> activities.