Early Functional Rehabilitation after Meniscus Surgery: Are Currently Used Orthopedic Rehabilitation Standards Up to Date?

Matthias Koch,Florian Zeman,Werner Krutsch,Johannes Zellner,Volker Alt,Christian G Pfeifer,Sanjay Weber-Spickschen,Clemens Memmel,Peter Angele

doi:10.1155/2020/3989535

Abstract

Meniscus therapy is a challenging process. Besides the respective surgical procedure such as partial meniscectomy, meniscus repair, or meniscus replacement, early postoperative rehabilitation is important for meniscus regeneration and return to sport and work as well as long-term outcome. Various recommendations are available. However, the current literature lacks information concerning the actual early rehabilitation in daily routine recommended by orthopedic surgeons. Thus, the purpose of this study was to investigate currently used standard early rehabilitation protocols in the daily routine of orthopedic surgeons. This study investigated the recommendations and concepts for early rehabilitation after meniscus therapy given by German, Austrian, and Swiss orthopedic institutions. Standardized criteria such as weight bearing, range of motion, use of an orthosis, and rehabilitation training were analyzed according to the conducted surgical procedure: partial meniscectomy, meniscus repair, or meniscus replacement. The analysis of standard rehabilitation concepts for partial meniscectomy (n = 15), meniscus repair (n = 54), and meniscus replacement (n = 7) showed significantly earlier functional rehabilitation in all criteria after partial meniscectomy in contrast to meniscus repair techniques (p < 0.001). In addition, significant restrictions were found in full weight bearing, full range of motion, and the use of braces. In summary, a wide range of recommendations for weight bearing, ROM, brace therapy, and mobilization is available, particularly after meniscus repair and meniscus replacement. Most concepts are in accordance with those described in the current literature. Further research is necessary to enhance the scientific evidence on currently used early rehabilitation concepts after meniscus therapy.

Highlights

Meniscus injuries are one of the most common knee injuries overall [1]
The majority (n = 54) of protocols referred to postoperative treatment after meniscus repair. 15 rehabilitation concepts were related to partial meniscectomy and 7 recommendations for early rehabilitation to rehabilitation after artificial meniscus replacement
In contrast to partial meniscectomy, which is marked by overall earlier functional rehabilitation and a nearly unrestricted start of weight bearing, full range of motion, and training, the start of early rehabilitation is more restricted after meniscus repair and after replacement of meniscus tissue

Summary

Introduction

Meniscus injuries are one of the most common knee injuries overall [1]. Traumatic lesions usually affect athletes and predispose those for the development of an osteoarthritis [2]. Concerning the treatment options, a radical change occurred in the therapeutic strategies of meniscus lesions considering the increasing knowledge about the significant relevance of the menisci for an intact knee joint [3, 4]. As a filling tissue between the femoral condyles and the tibia plateau, the menisci have decisive functional and biomechanical properties and are essential for load bearing, stabilization, proprioception, and lubrication as well as shock absorption in all knee movements [4,5,6,7,8]. In the case of a meniscus lesion, these properties are restricted or even reversed [4, 9]. Loss of meniscus integrity and tissue is associated with increased contact pressure on the articular cartilage, predisposing patients to early joint degeneration [10, 11]

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