Rehabilitation and Return to Play Following Meniscal Repair

Abstract

The outcome of meniscal repair has been good to excellent with regard to functional restoration and return to play (RTP). Athletes represent the most demanding subgroup of patients as they have high expectations to return to their preinjury level of activity and in doing so they place maximum stress on any meniscal repair. Physical therapy rehabilitation protocols and RTP decision-making remains controversial in the setting of meniscal repair. Protective protocols had been the mainstay of treatment for many years, however, newer research has shown no harm and quicker RTP for longitudinal and bucket-handle tears located close to the outer vascular zone of the periphery of the meniscus using accelerated rehabilitation. Protective protocols and slower RTP remain the most prudent choice in complex , horizontal and radial tears or those extending into the middle to central third of the more avascular zone of the meniscus. The authors have therefore, with evidence from current publications, developed 2 separate protocols to treat both peripheral and complex tears . One accelerated and one protective protocol is established. During the preoperative planning, it would be helpful for the surgeon, patient, and family to know what can be expected with regard to the surgical success of meniscal repair and the likelihood of RTP in this active population. A literature review on the outcome of meniscal repair related to RTP was performed and revealed that the majority of patients succeed to RTP at the same or similar to their preinjury level, between 4 and 6 months following meniscal repair. Factors that may affect the outcome and RTP along with rehabilitative considerations following meniscal repair are discussed.