Rehabilitation following meniscal repair: a systematic review

Abstract

Objective: To review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery.

Methods and data sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: (((("Weight-Bearing/physiology"[Mesh]) OR "Range of Motion, Articular"[Mesh]) OR "Rehabilitation"[Mesh])) AND ("Menisci, Tibial"[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients' outcome among original studies.

Results: Seventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair.

Conclusions: There is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.

Keywords: arthroscopy; knee injuries; knee surgery; rehabilitation; sporting injuries.

Figure 1

(A, B) All-inside suture-based repair, (C, D) inside-out suture repair and (E, F) anchor-based repair techniques.

Figure 2

(A) Outer red zones receive blood supply; (B) longitudinal tears have a higher likelihood of being vascularized.

Figure 3

(A) The pressure transducer ‘P’ was placed in the lateral meniscal cut and the knee was cycled into flexion and extension. (B) Intrameniscal pressures were reflected in neutral, internal, and external rotation.

Figure 4

Flow chart of the systematic review.

Figure 5

Transverse section of a cadaver knee under 100 lbs of load at 60°. (A) Longitudinaland (B) transverse measurements are depicted between the markers.

Figure 6

Transverse section of a cadaver knee without load at 60°. (A) Longitudinal and (B) transverse) measurements are depicted between the markers.

Figure 7

(A) Schematic of roentgen stereophotogrammetric analysis bead pair placement in relation to tear. Distances measured by vectors: a—absolute, b—transverse and c—vertical. (B) Changes in separation for each vector. Positive values indicate widening. Negative values indicate compression. MCL, medial collateral ligament region of posterior horn of medial meniscus; mid post, middle of posterior horn; post root, posterior root area of medial meniscus.

Figure 8

Meniscus repair success: standard versus accelerated. No difference in success rates exists between the standard accelerated rehabilitation groups.