Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 6;12(2):23259671231226134.
doi: 10.1177/23259671231226134. eCollection 2024 Feb.

Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine

Ting Cong  1   2 , Rajiv P Reddy  2 , Arielle J Hall  3 , Akhmad Ernazarov  3 , James Gladstone  1
Affiliations

Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine

Ting Cong et al. Orthop J Sports Med. .

Abstract

Background: There is no consensus among sports medicine surgeons in North America on postoperative rehabilitation strategy after meniscus repair. Various meniscal tear types may necessitate a unique range of motion (ROM) and weightbearing rehabilitation protocol.

Purpose: To assess the current landscape of how sports medicine practitioners in the American Orthopedic Society for Sports Medicine (AOSSM) rehabilitate patients after the repair of varying meniscal tears.

Study design: Cross-sectional study.

Methods: A survey was distributed to 2973 AOSSM members by email. Participants reviewed arthroscopic images and brief patient history from 6 deidentified cases of meniscus repair-in cases 1 to 3, the tears retained hoop integrity (more stable repair), and in cases 4 to 6, the tear patterns represented a loss of hoop integrity. Cases were shuffled before the presentation. For each case, providers were asked at what postoperative time point they would permit (1) partial weightbearing (PWB), (2) full weightbearing (FWB), (3) full ROM, and (4) ROM allowed immediately after surgery.

Results: In total, 451 surveys were completed (15.2% response). The times to PWB and FWB in cases 1 to 3 (median, 0 and 4 weeks, respectively) were significantly lower than those in cases 4 to 6 (median, 4 and 6 weeks, respectively) (P < .001). In tears with retained hoop integrity, the median time to PWB was immediately after surgery, whereas in tears without hoop integrity, the median time to PWB was at 4 weeks postoperatively. Similarly, the median time to FWB in each tear with retained hoop integrity was 4 weeks after surgery, while it was 6 weeks in each tear without hoop integrity. However, regardless of tear type, most providers (67.1%) allowed 0° to 90° of ROM immediately after surgery and allowed full ROM at 6 weeks. Most providers (83.3%) braced the knee after repair regardless of hoop integrity and utilized synovial rasping/trephination with notch microfracture-a much lower proportion of providers utilized biologic augmentation (9%).

Conclusion: Sports medicine practitioners in the AOSSM rehabilitated meniscal tears differently based on hoop integrity, with loss of hoop stresses triggering a more conservative approach. A majority braced and utilized in situ adjuncts for biological healing, while a minority added extrinsic biologics.

Keywords: meniscus; meniscus repair; range of motion; rehabilitation; survey; weightbearing.

PubMed Disclaimer

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.G. has received financial or material support from Springer; education payments from Gotham Surgical Solutions & Devices; consulting fees from Mitek, Trice Medical, Medical Device Business Services, and DePuy Synthes Products; nonconsulting fees from Mitek and Trice Medical; royalties from Springer; and stock options from Trice Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was waived by Mount Sinai Hospital (ref No. STUDY-21-00236).

Figures

Figure 1.
Figure 1.
The arthroscopic images used for the 6 meniscal tear cases in the survey. Cases were grouped randomly according to tears that retained hoop integrity as follows: (1) medial meniscus red-zone longitudinal peripheral tear; (2) medial meniscus red-white zone bucket-handle tear; and (3) lateral meniscus horizontal tear; and tears that showed loss of hoop integrity as follows: (4) lateral meniscus radial tear at mid-body anterior horn junction; (5) medial meniscus posterior root tear; and (6) lateral meniscus complete radial tear at popliteal hiatus.
Figure 2.
Figure 2.
Cumulative distribution (in %) of time to permitted (A) partial weightbearing, (B) full weightbearing, and (C) full range of motion.
Figure 3.
Figure 3.
Distribution of range of motion permitted immediately after surgery.
See this image and copyright information in PMC

References

    1. Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ. Trends in meniscus repair and meniscectomy in the United States, 2005-2011. Am J Sports Med. 2013;41(10):2333-2339. doi:10.1177/0363546513495641 - DOI - PubMed
    1. Ahmed AM. A pressure distribution transducer for in-vitro static measurements in synovial joints. J Biomech Eng. 1983;105(3):309-314. doi:10.1115/1.3138425 - DOI - PubMed
    1. Anderson DR, Gershuni DH, Nakhostine M, Danzig LA. The effects of non-weight-bearing and limited motion on the tensile properties of the meniscus. Arthroscopy. 1993;9(4):440-445. doi:10.1016/S0749-8063(05)80319-6 - DOI - PubMed
    1. Arnoczky SP, Warren RF. The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med. 1983;11(3):131-141. doi:10.1177/036354658301100305 - DOI - PubMed
    1. Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med. 1986;14(4):270-275. doi:10.1177/036354658601400405 - DOI - PubMed

LinkOut - more resources