6 Step Treatment Plan for Meniscus Repair Physical Therapy

By dpope2020

December 13, 2024

all about meniscus surgery, dan pope, dr. david middaugh, el paso manual physical therapy, fitness pain free, fitnesspainfree, knee injury, knee meniscus surgery, knee pain, knee surgery, meniscus, meniscus exercises, meniscus injury, meniscus rehab exercises, meniscus repair, meniscus surgery, meniscus surgery decoded, meniscus tear, meniscus tear exercises, meniscus tear rehab, new meniscus surgery, orthopedics, physical therapy, torn meniscus, torn meniscus exercises

6 Step Treatment Plan for Meniscus Repair Physical Therapy

To go along with today's episode I have a nice infographic to share...

Sign up to receive FREE: Meniscus Pathology Evidence Based "Cheat Sheet"

Click HERE to Download FREE

Grab the rest of the Mini Course and Sign up for the Certification Pre-sale list:

In today's video we go over: 6 Step Treatment Plan for Meniscus Repair Physical Therapy: FPF Show Episode 154

  • 0:00 Introduction
  • 2:28 Does the type of tear matter for post-op rehab? (Hoop strained maintained or not)
  • 4:41 How the location of the tear matters for rehabilitation
  • 6:26 Do chronic tears heal slower then acute tears?
  • 6:40 How tear SIZE dictates rehab speed
  • 6:57 How concomitant pathology changes the game (ACL tears, cartilage injuries etc.)
  • 7:29 Does age play a role with speed of meniscus tear rehab progression?
  • 11:39 Surgeon Concensus: Weightbearing timelines, ROM restrictions, accelerated vs. delayed rehab, bracing
  • 16:46 How to PROTECT the healing meniscus repair after surgery
  • 21:49 How to restore range of motion after meniscus repair
  • 29:50 How to MAINTAIN strength and fitness following a meniscus repair
  • 35:19 How to REDUCE arthrogenic muscle inhibition of the quads after surgery
  • 44:10 How to progress strength exercises for your meniscus repair patients over time
  • 52:26 How depth of squats and single leg exercises dictates strain on the meniscus
  • 53:55 Why stress increases on the meniscus [medial] in the bottom of the squat
  • 55:46 How double leg exercises (squat) strain the lateral meniscus more then single leg exercises
  • 56:49 How speed of movement and load increases strain on the meniscus
  • 57:09 Return to sport testing and progressions
  • 1:04:22 Return to sport timelines
  • 1:07:40 Case Study - Meniscus Repair Surgery Physical Therapy [Case Study - Powerlifter Chrissy Peracchi]

Get the scissors out...

- Dan Pope DPT,OCS,CSCS

Want to support me and decide topics for future episodes?  Click HERE to sign up for FPF "Insiders" for just a dollar. You'll gain access to 100+ webinars, e-books and complete guides.  Plus, you'll get private access to the "Insiders" Facebook group where you can have all of your questions answered by me.  

Looking for other ways to support me that are 100% free?

  • Like, comment and share on youtube, facebook and instagram 
  • Leave a 5-star review on apple podcasts

Thank you!

Dan Pope DPT, OCS, CSCS

References: 

  1. Dawson LJ, Howe TE, Syme G, Chimimba LA, Roche JJW. Surgical versus conservative interventions for treating meniscal tears of the knee in adults. Cochrane Database Syst Rev. 2017;2017(9):CD011411. Published 2017 Sep 7. doi:10.1002/14651858.CD011411.pub2

  2. Persson F, Turkiewicz A, Bergkvist D, Neuman P, Englund M. The risk of symptomatic knee osteoarthritis after arthroscopic meniscus repair vs partial meniscectomy vs the general population. Osteoarthritis Cartilage. 2018 Feb;26(2):195-201. doi: 10.1016/j.joca.2017.08.020. Epub 2017 Nov 14. PMID: 29146386.

  3. Weber J, Koch M, Angele P, Zellner J. The role of meniscal repair for prevention of early onset of osteoarthritis. J Exp Orthop. 2018;5(1):10. Published 2018 Apr 2. doi:10.1186/s40634-018-0122-z

  4. Englund M, Guermazi A, Roemer FW, et al. Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle-aged and elderly persons: The Multicenter Osteoarthritis Study. Arthritis Rheum. 2009;60(3):831-839. doi:10.1002/art.24383

  5. Knee Image: Source: https://commons.wikimedia.org/wiki/File:917_Knee_Joint.jpg Attribution: OpenStax College / CC BY (https://creativecommons.org/licenses/by/3.0)

  6. Source: https://commons.wikimedia.org/wiki/File:Gray349.png Attribution: Henry Vandyke Carter / Public domain Edited by fitness pain free LLC

  7. Schweizer C, Hanreich C, Tscholl PM, Ristl R, Apprich S, Windhager R, Waldstein W. Nineteen percent of meniscus repairs are being revised and failures frequently occur after the second postoperative year: a systematic review and meta-analysis with a minimum follow-up of 5 years. Knee Surg Sports Traumatol Arthrosc. 2021 Oct 20. doi: 10.1007/s00167-021-06770-x. Epub ahead of print. PMID: 34671817.

  8. Skou ST, Lind M, Hölmich P, et al. Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults. BMJ Open. 2017;7(8):e017436. Published 2017 Aug 21. doi:10.1136/bmjopen-2017-017436

  9. 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 Oct;41(10):2333-9. doi: 10.1177/0363546513495641. Epub 2013 Jul 17. PMID: 23863849.

  10. Madaleno FO, Santos BA, Araújo VL, Oliveira VC, Resende RA. Prevalence of knee osteoarthritis in former athletes: a systematic review with meta-analysis. Braz J Phys Ther. 2018;22(6):437‐451. doi:10.1016/j.bjpt.2018.03.012

  11. Chirichella, P. S., Jow, S., Iacono, S., Wey, H. E., & Malanga, G. A. (2018). Treatment of Knee Meniscus Pathology: Rehabilitation, Surgery, and Orthobiologics. PM&R. doi:10.1016/j.pmrj.2018.08.384

  12. Raj MA, Bubnis MA. Knee Meniscal Tears. [Updated 2020 July]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431067/

  13. Siemieniuk RAC, Harris IA, Agoritsas T, et al. Arthroscopic surgery for degenerative knee arthritis and meniscal tears: A clinical practice guideline. BMJ 2017;357:j1982

  14. Beaufils P, Becker R, Kopf S, Matthieu O, Pujol N. The knee meniscus: management of traumatic tears and degenerative lesions. EFORT Open Rev. 2017;2(5):195‐203. Published 2017 May 11. doi:10.1302/2058-5241.2.160056

  15. Hohmann E, Glatt V, Tetsworth K, Cote M. Arthroscopic Partial Meniscectomy Versus Physical Therapy for Degenerative Meniscus Lesions: How Robust Is the Current Evidence? A Critical Systematic Review and Qualitative Synthesis. Arthroscopy. 2018 Sep;34(9):2699-2708. doi: 10.1016/j.arthro.2018.04.018. Epub 2018 Jul 20. PMID: 30037571.

  16. Calanna F, Duthon V, Menetrey J. Rehabilitation and return to sports after isolated meniscal repairs: a new evidence-based protocol. J Exp Orthop. 2022 Aug 17;9(1):80. doi: 10.1186/s40634-022-00521-8. PMID: 35976500; PMCID: PMC9385921.

  17. Cong T, Reddy RP, Hall AJ, Ernazarov A, Gladstone J. Current Practices for Rehabilitation After Meniscus Repair: A Survey of Members of the American Orthopaedic Society for Sports Medicine. Orthop J Sports Med. 2024 Feb 6;12(2):23259671231226134. doi: 10.1177/23259671231226134. PMID: 38639001; PMCID: PMC11025434.

  18. Wedge C, Crowell M, Mason J, Pitt W. Rehabilitation and Return to Play Following Meniscus Repair. Sports Med Arthrosc Rev. 2021 Sep 1;29(3):173-179. doi: 10.1097/JSA.0000000000000303. PMID: 34398124.

  19. Nagura T, Matsumoto H, Kiriyama Y, Chaudhari A, Andriacchi TP. Tibiofemoral joint contact force in deep knee flexion and its consideration in knee osteoarthritis and joint replacement. J Appl Biomech. 2006;22(4):305‐313. doi:10.1123/jab.22.4.305

  20. van Rossom S, Smith CR, Thelen DG, Vanwanseele B, Van Assche D, Jonkers I. Knee Joint Loading in Healthy Adults During Functional Exercises: Implications for Rehabilitation Guidelines. J Orthop Sports Phys Ther. 2018;48(3):162‐173. 

  21. Blackburn JT, Pamukoff DN, Sakr M, Vaughan AJ, Berkoff DJ. Whole body and local muscle vibration reduce artificially induced quadriceps arthrogenic inhibition. Arch Phys Med Rehabil. 2014 Nov;95(11):2021-8. doi: 10.1016/j.apmr.2014.07.393. Epub 2014 Jul 30. PMID: 25083559.

  22. Son SJ, Kim H, Seeley MK, Feland JB, Hopkins JT. Effects of transcutaneous electrical nerve stimulation on quadriceps function in individuals with experimental knee pain. Scand J Med Sci Sports. 2016 Sep;26(9):1080-90. doi: 10.1111/sms.12539. Epub 2015 Sep 8. PMID: 26346597.

  23. Bremner CB, Holcomb WR, Brown CD, Perreault ME. The Effectiveness of Neuromuscular Electrical Stimulation in Improving Voluntary Activation of the Quadriceps: A Critically Appraised Topic. J Sport Rehabil. 2017 Jul;26(4):316-323. doi: 10.1123/jsr.2015-0100. Epub 2016 Nov 11. PMID: 27834612.

  24. Minshull C, Gallacher P, Roberts S, Barnett A, Kuiper JH, Bailey A. Contralateral strength training attenuates muscle performance loss following anterior cruciate ligament (ACL) reconstruction: a randomised-controlled trial. Eur J Appl Physiol. 2021 Dec;121(12):3551-3559. doi: 10.1007/s00421-021-04812-3. Epub 2021 Sep 20. PMID: 34542671.

  25. Charles D, White R, Reyes C, Palmer D. A SYSTEMATIC REVIEW OF THE EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON QUADRICEPS MUSCLE ATROPHY AND CIRCUMFERENCE POST ACL RECONSTRUCTION. Int J Sports Phys Ther. 2020 Dec;15(6):882-891. doi: 10.26603/ijspt20200882. PMID: 33344004; PMCID: PMC7727417.

  26. Hart JM, Kuenze CM, Diduch DR, Ingersoll CD. Quadriceps muscle function after rehabilitation with cryotherapy in patients with anterior cruciate ligament reconstruction. J Athl Train. 2014 Nov-Dec;49(6):733-9. doi: 10.4085/1062-6050-49.3.39. PMID: 25299442; PMCID: PMC4264644.

  27. Baz-Valle E, Balsalobre-Fernández C, Alix-Fages C, Santos-Concejero J. A Systematic Review of The Effects of Different Resistance Training Volumes on Muscle Hypertrophy. J Hum Kinet. 2022 Feb 10;81:199-210. doi: 10.2478/hukin-2022-0017. PMID: 35291645; PMCID: PMC8884877.

  28. Gronbeck KR, Tompkins MA. Functional testing following isolated meniscus repair may help to identify patients who need additional physical therapy prior to a return to activity. J ISAKOS. 2024 Aug;9(4):557-561. doi: 10.1016/j.jisako.2024.04.007. Epub 2024 Apr 12. PMID: 38616017.

  29. Lepley AS, Gribble PA, Pietrosimone BG. Effects of electromyographic biofeedback on quadriceps strength: a systematic review. J Strength Cond Res. 2012 Mar;26(3):873-82. doi: 10.1519/JSC.0b013e318225ff75. PMID: 22289696.

Images:

  1. Medial Meniscus Source: https://commons.wikimedia.org/wiki/File:Medial_Meniscus_Injury.png Attribution: BruceBlaus / CC BY-SA (https://creativecommons.org/licenses/by-sa/4.0) Edited by fitness pain free LLC