Poorly Contained Lesions
The panel’s recommendations for patients with poorly contained or larger cartilage lesions, detailed here, also includes a four-phase rehabilitation period, but this time over 26 weeks.
Physio therapy, the panel said, should consist of “passive motion, edema control, patella mobilization, quad activation and cryotherapy” during the first 6 weeks after the surgical repair of a poorly contained cartilage lesion. In addition, in Phase III (Week 7-12) patients could benefit from stationary bike exercises and hydrotherapy, and from neuromuscular training and a home exercise program during Phase IV (Weeks 13-26).
They indicated as well that the patient should wear an Immobilizer/ROM brace during first 6 weeks (Phase 1 & 2) and then switch to an Unloader during Phase III and IV.
Meniscal Repair
The biggest concern when it comes to meniscal repair, according to this panel of experts, was the increased risk for developing osteoarthritis in younger patients because of the lack of a consensus on the best rehabilitation protocols for meniscal tears, including a bucket handle tear, a radial meniscal tear, and a lateral/medial meniscal root tear.
For rehabilitation of meniscal tears, they outlined five phases of recovery lasting about 26 weeks. In the early phases of rehabilitation, they warned against doing deep squats and suggested that loaded squats should only be performed when the patient has free range of motion again.
The panel also suggested isometric exercises and cryotherapy in the beginning until more activity can be tolerated. For these patients, an Unloader brace was also recommended.
The panel of orthopedic experts also emphasized that patients should not resume plyometric and any sport-specific training until after week 26. And that patients recovering from a repair of a radical meniscal tear or the repair of a lateral/medial meniscal root tear with fixation should be weaned off their crutches by week 12 post-op. All the suggested guidelines can be found here.
A Major Milestone
LaPrade talked to OTW about why having a consensus on cartilage and meniscal rehabilitation is so crucial right now.
He said, “Over the last decade clinical data on cartilage and meniscal repair have been gathered extensively. Whereas surgical techniques have changed to enhance clinical outcomes, rehabilitation protocols have varied significantly. Especially the ‘return to play’ or ‘return to work’ aspects within the management of knee cartilage or meniscal lesions—therefore, we felt that the time had come to develop a global consensus on the rehabilitation following cartilage and meniscal repair.”
LaPrade emphasized, “The recommendations are not really product related—as an example we recommended that knee immobilizers or post-OP ROM braces be utilized in some cases—but as Össur offers the only knee unloader brace with dynamic force straps being indicated specifically for cartilage and meniscal injuries, we mentioned the Rebound Cartilage brace specifically.”
He added, “Össur is also committed to invest in biomechanical and clinical data—just a couple of weeks ago biomechanical data on the reduction of medial meniscal strain with the use of the Rebound Cartilage was published—demonstrating the value of the brace for meniscal repairs.”
Overall, he said, “We—as a group of global experts—agreed on indications and arrived at surgical procedure related consensus for rehabilitation following cartilage and meniscal surgery. This is a huge milestone because we had endless discussions in many other groups before. It was important that Össur was able to bring so many experts together and conduct such a meeting which reached consensus on this issue.”
