REHABILITATION FOLLOWING MENISCAL REPAIR: A SYSTEMATIC REVIEW

Review written by Dr Teddy Willsey info

BACKGROUND & OBJECTIVE

The menisci play a vital role in knee health by increasing tibiofemoral joint space and contact area, reducing localized stress, and buffering against both rotational and axial shear force. Loss of meniscus tissue can lead to progressive arthrosis of the tibiofemoral joint surfaces. A growing appreciation for the role of the menisci in long term knee health has led to a 25% increase in the frequency of meniscus repairs over the past twenty years. Previously, the more common approach was meniscectomy: a procedure where the damaged tissue is simply removed.

The primary objective of this systematic review was to better understand the implications of various postoperative meniscus repair rehabilitation protocols. The authors made recommendations for care by comparing conservative vs. accelerated weight bearing and taking location, size, and biomechanical factors into consideration.

METHODS

The authors used a PRISMA system to gather and assess relevant articles for the systematic review. PRISMA is an acronym standing for preferred reporting items for systematic reviews and meta-analyses. The authors were unable to run a meta-analysis due to the heterogeneity of studies. After screening 453 studies for eligibility, 17 studies were used with a total of 798 patients. There was a wide range of methodological quality amongst the studies. Level of evidence for each study was reported. Although specific inclusion and exclusion criteria were not listed, high value was placed on detailed patient population data, reported long term outcomes, papers with second look diagnostic arthroscopy, and biomechanical research on the role of the meniscus.

The biomechanical studies included measured meniscus pressure and excursion on freshly repaired cadaveric menisci by using implanted pressure transducers. Researchers created 2.5 mm posteromedial meniscus tears, repaired them with the inside-out technique, and then tested the repair resiliency with a variety of loads and flexion angles.

VIDEO:

https://www.youtube.com/watch?v=gVKA3mV2j1E

RESULTS

Amongst the 17 studies, a restricted rehabilitation protocol was used for 54% of patients. The 46% of patients under an accelerated protocol were allowed to immediately weight bear to tolerance. Three studies directly compared restricted and accelerated protocols with no

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