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 Meniscectomy or Meniscus Debridement Surgical Rehabilitation

Progression to the next phase is based on clinical criteria and meeting the established goals for each phase.

 

Phase I – Acute Phase:

 

Goals:

  • Diminish pain, edema

  • Restore knee range of motion (goal 0-115, minimum of 0 degrees extension to 90 degrees of flexion to progress to phase II)

  • Reestablish quadriceps muscle activity/re-education (goal of no quad lag during SLR)

  • Educate the patient regarding Weight bearing as tolerated, use of crutches, icing, elevation and the rehabilitation process

 

Weight bearing:

 

  • Weight bearing as tolerated. Use two crutches initially progressing to weaning crutches as swelling and quadriceps status dictates.

 

Modalities:

  • Cryotherapy for 15 min 4 times a day

  • Electrical stimulation to quadriceps for functional retraining as appropriate

  • Electrical stimulation for edema control- high volt galvanic or interferential stimulation as needed

 

Therapeutic Exercise:

 

  • Quadriceps sets

  • SLR

  • Hip adduction, abduction and extension

  • Ankle pumps

  • Gluteal sets

  • Heel slides

  • ½ squats

  • Active-assisted ROM stretching, emphasizing full knee extension (flexion to tolerance

  • Hamstring and gastroc/ soleus and quadriceps stretches

  • Use of compression wrap or brace

  • Bicycle for ROM when patient has sufficient knee ROM. May begin partial revolutions to recover motion if the patient does not have sufficient knee flexion

 

Phase II:

 

Goals:

 

  • Restore and improve muscular strength and endurance

  • Reestablish full pain free ROM

  • Gradual return to functional activities

  • Restore normal gait without an assistive device

  • Improve balance and proprioception

 

Weight bearing status:

 

Patients may progress to full weight bearing as tolerated without antalgic gait. Patients may require one crutch or cane to normalize gait before ambulating without assistive device.

 

Therapeutic exercise:

 

  • Continue all exercises as needed from phase one

  • Toe raises- calf raises

  • Hamstring curls

  • Continue bike or motion and endurance

  • Cardio equipment- stairmaster, elliptical trainer, treadmill and bike as above.

  • Lunges- lateral and front

  • Leg press

  • Lateral step ups, step downs, and front step ups

  • Knee extension 90-40 degrees

  • Closed kinetic chain exercise terminal knee extension

  • Four way hip exercise in standing

  • Proprioceptive and balance training

  • Stretching exercises- as above, may need to add ITB and/or hip flexor stretches

 

Phase III – Advanced activity phase:

 

Goals:

 

  • Enhance muscular strength and endurance

  • Maintain full ROM

  • Return to sport/functional activities/work tasks

 

Therapeutic Exercise:

 

  • Continue to emphasize closed-kinetic chain exercises

  • May begin plyometrics/ vertical jumping

  • Begin running program and agility drills (walk-jog) progression, forward and backward running, cutting, figure of eight and carioca program

  • Sport specific drills

 

Criteria for discharge from skilled therapy:

 

  • Non-antalgic gait

  • Pain free /full ROM

  • LE strength at least 4+/5

  • Independent with home program

  • Normal age appropriate balance and proprioception

  • Resolved palpable edema

 

 

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