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Figure 7: Isokinetic work in prone lying

Figure 8: Isometric quadriceps/hamstring work in sitting

menisci injury, two rehabilitation schedules have been produced in the Practitioner Prompt to demonstrate the need for different approaches following menisectomy, partial or total, and meniscal repair. The decision to repair or remove has many contributing factors. In the short term, arthroscopic menisectomy has a rela- tively short period of rehabilitation (4-6 weeks) compared to meniscal repair (3-6 months). A return to activity in 5-7 days has been reported after arthroscopic menisectomy, but these are usu- ally old or minor tears without trauma to soft tissue. In the long term, meniscal repair has the potential to reduce the degree and incidence of arthrosis. However, with recent research the long- term benefits of the different surgical approaches may not be sig- nificantly different (4).

Each rehabilitation schedule is divided into three phases: 1. Maximum protection 2. Moderate protection 3. Minimal protection

The priority during all three phases for arthroscopic menisectomy or meniscal repair is: 1. Control of swelling - once this has been achieved progress to the following: 2. Regain pain-free active range of movement 3. Progressive muscle strengthening 4. Regain proprioception 5. Return to full functional activities

The presence of oedema though will have an inhibitory effect on ROM, strength, proprioception and ultimately function. The therapist should not ignore the presence of swelling in the hope that it will disappear as function begins to improve. The lack of extensive super- ficial wounds often encourages the athlete/therapist to progress too quickly; this is often the cause of any acute joint reaction.

Following meniscal repair the emphasis initially is on knee exten- sion (not flexion). Open kinetic chain (OKC) knee flexion in prone lying should be avoided in phase 1 due to semimembranosis and popliteus attachments to medial and lateral menisci respectively.

Figure 9: Leg presswork using the isokinetics dynamometer

References 1. Soderberg GL, Miner SD, Arnold K et al. Electromyographic analysis of knee exercises in healthy subjects and in patients with knee pathologies. Physical Therapy 1987;76: 1691-1696 2. Gryzlo SM, Patek RM, Pink M, Perry J. Electromyographic analysis of knee rehabilitation exercises. J. Sports Physical Therapy 1994;20(1):36-43 3. White AA, Raphael IG. The effect of quadriceps loads and knee position on strain measurements of the tibiocollateral ligament: an experimental study on human amputation specimens. Acta Orthop Scand 1972;43(3):176-187 4. Rockborn P, Messner K. Long-term results of meniscus repair and meni- sectomy: a 13-year functional and radiographic follow-up study. Knee Surgery, Sports Traumatology, Arthroscopy 2000;8:2-9

Dave Fevre, MCSP is is senior chartered physiotherapist to Blackburn Rovers FC. His other posts include World Class Adviser for Sport England in relation to sports medicine and sports science, and exter- nal lecturer specialising in sports physiotherapy, sports rehabilita- tion and isokinetics. Dave completed his MSc in sports physiother- apy and isokinetics in 1997.

Author’s recommended reading

Clinical Sports Medicine (rev.2nd Ed) by Brukner and Kahn. McGraw Hill 2001. ISBN 0074711083 (fully reviewed at sportex.net) An excellent comprehensive, diagnostic aid - essential reading for any sports medicine practitioner. RRP £50.00 Non-subscribers £47.50 Subscribers £45.00

Muscle Energy Techniques by L Chaitow. Churchill Liv. 2001. ISBN 0443064962 (fully reviewed at sportex.net) An excellent book on the theory and practice of MET. The lat- est edition comes with a CD ROM which further adds to the practical nature of the subject and book. RRP £38.99 Non-subscribers £37.04 Subscribers £35.09

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