PRACTITIONER PROMPT Meniscal rehabilitation

Menisectomy Phase 1: Maximum protection (3-7 days) Goals ● Protect wound ● Control inflammation ● Full knee extension ● Regain quadriceps control

● Restore normal gait (elbow crutches first 1-2 days)

ROM - 0o - Pain free range (At 1 week, approximate range 0-120o) Treatment ● Heel slides ● Quadriceps sets, trophic stimulation as required ● Non weight bearing hamstring/gastrocnemius/soleus stretches ● Single leg raise - 4 planes ● Hip abduction/extension ● Patella mobilisations ● Non-operative leg/abdominal circuits ● Isokinetics non-operative leg

Phase 2: Moderate protection (7-21 days) Goals ● Increase lower extremity strength and ROM ROM - No limits Treatment ● Continue Phase 1 ● Angle specific isometrics knee flexion/extension (30o steps) ● Hydrotherapy, lower limb exercises ● Isokinetics (High speed > low speed) ● Bike ● Swimming, no breaststroke ● Closed kinetic chain exercises (initially bilateral > unilateral) ● Open kinetic chain exercises 0-90o (initially bilateral > unilateral) ● Step ups > step downs ● Calf work ● Proprioceptive work ● Commence jogging > running (pool>trampet>sand>grass)

Advancement criteria Necessary strength, ROM, endurance and proprioception + no patellofemoral symptoms

Phase 3: Minimum protection (21-42 days) Goals ● Safe and gradual return to activity ● Initiate isolated hamstring work ● Improve ROM, strength, endurance and proprioceptive Treatment ● Continue phase 1 and 2 ● Stairmaster ● Hamstring 0-60º ● Sprinting-acceleration/deceleration ● Agility work ● Sports-related drills

Meniscal repair Phase 1: Maximum protection (0-6 weeks) Goals ● Protect repair ● Control inflammation ● Full knee extension ● Regain quadriceps control

ROM - 0-90o Treatment ● Heel slides 0-90o

● Quadriceps sets, trophic stimulation as required

● Non weight bearing gastrocnemius/soleus stretches, hamstring stretches

● Single leg raises - 4 planes ● Patella mobilisations ● Hydrotherapy at 4 weeks ● CPM pain free range (up to 0-90o)

Phase 2: Moderate protection (6-10 weeks) Goals ● Restore normal gait ● Avoid overstressing the repair ● Increase lower extremity strength and ROM ROM - No limits Treatment ● Continue Phase 1 ● Closed kinetic chain exercises 0-60o flexion ● Open kinetic chain exercises 0-90o (45-90o if associated cruciate involvement) ● Calf work ● Proprioceptive work

Advancement criteria Necessary strength, ROM, endurance and proprioception + no patellofemoral symptoms

Phase 3: Minimum protection (10-16 weeks) Goals ● Safe and gradual return to activity ● Initiate isolated hamstring work ● Improve ROM, strength, endurance and proprioceptive Treatment ● Continue phase 1 and 2 ● Stairmaster, stationary bike ● Hamstring 0-60o ● Swimming no breaststroke ● Commence running programme ● Commence functional progression

The information contained in this article is intended as general guidance and information only and should not be relied upon as a basis for planning individual medical care or as a substitute for special- ist medical advice in each individual case. To the extent permissable by law, the publisher, editors and contributors accept no liability for any loss, injury or damage howsoever incurred (including negli- gence) as a consequence, whether directly or indirectly, of the use of any person of the contents of this article.

WWW.SPORTEX.NET