SIMPLE MENISCUS REPAIR
WITH REPAIR OF THE MEDIAL PATELLOFEMORAL LIGAMENT
- -Patients are weight bearing as tolerated with crutch use as needed post-operatively.
- -Range of motion will be blocked at 0 degrees in a knee immobilizer for 4 weeks. They will wean to a patellofemoral neoprene brace first for sleeping, then around their house, and finally with all ADL’s as soon as they are able to demonstrate adequate control of the lower extremity.
- -Important not to push for flexion past 90 degrees for 8 weeks post-op to protect repair.
- -Passive range of motion after the first 2 weeks once a day ONLY.
- -Regular manual and self-mobilization of the patella (superior and inferior only), patella tendon, and portals should be performed to prevent fibrosis, improve range of motion, an functional mobility
- -Regular attention to proper VMO recruitment and patellofemoral mechanics will optimize outcome.
- *Return to sport and activities are dependent upon passing a functional, sports test.
- -M.D. office visit at 1 day and 1 week post-op.
- -Gait training, pain and edema control, and muscle stimulation to improve quadriceps recruitment.
- -Ankle exercises, quad, adduction and gluteal sets, leg raises in multiple planes (except hip flexion).
- -Extension stretching to hamstrings, calves, and lateral musculature to maintain extension range of motion.
- -Well-leg stationary cycling and UBE. Upper body weight machines and trunk exercises.
Weeks 2 – 4:
- -Continue to progress weight bearing and functional mobility as able
- -Resistive band hip exercises (except flexion)
- -Submaximal quad, gluteal and abduction/adduction isometrics within the range restrictions.
- -Hip flexion leg raises when able to demonstrate no quadricep lag
- -Calf raises, weight shifting, ankle exercises, balance and proprioception exercises.
- -Patella, suprapatellar pouch and scar mobilization regularly.
- -Pool walking and workouts as soon as incisions are well-healed.
Weeks 4 – 6:
- -M.D. visit at 1 month post-op.
- -Wean from immobilizer first with sleeping, then around the house.
- -Submaximal quad isometrics and ankle isometrics through multiple ranges.
- -Abduction, adduction and hip machines at the gym.
- -Initiate weight shifting, short-arc knee bends and steps, and proprioceptive exercises within range.
Weeks 6 – 8:
- -Functional exercises should focus on eccentrics. Increase depth of knee bends and add stepups as able to demonstrate good motion and control.
- -Continue to increase intensity and resistance of other exercises.
- -Passive flexion to 90 degrees for stretching.
- -More aggressive passive flexion stretching to increase range of motion.
- -Add lateral exercises (i.e. lateral stepping, lateral step-ups, etc.).
- -Continue all exercises with emphasis on closed-chain, functional and proprioceptive program.
- -Initiate two-legged stationary bicycling.
- -Stair machine and Nordic Track in brace for cardiovascular.
- -Goals are to increase strength, power, and cardiovascular conditioning.
- -Sport-specific exercises and training program
- -Maximal eccentric focused strengthening program
- -Increase resistance of cycling, stair machine, and pool programs.
- -Goals are to develop maximal strength, power, and advance to sporting-simulation activities.
- -Resisted closed-chain rehabilitation through multiple ranges.
- -Begin light running program as able to demonstrate good strength and mechanics.
- -Running program, intensive balance drills and agility program.
- -Initiate plyometric training as able to demonstrate adequate strength and proper mechanics.