SCPT

USA
10 Posts
 
Posted - 02/09/2006 :  14:49:06  Show Profile  Reply with Quote
I will be seeing a patient that has a diagnosis of meniscus replacement of the knee this coming up Monday. I am wondering if anyone has worked with a patient with such a diagnosis before. I would be interested in learning and discussing more about your treatment approach and experiences with this condition.

SCPT

USA
10 Posts
 
Posted - 02/13/2006 :  09:54:31  Show Profile  Reply with Quote
My patient ended up not having the meniscus replacement. When the surgeon performed the surgery he felt that the patient was not a good candidate because of the amount of deterioration of the cartilage and meniscus. The surgeon ended up scoping his knee and performing a medial meniscetomy.
I did find useful information on meniscus replacement at: www.meniscustransplantation.org/patients/questions.asp

Also protocol:
Post-Operative Physical Therapy Protocol
General Considerations:
-Partial weight-bearing status for 4 weeks post-op. 10-20% toe-touch for 1-2 weeks, progress as tolerated.
-Most patients will be in a hinged rehab brace locked in full extension for 4 weeks post-op unless otherwise indicated.
-Regular assessment of gait to avoid compensatory patterns.
-Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis.
-No resisted leg extension machines (isotonic or isokinetic).
-No high impact or cutting / twisting activities for at least 4 months post-op.
-M.D. follow-up visits at Day 1, Day 8-10, 1 month, 4 months, 6 months, and 1 year post-op.
-During the first 4 weeks: TWICE PER DAY: Without brace, allow GRAVITY ONLY to bend knee back as tolerated BUT NO MORE THAN 90 DEGREES for a good knee stretch without increase in pain. Relax knee and stretch for 60 seconds.

Week 1:
-M.D. visit day 1 post-op to change dressing and review home program.
-Icing and elevation regularly. Aim for 5x per day, 15-20 minutes each time. For ice machine: use as directed.
-Exercises: 1) straight leg raise exercises (lying, seated, and standing): quadriceps/adduction/abduction/gluteal sets; 2) once daily passive and active range of motion exercises;
-Hip and foot / ankle exercises, well-leg stationary cycling, upper body conditioning.
-Pool / deep water workouts after the first 8-10 days and with the use of a brace.
-Soft tissue treatments for edema / pain control and to posterior musculature, patella and incisions.

Weeks 2 - 4:
-M.D. visit at 8 - 10 days for suture removal and check-up.
-Manual resisted exercises (i.e. PNF patterns) of the foot, ankle and hip. Trunk stabilization program.
-Continue with pain control, range of motion, soft tissue treatments and proprioception exercises.
-Non-weightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne with uninvolved leg and arms only, pool workouts).

Weeks 4 - 6:
-M.D. visit at 4 weeks post-op, will progress to full weight bearing and discontinue use of rehab brace.
-Stretching and manual treatments to improve range of motion (especially extension).
-Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, proprioception).
-Stationary bike and progressing to road cycling as tolerated.
-Slow walking on treadmill for gait training (preferably a low-impact treadmill).

Weeks 6 - 8:
-Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exs., Shuttle/leg press). Do not overload closed- or open-chain exercises.
-Patients should be progressing to walking without a limp and range of motion should be at 80%.

Weeks 8 - 12:
-Add lateral training exercises (side-step ups, Theraband resisted side-stepping, lateral stepping).
-Introduce more progressive single leg exercise.
-Patients should be pursuing a home program with emphasis on sport/activity-specific training.

Weeks 12-16:
-Low-impact activities until 16 weeks.
-Increase the intensity of strength and functional training for gradual return to activities.