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Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
Rehabilitation after Meniscus Transplant
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Rehabilitation after Meniscus Transplant

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The importance of rehabilitation following a meniscus transplant

The importance of rehabilitation following a meniscus transplant

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  • Glucosamine: as a natural anti-inflammatory, analgesic, hydrator, and a stimulant to cartilage repair. A beverage-based supplement may result in a higher compliance rate and enhanced bioavailability over pill-based forms (Joint Juice, Inc).
  • Transcript

    • 1. Meniscal Allograft Transplantation Rehabilitation Goals and Outcomes Kevin R. Stone, MD Laura Keller, MPT
    • 2. There Is No Single Joint Chronic Problem
      • All patients with significant knee injury present with associated disability
      • Compensatory Movement Patterns:
        • Gait
        • Posture
        • Foot mechanics
      • Muscle atrophy, balance loss, ROM loss
    • 3. THE GOAL
      • Fitter, Faster, Stronger
      • … than before surgery
    • 4. Surgeon & PT Work as a Team
      • Patient must commit to a dedicated rehab
      • Therapist must correct gait, muscle imbalance, ROM, proprioception, training program
      • Clearly identify pain site with activity
        • =Efficacy of surgery
    • 5. Preoperative Physical Therapy
      • Treat swelling, pain, and loss of motion
      • Activity Modification, not Activity Cessation
      • Creative exercise
        • “ Listen” to symptoms to determine level of activity a patient can tolerate – Keep Moving!
      • Better condition before surgery -> Better Outcome after surgery
    • 6. Preoperative Physical Therapy
      • Pain/Swelling Control
        • Soft Tissue Mobilization
        • Compression
        • Ice (Cryotherapy Unit)
        • Elevation
      • Exercise Program
        • Resistance Training of uninjured limbs
        • Muscle Recruitment
        • Joint Range of Motion
        • Trunk Exercises
    • 7. Importance of Exercise
      • Supports healthy body weight -> helps relieve stress on the joint
      • Strengthens the muscles surrounding the joint
      • Improves joint stability, flexibility, and decreases pain
      • Positive effect on wound healing (Emery, J Gerontol A Biol Sci Med Sci 2005; Keylock Am J Physiol Regul Integr Comp Physiol 2008)
      CREATE AN EXERCISE ADDICTION
    • 8. Importance of Nutrition
      • Feed the body, feed the brain, feed the joint!
      • Glucosamine, Vitamin D, Calcium
      • Diet used to optimize body weight and exercise training program.
    • 9. Day Before Surgery
      • Pre-Operative Education empowers patients in their role as “Athletes In Training”
      • Meet with Physical Therapist to review:
        • Pain Management
        • Icing
        • Physical Therapy Protocol
    • 10. Meniscus Allograft Transplantation
      • < 15%: Performed in Isolation
        • Partial-weight bearing locked in full extension for 4 weeks (OOB ROM in PT, no brace @ night)
      • >85%: Combined Articular Cartilage Repair
        • Non-Weight bearing locked in full extension for 4 weeks (OOB ROM in PT, no brace @ night)
      The Stone Clinic Experience
    • 11. Rehabilitation Protocol
      • 1) Maximal Protective Phase (1 – 4 wks)
      • 2) Moderate Protective Phase (5 – 12 wks)
      The Stone Clinic Rehab Protocol: http://www.stoneclinic.com/rehabilitation
    • 12. The Stone Clinic Postoperative Protocol
      • Leave day of surgery with a knee brace to limit range of motion.
      • Returned the day after surgery to initiate soft tissue mobilization, non-operative leg bicycling, and range-of-motion exercises.
      • MD follow-up visits: 1 day, 8-10 days, 1 month, 4 months, 6 months, 1 year post-op
      • Research follow-up visits: 2, 3, 5, 7, 10, 15+ years post-op
    • 13. General Considerations
      • Regular assessment of gait to avoid compensatory patterns
      • Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis
    • 14.
      • Focus on control of pain and inflammation
        • Iced for 20 min 5 times/day for first 3 – 4 days with Cryotherapy unit
        • Elevate above the heart as much as possible
      Initial Postoperative Rehabilitation Week 1
    • 15.
      • Soft tissue treatments to musculature for edema and pain control
      • Resisted plantar flexion and dorsiflexion at ankle
      • Passive range-of-motion exercises with flexion ≤ 90°and extension ≥ 0°
        • Sitting on edge of table, in dangling position
      Initial Postoperative Rehabilitation Week 1
    • 16. Initial Postoperative Rehabilitation Week 1 Exercises
      • Straight leg raise exercises (supine, and side lying)
      • Quad sets – tightening muscles on front of and inner thigh for 5 seconds, 20 times, 10 times/day
      • Once daily passive and active ROM
      • Ankle pumps
    • 17.
      • Non-operative, single leg stationary cycling for 15 minutes per day with operative leg braced and supported
      • Upper extremity, trunk, and trunk training using light weights and bands
      Initial Postoperative Rehabilitation Week 1 Exercises
    • 18. Early Rehabilitation Weeks 2 – 4
      • Continuation of Week 1 Exercises
      • Myofascial Release
      • Soft tissue mobilization
      • Daily manual patella glides (up/down/side-to-side) by therapist and patient
    • 19.
      • Manual treatments to restore range-of-motion up to 90°
        • Extension should be equal bilaterally
      • Trunk stabilization
      • Pool / deep water workouts with brace once surgical wounds have healed
      Early Rehabilitation Weeks 2 – 4
    • 20. Functional Phase Weeks 4 – 6
      • Combined Articular Cartilage Repair: Progression from partial to full weight bearing starting at 4 wks.
      • Wean off use of brace.
      • Stretching, manual treatments to improve ROM, with focus on flexion.
    • 21.
      • Incorporate functional exercises with focus on closed-chain movements (e.g., partial squats, leg presses, calf raises, mini step-ups, balance activities).
      • Stationary bike with progression to road cycling as tolerated
      • Walking on treadmill
      Functional Phase Weeks 4 – 6
    • 22.
      • Progressively and cautiously increase intensity of functional exercises
      • Patients should be walking without a limp
      • Flexion should be 120 degrees
      Functional Phase Weeks 6 – 8
    • 23. Advanced Functional Phase Weeks 8 – 12
      • Add lateral training exercises (e.g. side-step ups, Theraband resisted side-stepping, lateral stepping, etc.)
      • Introduce more progressive single leg exercises.
      • Initiate a home program with emphasis on sport-specific training.
    • 24.
      • Low-impact activities until 16 weeks.
      • Increase intensity and strength of functional training for gradual return to all activities.
      Advanced Functional Phase Weeks 12 – 16
    • 25.
      • Return to sport is ultimately based on patient’s performance in functional tests which simulate the sport or activity.
      • Comparisons should be made between the surgical and non-surgical legs.
      • No high-impact, cutting or twisting activities for at least four months postoperatively.
      Advanced Functional Phase 16 Weeks On
    • 26. Fitter, Faster, Stronger
      • Patients go through surgery and extensive physical therapy to regain an active lifestyle.
      • We encourage patients to enjoy life and stay active until the day they drop…
    • 27. EXERCISE AND BIOLOGY
      • Stay biologic so you can avoid being bionic
      • Stay fit so you can enjoy every day of your life
      • Stay light so can live without pain
      • Have a good attitude = mind to body connection

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