Rehabilitation after Meniscus Transplant


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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).
  • Rehabilitation after Meniscus Transplant

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