MENISCUS ALLOGRAFT RECONSTRUCTIONProtocol.pdf

MENISCUS ALLOGRAFT

REHABILITATION PROTOCOL

Dr. Walter R. Lowe

This rehabilitation protocol has been developed for the patient with an

osteochondral allograft transfer procedure. It is extremely important to protect

this patient against high weight bearing forces during the early postoperative

period to avoid shearing or disruption of the graft tissues. Early passive range of

motion is highly beneficial to enhance the cartilage and the remodeling process.

The protocol is divided into phases. Each phase is adaptable based on the

individual patient and special circumstances.

The overall goals of the surgical procedure and rehabilitation are to:

• Control pain, swelling, and hemarthrosis

• Regain normal knee range of motion

• Regain a normal gait pattern and neuromuscular stability for

a bulation

• Regain normal lower extremity strength

• Regain normal proprioception, balance, and coordination for daily

activities

• Achieve the level of function based on the orthopedic and patient

goals

The physical therapy should be initiated within 3 to 5 days post-op. It is

extremely important for the supervised rehabilitation to be supplemented by a

home fitness program where the patient performs the given exercises at home or

at a gym facility. Important post-op signs to monitor:

• Abnormal pain response, hypersensitive

• Abnormal gait pattern, with or without assistive device

• Limited range of motion

• Weakness in the lower extremity musculature ( quadriceps,

ha string)

• Insufficient lower extremity flexibility

Return to activity requires both time and clinical evaluation. To safely and most

efficiently return to normal or high level functional activity, the patient requires

adequate strength, flexibility, and endurance. Isokinetic testing and functional

evaluation are both methods of evaluating a patient’s readiness to return to

activity. Return to intense activities following a meniscal transplant may increase

the risk of repeat injury or the potential of compounding the original injury.

Symptoms such as pain, swelling, or instability should be closely monitored by the

patient.

• Swelling of the knee or surrounding soft tissue

Dr. Walter R. Lowe

Phase 1: Week 1-4

Meniscal Transplant

WEEK

EXERCISE

GOAL

1-4

0-90 °

Passive, 0-90 °

Patella obs

nkle pups

Gastoc/Soleus/Hamstring stretch

Heel/Wall slides to reach goal

TETH

Quad sets with e-stim/biofeedback

SLR in (flex, abd, add) as tolerated

Multi-angle isometrics (0-60 ° )

Hamstring/Gluteal isometric sets

Knee extension (90-30 ° ) (active assisted)

WEIGHT BEARING

TB TO PB

T-PB

rutches post-op

Removed during range of motion exercise

0-90 °

LITIES

E-stim/biofeedback as needed

Ice 15-20 minutes

GOALS OF PHASE:

• ROM 0-90 °

• Adequate quad/VMO contraction

• Independent in HEP

• Control pain, inflammation, and effusion

• TDWB to PWB as noted by Dr. Lowe

racing ith 0-90 ° range of motion

Phase 2: Week 4-12

Meniscal Transplant

WEEK

EXERCISE

GOAL

4-12

ROM

0-135 °

Passive, 0-135 °

Patella obs

Gastoc/Soleus/Hamstring stretch

IT/uad stretch

Heel/Wall slides to reach goal

Prone hang to reach goal

TETH

Progression of isometric exercises

SLR in 4 planes with ankle wt/tubing

Knee extension (90-30 ° ) with light weight

Hamstring curl with light weight

Leg press (0-60 ° )/Total Gym

Heel raise/Toe raise

Multi-hip in 4 directions

Mini-squats (0-30 ° )

Initiate 3-6” lateral/forward step-up/down

BALANCE TRAINING

Weight shift (side-to-side, fwd/bkwd)

Initiate single leg balance work

½ Foam roller work

Wobble board work

Sportscord balance/agility work

WEIGHT BEARING

PWB to FWB with quad control

PWB to FWB

Discharge at week 4

/C k 4

AEROBIC CONDITIONING

Bicycle when flexion is 110 °

EFX

alking program

iing

LITIES

Ice 15-20 minutes

GOALS OF PHASE:

• PWB to FWB

• ROM 0-135 °

• Control pain, inflammation, and effusion

• Increase lower extremity strength

• Enhance proprioception, balance, and coordination

Phase 3: Week 12-16

Meniscal Transplant

WEEK

ROM

EXERCISE

Gastroc/Soleus/Hamstring stretch

ITB/Quad stretch

TETH

Continue all strengthening exercises from

previous phases

Progress with all single leg activity

BALANCE TRAINING

Advanced proprioception/balance activity

Single leg work with plyotoss

Dynamic balance work on advanced surfaces

RUNNING PROGRAM

Initiate jump rope for endurance and impact

Initiate running on minitramp, progress to

treadmill as tolerated

FUNCTIONAL TRAINING

Lateral movements (slide board, shuffles)

Initiate light plyometric training

LITIES

Ice 15-20 minutes as needed

GOALS OF PHASE

• Maintain full range of motion

• Increase lower extremity strength and endurance

• Initiate functional activity

• Initiate sport specific activity

12-16

Phase 4: Week 16-24

Meniscal Transplant

WEEK

ROM

EXERCISE

Continue with all stretching activities

TETH

Continue with all strengthening activities

from previous phases increasing weight and

repetition

RUNNING/CONDITIONING PROGRAM

Bicycle with resistance for endurance

EFX/StairMaster for endurance

Increase running program

Increase walking program

Swimming for endurance

Backward running

CUTTING/AGILITY PROGRAM

Lateral shuffle/slide board

arioca

Figure 8’s

FUNCTIONAL TRAINING

Advance plyometric program

Advance sport specific drills

LITIES

Ice 15-20 minutes as needed

GOALS OF PHASE:

• Enhance lower extremity strength and endurance

• Return to previous activity level

• Return to sport specific functional level

16-24

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