Meniscal Allograft Transplantation: Post op Rehabilitation

Outline
Post-operative treatment following allograft meniscal transplantation is similar to regimes following meniscal repair surgery. Progress is slow, because of the requirement for protecting the transplanted meniscus from higher loads while it heals fully in the joint, which may already have early wear changes.
Results show that the risk to the meniscus for re-tearing is in the first 15 months – this is why the rehabilitation process is slow.

0-6 Weeks

• Range of movement: restricted to 0-90 flexion, initially using a hinged knee brace. The meniscus is known to show little movement from 0-60 degrees of flexion, but beyond 90 degrees flexion the meniscus is compressed and moves backwards (posteriorly), pulling on the attachment points.
• Knee brace: applied immediately following surgery to hold the knee still. This should be worn day and night for the first 2 weeks providing protection to the knee. The hinges are locked holding the knee in full extension when walking but can be released when sitting or resting.
• After 2 weeks it is safe to move around without the brace staying touch weight bearing but still not bending beyond 900. The brace may still be worn for comfort if required.
• Weight bearing: Touch Weight bearing on crutches for 6 weeks to avoid damage to the healing meniscal rim and anchor points during the initial healing phase.
• Exercises to push full extension are avoided for the first 4 weeks as forced extension compresses the meniscus and pulls on the attachment points. At 4 weeks extension exercises can be started.
• Isometric exercises are encouraged. Inner range quads (terminal extension) are avoided as these put high sheer forces on the meniscus.

6-12 Weeks

• At 6 weeks the new meniscus should have healed well enough to allow full bending of the knee – but not by loading the knee in flexion, just by heel slides and flexion exercises
• This phase is to work on regaining strength and proprioception, while avoiding forced flexion and pivoting activities (for at least 6 months).
• Closed kinetic chain exercises can be begun with full weight bearing.
• Cycling is allowed from 6 weeks building up strength.
• Cross trainer from 8 weeks so long as swelling has resolved or is not made worse by exercise.
• Wall slide exercises must be avoided as this puts excessive force on the healing meniscus

3-6 Months and then beyond

• Rehabilitation can proceed similar to ACL reconstruction and meniscal repair, but at a slower timescale allowing running at the earliest at 6 months and the introduction of pivoting and sport training if appropriate at 6 months.
• Full rehabilitation takes up to 9 months and any decision to return to high impact sports should be taken by discussion with the consultant
• At 12 months An MRI scan is usually performed to evaluate the healing and follow-up outcome scores are collected either by email or in person.