SPORTS MEDICINE SERVICE
Meniscal Allograft Transplantation
General Guidelines
- No open kinetic chain hamstring work for 3 months
- No terminal knee extension exercises for 3 months
- Meniscal transplant performed with ACL reconstruction follows ACL post-op protocol, with the above exceptions
- Supervised physical therapy take place 3-9 months post-operatively
General Progression of Activities of Daily Living
- Bathing/Showering without brace after suture removal
- Sleep with brace locked in extension for 6 weeks
- Driving at 8 weeks post-op
- Brace locked in extension for ambulation for 6 weeks
- Use of crutches continued for 8-12 weeks post-op
- Weightbearing as tolerated without use of crutches at 8-12 weeks post-op
Physical Therapy Attendance
- Phase I (0-8 weeks): 1 visit/week
- Phase II (8-12 weeks): 2-3 visits/ week
- Phase III (3-9 months): 2-3 visits/week first month, reduce one visit/ 1-2 weeks
- Phase IV (9 months +): Discontinue PT on completion of functional progression
Rehabilitation Progression
The following is a general guideline for progression of the rehabilitation program following meniscal allograft transplant surgery. Progression through each phase should take into consideration patient status and physician advisement. Pleas consult the attending physician if there is any uncertainty in regards to either the protocol provided or patient progression to the next Phase.
Phase I (0-8 weeks)
Goals
- Protect allograft fixation and surrounding soft tissue
- Control inflammation
- Minimize the effects of immobilization through ROM exercises (heel slides)
- Education of patient regarding limitations and the rehabilitation process
Brace
0- 6 weeks Locked in full extension for gait and sleeping, unlock for therapeutic exercise
6-8 weeks Unlocked for controlled gait training in physical therapy or at home, discontinue use at night
Weightbearing status
0-8 weeks Weightbearing as tolerated with 2 crutches
Therapeutic Exercise
- Quad sets
- Ankle pumps, progress to resistive theraband exercises
- Heel slides from 0-90 degrees of knee flexion
- Non-weightbearing calf, hamstring stretches
- SLR in flexion, abduction, adduction, extension of hip with brace locked in full extension until quadriceps strength is sufficient to prevent extensor lag
- Patellar mobilization
- Begin aquatic therapy at 4 weeks (if available) with emphasis on normalization of gait
Phase II (8 weeks – 3 months)
Criteria for advancement
- Good quad set
- Approximately 90 degrees of flexion
- Full extension
- No signs of active inflammation
Goals
- Increase flexion range of maotion
- Increase quadriceps strength
- Restore normal gait
- Avoid overstressing the graft
Brace Discontinue at 8 weeks
Weight bearing status Discontinue use of crutches at 8 weeks if following criteria are met
- No extensor lag
- Full extension
- Non-antalgic gait pattern
Therapeutic Exercises
- Wall slides 0-45 degrees, progressing to mini-squats
- 4 way hip for flexion, adduction, abduction, and extension
- Stationary bike (No toe clips)
- Leg press 0-60 degrees of flexion
- Step-ups (begin at 2 ” progress to 8”)
- Knee extensions 50-90 degrees
- Toe raises
- Balance exercises (eg single leg balance)
Phase III (3 months -9 months)
Criteria for Advancement
- Full knee extension, at least 100 degrees of flexion
- Good quadriceps strength
- No patellofemoral or soft tissue complaints
- No signs of active inflammation
Goals
- Restore full range of motion
- Continue improvement of quadriceps strength
- Initiate isolated hamstring strengthening
- Improve functional strength and proprioception
Therapeutic Exercise
- Progression of closed chain kinetic chain and balance activities
- Closed kinetic chain terminal extension with resistive tubing or weight machine
- Hamstring curls 0-60 degrees of flexion
- Swimming – No breaststroke
- Jogging in pool with wet vest or belt
- Stairmaster ( begin with high resistance)
Phase IV (9 months +)
Criteria for Advancement
- Physician clearance to initiate functional progression
- No patellofemoral or soft tissue complaints
- Necessary joint range of motion, strength, endurance, and propioception to safely return to work or athletics
Goals
- Sport-specific training or work hardening program
- Maintenance of strength, endurance, and proprioception
- Patient education with regards to any possible limitations
Therapeutic Exercise
- Continue strength, endurance, proprioceptive program
- Functional progression including but not limited to
o Slide board
o Walk/jog progression
o Forward, backward running, cutting, carioca, etc.
o Work hardening program as prescribed by physician
Return to Full Activity
The patient may return to full activity including sports participation when he/she completes an appropriate functional progression and has clearance from the physician. This usually occurs at approximately 9 months post-operatively