Publicly Available Rehabilitation Protocols Designated for Meniscal Repairs Are Highly Variable

Abstract

Purpose: To compare publicly available rehabilitation protocols designated for meniscal repairs published online to determine the variability in meniscus repair protocols including different types of tears (radial vs nonradial repairs). Methods: From the Fellowship and Residency Electronic Interactive Database Access System (FREIDA), a list of publicly available academic residency programs and orthopaedic sports medicine fellowships was obtained. With this list, an electronic search using Google was performed looking for meniscal repair rehabilitation protocols. In addition to academic institutions, private practice organizations with published meniscus repair rehabilitation protocols found during the search also were examined. Results: Of 189 academic institutions, a total of 30 academic institutions had protocols that were included. Another 29 private practice programs were subsequently found and included. In total, 59 rehabilitation protocols fit the inclusion criteria. Six of the 59 specified radial repair and 53 did not. For return to full range of motion, nonradial protocols averaged 6.7 weeks and radial protocols averaged 7.3 weeks. For return to full weight-bearing, nonradial protocols averaged 6.2 weeks and radial protocols averaged 7.5 weeks. For return to sport, nonradial protocols averaged 17.8 weeks and radial protocols averaged 23.3 weeks. For time spent in a brace, nonradial protocols averaged 5.7 weeks and radial protocols averaged 6.7 weeks. Conclusions: Of publicly available meniscal repair rehabilitation protocols, a small percentage (10.2%) changed their protocol in relation to tear type and there was a wide range of timeframes for each rehabilitation component. Protocols for radial tears tended to brace patients longer, limit their range of motion longer, delay full weight-bearing, and delay return to sport. However, it is recognized that some surgeons could be modifying their protocols in relation to tear type without publishing that information online. Clinical Relevance: As stated in the purpose, the point of this study was to access only the protocols that would be available to the public. If anything, awareness should be raised for surgeons to look at their existing protocols and update them if they are truly incomplete and outdated. More research needs to be done to structure a rehabilitation protocol that is specific to the meniscal tear type, as the current protocols have a wide range of variance.

Outside‐in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review

“…This technique allows an anatomic repair and does not change the meniscus physiological properties after a posterior horn lesion [31]. The literature shows little agreement on guidelines on rehabilitation after meniscal repair [12, 23, 54, 67]. Weight‐bearing was not allowed in four of the included studies for the first 2–6 weeks [13, 38, 51, 68].…”

Comparison of Functional Outcomes after Anterior Cruciate Ligament Reconstruction with Meniscal Repair for Unstable versus Stable Meniscal Tears

“…Our rehabilitation protocols, differentiated by meniscal tear stability, were designed based on evidence suggesting varied recovery trajectories [15][16][17][18][19]. Each protocol aims to optimize recovery while mitigating risk of reinjury.…”

“…Therefore, previous study has shown varied recovery trajectories based on the type of meniscal tear, highlighting the need for tailored rehabilitation approaches [15]. Furthermore, in several previous studies [15][16][17], there was a difference in rehabilitation programs, including ROM, WB, and muscle strengthening after surgery in patients with stable and unstable meniscal tears; in particular, restricted rehabilitation was recommended after meniscal repair for unstable meniscal tears [16][17][18]. Differences in rehabilitation methods, especially restricted rehabilitation, may affect the recovery of functional outcomes after surgery.…”