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Meniscal repair rehabilitation

Jack Feehan, Chris Macfarlane, Brett Vaughan
Meniscal injury is one of the most common knee soft tissue injuries, commonly affecting young athletes and an older, degenerative population. Treatment largely depends on the type and extent of the injury with arthroscopic repair or meniscectomy being mainstays. Although non-surgical approaches have been described, there is no published literature regarding a combination of indirect osteopathic techniques and rehabilitation in the management of these injuries. The current case report follows a 20-year-old male presenting with a 5-day history of acute knee pain, following trauma during an Australian Rules Football (AFL) match...
August 2017: Complementary Therapies in Medicine
Jelle P van der List, Gregory S DiFelice
INTRODUCTION: Recently, there has been a resurgence of interest in primary anterior cruciate ligament (ACL) repair. The procedure is less invasive than ACL reconstruction, yet studies assessing early postoperative course are lacking. Goal therefore was to assess postoperative range of motion (ROM), complications and operative times following primary repair and compare this to the gold standard of reconstruction. METHODS: A retrospective study was performed for which 52 repair and 90 reconstruction patients could be included...
May 24, 2017: Knee
Kevin O'Donnell, Kevin B Freedman, Fotios P Tjoumakaris
BACKGROUND: Current postoperative rehabilitation protocols after isolated meniscal repair vary widely. No consensus exists with regard to the optimal amount of weightbearing, range of motion, or speed at which the patient progresses through the rehabilitation phases. Confounding factors including concomitant ligamentous or cartilaginous injuries have made studying isolated meniscal tears problematic. PURPOSE: To systematically review and evaluate the influence of range of motion and weightbearing status during the postoperative rehabilitation period after isolated meniscal repair on clinical efficacy and outcome scores...
June 2017: American Journal of Sports Medicine
Helge Eberbach, Jörn Zwingmann, Lisa Hohloch, Gerrit Bode, Dirk Maier, Philipp Niemeyer, Norbert P Südkamp, Matthias J Feucht
PURPOSE: The purpose of this systematic review was to assess sport-specific outcomes after repair of isolated meniscal tears. METHODS: A systematic electronic search of the MEDLINE and Cochrane database was performed in May 2016 to identify studies that reported sport-specific outcomes after isolated meniscal repair. Included studies were abstracted regarding study characteristics, patient demographics, surgical technique, rehabilitation, and outcome measures. The methodological quality of the included studies was assessed with the Coleman Methodology Score (CMS)...
February 27, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Cécile Toanen, Guillaume Demey, Panagiotis G Ntagiopoulos, Paolo Ferrua, David Dejour
BACKGROUND: Results of anterior cruciate ligament (ACL) reconstruction are traditionally excellent in younger and nonarthritic patients. During the past few decades, people older than 60 years have become more active than ever, with more demanding physical lifestyles. An increase also has been noted in active patients with diagnosed ACL injuries. More patients are requesting treatment for ACL deficiency in hopes of returning to preinjury levels of activity. PURPOSE: The aims of this study were to evaluate the results of ACL reconstruction in patients older than 60 years in terms of functional recovery, return to sports, and postoperative incidence of osteoarthritis and to compare their results with published results of different age groups...
March 2017: American Journal of Sports Medicine
Alaina M Brelin, John-Paul H Rue
Meniscus tears are commonly encountered in the athletic population and can result in significant loss of playing time. Current treatment methods for acute tears consist of meniscectomy and meniscal repair, whereas meniscal allograft transplant is reserved as a salvage procedure for symptomatic meniscectomized patients who desire a more functional knee. This review describes the postoperative rehabilitation protocol for each procedure and evaluates the outcomes in existing literature as it pertains to the athlete...
October 2016: Clinics in Sports Medicine
W Michael Pullen, Brandon Bryant, Trevor Gaskill, Nicholas Sicignano, Amber M Evans, Marlene DeMaio
BACKGROUND: Arthroscopically assisted anterior cruciate ligament (ACL) reconstruction is a common orthopaedic procedure. Graft failure after reconstruction remains a devastating complication, often requiring revision surgery and less aggressive or modified rehabilitation. Worse functional and patient-reported outcomes are reported compared with primary reconstruction. Moreover, both rates and risk factors for revision are variable and inconsistent within the literature. PURPOSE: To determine the rate of revision surgery after ACL reconstruction in a large cohort of patients, to assess the influence of patient characteristics on the odds of revision, and to compare revision rates between active-duty military members and non-active-duty beneficiaries...
December 2016: American Journal of Sports Medicine
Jorge Chahla, Chase S Dean, Gilbert Moatshe, Justin J Mitchell, Tyler R Cram, Carlos Yacuzzi, Robert F LaPrade
Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and consequently, ramp lesions often go undiagnosed...
July 2016: Orthopaedic Journal of Sports Medicine
Patrick C McCulloch, Hugh L Jones, Kendall Hamilton, Michael G Hogen, Jonathan E Gold, Philip C Noble
BACKGROUND: The objective of rehabilitation following meniscal repair is to promote healing by limiting stresses on repairs, while simultaneously preserving muscle strength and joint motion. Both protective protocols limiting weight bearing and accelerated which do not, have shown clinical success. This study assesses the effects of physiologic gait loading on the kinematic behavior of a repaired medial meniscus. METHODS: The medial menisci of eight fresh cadaveric knees were implanted with arrays of six 0...
December 2016: Journal of Experimental Orthopaedics
Brett T Mueller, Samuel G Moulton, Luke O'Brien, Robert F LaPrade
There is a growing body of evidence surrounding the pathology and treatment of meniscal root tears. As surgical techniques are being developed and refined, rehabilitation protocols for meniscal root repairs must be defined and tested. Little information has been published regarding specific rehabilitation parameters for meniscal root repairs through all phases of rehabilitation. The goal of this commentary is to describe a rehabilitation program for meniscal root repairs that is founded on anatomical, physiological, and biomechanical principles with criteria-based progressions...
February 2016: Journal of Orthopaedic and Sports Physical Therapy
Kelly L VanderHave, Crystal Perkins, Michael Le
CONTEXT: Optimal rehabilitation after meniscal repair remains controversial. OBJECTIVE: To review the current literature on weightbearing status after meniscal repairs and to provide evidence-based recommendations for postoperative rehabilitation. DATA SOURCES: MEDLINE (January 1, 1993 to July 1, 2014) and Embase (January 1, 1993 to July 1, 2014) were queried with use of the terms meniscus OR/AND repair AND rehabilitation. STUDY SELECTION: Included studies were those with levels of evidence 1 through 4, with minimum 2 years follow-up and in an English publication...
September 2015: Sports Health
Craig R Bottoni, Eric L Smith, James Shaha, Steven S Shaha, Sarah G Raybin, John M Tokish, Douglas J Rowles
BACKGROUND: The use of allografts for anterior cruciate ligament (ACL) reconstruction in young athletes is controversial. No long-term results have been published comparing tibialis posterior allografts to hamstring autografts. PURPOSE: To evaluate the long-term results of primary ACL reconstruction using either an allograft or autograft. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: From June 2002 to August 2003, patients with a symptomatic ACL-deficient knee were randomized to receive either a hamstring autograft or tibialis posterior allograft...
October 2015: American Journal of Sports Medicine
G A Cristiani-Díaz, H A Delgado-Brambila
UNLABELLED: The practice of sports has experienced a huge boom in societies worldwide. It often involves knee injuries, specifically meniscal tears that warrant surgical treatment which may include: fragment remodeling and resection, meniscal repair or, in extreme cases, the use of a meniscal graft. In this prospective study we performed fragment resection and meniscal remodeling in athletes and we measured their postoperative physical-athletic performance. METHODS: Inclusion criteria: Patients of both sexes who practice a sport either as amateurs or at a recreational competitive level, who sustained a meniscal injury...
January 2014: Acta Ortopédica Mexicana
Matthias J Feucht, Jan Kühle, Gerrit Bode, Julian Mehl, Hagen Schmal, Norbert P Südkamp, Philipp Niemeyer
PURPOSE: To systematically review the results of arthroscopic transtibial pullout repair (ATPR) for posterior medial meniscus root tears. METHODS: A systematic electronic search of the PubMed database and the Cochrane Library was performed in September 2014 to identify studies that reported clinical, radiographic, or second-look arthroscopic outcomes of ATPR for posterior medial meniscus root tears. Included studies were abstracted regarding study characteristics, patient demographic characteristics, surgical technique, rehabilitation, and outcome measures...
September 2015: Arthroscopy: the Journal of Arthroscopic & related Surgery
Christopher M LaPrade, Matthew D LaPrade, Travis Lee Turnbull, Coen A Wijdicks, Robert F LaPrade
BACKGROUND: Current methods of the transtibial pull-out meniscal root repair significantly displace under cyclic loading in porcine models but have not been evaluated in human models. One potential explanation for the displacement is that a single transtibial tunnel may not fully restore the attachment of the entire posterior medial meniscal root. PURPOSE/HYPOTHESIS: The purpose of this study was to biomechanically evaluate the transtibial pull-out technique in a human cadaveric model using either 1 or 2 transtibial bone tunnels...
April 2015: American Journal of Sports Medicine
Robert F LaPrade, Christopher M LaPrade, Michael B Ellman, Travis Lee Turnbull, Anthony J Cerminara, Coen A Wijdicks
BACKGROUND: Recent biomechanical evidence suggests that the meniscus-suture interface contributes the most displacement to the transtibial pull-out repair for meniscal root tears. Therefore, optimization of surgical technique at the meniscus-suture interface may minimize displacement and improve the strength of meniscal root repairs. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate the cyclic displacement and ultimate failure loads of 4 different meniscus-suture fixation techniques for posterior medial meniscal root repairs in human meniscus tissue...
April 2015: American Journal of Sports Medicine
Roger Menta, Scott Howitt
Meniscal allograft transplantation (MAT) is a relatively new procedure that has gained popularity in the last couple of decades as a possible alternative to a meniscectomy to provide significant pain relief, improve function, and prevent the early onset of degenerative joint disease (DJD). As of present, evidence is limited and conflicting on the success of such procedures. In this case, a 16-year old male athlete underwent numerous surgical procedures to correct a left anterior cruciate ligament (ACL) rupture with associated medial and lateral meniscal damage that occurred as a result of a non-contact mechanism of injury...
December 2014: Journal of the Canadian Chiropractic Association
John T Cavanaugh
Meniscal cartilage plays an essential role in the function and biomechanics of the knee joint. The meniscus functions in load bearing, load transmission, shock absorption, joint stability, joint lubrication, and joint congruity. Individuals today are increasingly more active in later decades of life. Although the incidence of meniscal pathology is difficult to estimate, this increased exposure to athletic activity increases the risk of injury to these structures. Hede and coworkers reported the mean annual incidence of meniscus tears as 9...
December 2014: Journal of Knee Surgery
Anthony J Cerminara, Christopher M LaPrade, Sean D Smith, Michael B Ellman, Coen A Wijdicks, Robert F LaPrade
BACKGROUND: A common treatment for posterior meniscal root tears is transtibial pull-out repair, which has been biomechanically reported to restore tibiofemoral contact mechanics to those of the intact knee. Biomechanical data suggest that there is significant displacement of the repaired meniscal root with cyclic loading, which may be responsible for the poor healing and meniscal extrusion demonstrated in some clinical studies. HYPOTHESIS/PURPOSE: The purpose of this study was to quantify the time-zero displacement of the posterior meniscal root in response to cyclic loading after transtibial pull-out repair and to quantify the individual contributions to displacement of the following: (1) suture elongation, (2) button-bone interface, and (3) meniscus-suture interface...
December 2014: American Journal of Sports Medicine
Simon C Mordecai, Nawfal Al-Hadithy, Howard E Ware, Chinmay M Gupte
Treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair. Selecting the most appropriate treatment for a given patient involves both patient factors (e.g., age, co-morbidities and compliance) and tear characteristics (e.g., location of tear/age/reducibility of tear). There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line...
July 18, 2014: World Journal of Orthopedics
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