Torsten Grønbech Nielsen

TY - JOUR

T1 - Free rehabilitation is safe after isolated meniscus repair

T2 - a prospective randomized trial comparing free with restricted rehabilitation regimens

AU - Lind, Martin

AU - Nielsen, Torsten

AU - Faunø, Peter

AU - Lund, Bent

AU - Christiansen, Svend Erik

PY - 2013/12

Y1 - 2013/12

N2 - BACKGROUND: The optimal rehabilitation program after meniscus repair has not been established. Numerous regimens have been suggested as beneficial for meniscus healing, but no controlled trials exist in the literature.HYPOTHESIS: The purpose of this prospective randomized trial was to investigate outcome with a free or a restricted rehabilitation regimen after isolated meniscus repair. The hypothesis was that free rehabilitation would result in increased failure of meniscus healing.STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1.METHODS: A total of 60 patients were included in this study within 2 to 3 days after meniscus repair. No patients with concomitant ligament reconstruction or cartilage repair surgery were included. Meniscus repair was performed with the all-inside technique; only vertical meniscus lesions close to the capsule were repaired. Patients were randomized to free (n = 32) or restricted (n = 28) rehabilitation. Free rehabilitation consisted of 2 weeks (range of motion [ROM], 0°-90°, no brace) and touch weightbearing, with unrestricted activity and free ROM allowed thereafter. Restricted rehabilitation consisted of 6 weeks of hinged brace use with a gradual increase ROM to 90° and only touch weightbearing during the 6 weeks. Patients were seen for follow-up at 3 months, 1 year, and 2 years. Those patients with joint line pain at the 3-month follow-up underwent MRI scanning to evaluate meniscus healing; a subsequent arthroscopy was performed for final evaluation meniscus healing if the MRI indicated lack of meniscus healing. At follow-up, the Knee Osteoarthritis Outcome Score (KOOS), Tegner function score, pain assessment, and patient satisfaction were used to evaluate outcomes.RESULTS: Eleven patients were lost to follow-up. Repeat arthroscopy in patients with persistent symptoms demonstrated partial healing or lack of healing in 28% and 36% of patients in the free and the restricted rehabilitation groups, respectively (P = .53, nonsignificant). The KOOS and Tegner function scores were similar between groups at all follow-up times, as was patient satisfaction. Patients who underwent subsequent partial meniscectomy because of meniscus repair failure had lower KOOS score and Tegner function score than did patients without repair failure.CONCLUSION: Free rehabilitation after meniscus repair is safe and does not entail increased failure rates compared with restricted rehabilitation. Subjective and functional outcomes at 1- and 2-year follow-up were not affected by rehabilitation regimen. Clinical outcomes in patients with repair failure who underwent subsequent partial meniscectomy were poorer than in those with healed meniscus repairs. A concern is the 30% overall lack of healing for patients with isolated meniscus lesions repaired with the all-inside technique.

AB - BACKGROUND: The optimal rehabilitation program after meniscus repair has not been established. Numerous regimens have been suggested as beneficial for meniscus healing, but no controlled trials exist in the literature.HYPOTHESIS: The purpose of this prospective randomized trial was to investigate outcome with a free or a restricted rehabilitation regimen after isolated meniscus repair. The hypothesis was that free rehabilitation would result in increased failure of meniscus healing.STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1.METHODS: A total of 60 patients were included in this study within 2 to 3 days after meniscus repair. No patients with concomitant ligament reconstruction or cartilage repair surgery were included. Meniscus repair was performed with the all-inside technique; only vertical meniscus lesions close to the capsule were repaired. Patients were randomized to free (n = 32) or restricted (n = 28) rehabilitation. Free rehabilitation consisted of 2 weeks (range of motion [ROM], 0°-90°, no brace) and touch weightbearing, with unrestricted activity and free ROM allowed thereafter. Restricted rehabilitation consisted of 6 weeks of hinged brace use with a gradual increase ROM to 90° and only touch weightbearing during the 6 weeks. Patients were seen for follow-up at 3 months, 1 year, and 2 years. Those patients with joint line pain at the 3-month follow-up underwent MRI scanning to evaluate meniscus healing; a subsequent arthroscopy was performed for final evaluation meniscus healing if the MRI indicated lack of meniscus healing. At follow-up, the Knee Osteoarthritis Outcome Score (KOOS), Tegner function score, pain assessment, and patient satisfaction were used to evaluate outcomes.RESULTS: Eleven patients were lost to follow-up. Repeat arthroscopy in patients with persistent symptoms demonstrated partial healing or lack of healing in 28% and 36% of patients in the free and the restricted rehabilitation groups, respectively (P = .53, nonsignificant). The KOOS and Tegner function scores were similar between groups at all follow-up times, as was patient satisfaction. Patients who underwent subsequent partial meniscectomy because of meniscus repair failure had lower KOOS score and Tegner function score than did patients without repair failure.CONCLUSION: Free rehabilitation after meniscus repair is safe and does not entail increased failure rates compared with restricted rehabilitation. Subjective and functional outcomes at 1- and 2-year follow-up were not affected by rehabilitation regimen. Clinical outcomes in patients with repair failure who underwent subsequent partial meniscectomy were poorer than in those with healed meniscus repairs. A concern is the 30% overall lack of healing for patients with isolated meniscus lesions repaired with the all-inside technique.

KW - Adolescent

KW - Adult

KW - Arthralgia/surgery

KW - Arthroscopy/methods

KW - Braces

KW - Female

KW - Fractures, Cartilage/surgery

KW - Humans

KW - Knee Injuries/rehabilitation

KW - Magnetic Resonance Imaging

KW - Male

KW - Menisci, Tibial/surgery

KW - Middle Aged

KW - Osteoarthritis, Knee/etiology

KW - Pain Measurement

KW - Patient Satisfaction

KW - Prospective Studies

KW - Range of Motion, Articular

KW - Rupture/surgery

KW - Tibial Meniscus Injuries

KW - Weight-Bearing

KW - Wound Healing

KW - Young Adult

U2 - 10.1177/0363546513505079

DO - 10.1177/0363546513505079

M3 - Journal article

C2 - 24114748

VL - 41

SP - 2753

EP - 2758

JO - The American Journal of Sports Medicine

JF - The American Journal of Sports Medicine

SN - 0363-5465

IS - 12

ER -