Rehab after meniscal repair
Best case scenario
If relatively minor arthroscopic surgery has been performed (such as removing a cartilage loose body or trimming a small meniscal cartilage tear) then most patients are able to fully weight bear without support within just a couple of hours of the operation, with minimal pain. They may not require crutches at all and may be comfortable to go home a few hours (usually about 4) after the procedure.
The bandage and dressings from the operation can be taken down and discarded 48 hours post-op, with waterproof dressings applied to the wounds and a tubigrip bandage put over the knee.
Patients are encouraged to keep the knee moving gently but to take things very easy and rest for the first 1 or 2 weeks after the surgery. A gradual step-wise return to full exercise should then be undertaken, often best under the supervision of an appropriate physiotherapist. Once the swelling in the knee has gone (which can take a few weeks), the range of motion has recovered, the muscle strength returned and the knee's reflexes come back patients can then return to full exercise and sporting activities.
This scenario applies mostly to patients undergoing:-
- Removal of loose bodies
- Medial plica excision
- Abrasion chondroplasty
- Radiofrequency ablation chondroplasty
- Excision of scarring of the fat pad
For more major cases
The more has been found and done inside the knee, the slower and more cautious a patient's rehab and recovery will need to be.
In cases where a lateral release has been performed, swelling of the knee is more common and return to comfortable full motion and function slower. Depending on the exact nature of the procedure, patients are normally advised to take things easy for the first 6 weeks, with only gentle range of motion exercises and gentle muscle training. More vigorous and heavier exercising is commenced at 6 weeks post-op, aiming at a return to sport by 3 months.
Where meniscal repair or microfracture has been performed, it may be necessary for a patient to be non- or partial weight bearing, with or without a knee brace. This is determined on a case-by-case basis depending on what is found and what is done intra-operatively within the knee.
Standard rehab protocol after meniscal repair
- At 48 hours:Removal of bandages and dressings, with application of fresh dressings plus tubigrip bandaging
- For the 1st 6 weeks:Crutches, with partial weight bearing plus a hinged knee brace locked so as to allow the knee to only move between full extension (straight) up to about 45degrees flexed (bent). The brace does need to be kept on day and night to prevent the knee from flexing up. This is because the cartilages in the knee are put under significant stress when the knee flexes, and this can potentially rupture the tiny sutures used in a meniscal repair, causing the repair to fail and the tissue to re-tear. The brace can be removed for washing, but if it is then great care must be taken and the knee must be kept straight.
- At 6 weeks:The brace is removed and the crutches are discarded. Patients are then encouraged to fully weight bear and to start intensive physiotherapy.
The physio treatment is aimed at -
- Regaining the range of motion in the knee
- Regaining muscle strength
- Restoring the reflexes in the joint (proprioception)
- At 12 weeks (3 months):If your physiotherapist feels that you knee is ready, then you will be able to gradually make a careful return to full exercise and sport, although great caution is urged if the intention is to return to heavy impact or contact sport, in which case a slowly progressive staged return to competition is recommended.
But what will my expected recovery be?
It is acknowledged that the lack of certainty regarding post-operative recovery, mobility and rehab does make it extremely difficult for patients to make firm plans for travel, home life and work post-operatively.
However, your surgeon will normally be able to give you a reasonably firm indication pre-operatively regarding your presumed diagnosis, the nature of the expected procedure and hence the anticipated rehab.
When will I be able to go home after the operation?
Most patients can go home on the same day as their operation, if the operation is performed early enough in the day, depending on how extensive the actual surgery inside the knee has had to be. With operations performed in the evening, for patients who are generally less mobile or less medically fit, and where larger or multiple procedures have been performed, patients may need to stay in for 1 night post-operatively, although they can normally then be discharged first thing the next morning if they are comfortable and sufficiently mobile.
You should always plan to have a friend or family member available to take you or accompany you home after your operation, and to stay with you and keep you company for the first 24 hours post-operatively.