22.
The impact of free or restricted rehabilitation on healing of meniscus
repair. A prospective randomized clinical trial.
Martin Lind, Torsten Nielsen, Bent Lund, Faunø Peter, Svend Erik
Christiansen
Div of Sportstrauma, Orthopedic Dept. Århus University Hospital ; Div of
Sportstrauma, Orthopedic Dept. , Aarhus University Hospital; Div of
Sportstrauma, Orthopedic Dept. , Aarhus University Hospital; Div of
Sportstrauma, Orthopedic Dept. , Aarhus University Hospital; Div of
Sportstrauma, Orthopedic Dept. , Aarhus University Hospital
Background:
The optimal rehabilitation after meniscus repair has not been
established. No controlled trials exist in the literature and numerous regimes
have been suggested.
Purpose / Aim of Study:
The purpose of this study was to investigate the
outcome of meniscus repair with an either free or restricted rehabilitation
regimen in a prospective randomized controlled clinical trial.
Materials and Methods:
60
patients were included in the trial. Patients were
randomized within 4 days after all-inside meniscus repair. 33 patients and 27
patients were randomized to free and restricted rehabilitation respectively. Free
rehabilitation consisted of 2 weeks in brace and touch weight bearing,
followed by unrestricted activity. Restricted rehabilitation consisted of 6 weeks
of brace usage with gradually increased range of motion and touch weight
bearing. Patients were seen for follow-up at 3, 12, 24 months. Any patients
with joint line pain after 3 months had MRI to evaluate meniscus healing. A
subsequent arthroscopy was performed for final evaluation meniscus healing if
MRI indicated lack of healing. At follow-up, KOOS, Tegner Score, and patient
satisfaction were used to evaluate outcome.
Findings / Results:
Six patients were lost to follow-up. Re- arthroscopy in
patients with continuous symptoms demonstrated partial healing or lack of
healing in 41 % and 33 % of patients in the restricted and free rehabilitation
groups respectively. KOOS, Tegner score, and satisfaction was similar
between groups.
Conclusions:
Free rehabilitation after meniscus repair is safe with a tendency
to better meniscus healing compared to restricted rehabilitation. Subjective and
functional outcome at one and two year’s follow-up was not affected by
rehabilitation regimen. An overall lack of healing of 35 % for isolated
meniscus lesions repaired with all-inside technique is a concern.
