半月板损伤不同手术方式的康复要点

Meniscal Injuries
Specific Rehabilitation Considerations
Surgical Interventions
• Total menisectomy
• Partial menisectomy
• Meniscal repair
• Meniscal transplantation
Total Menisectomy
• Quickly alleviates mechanical symptoms of meniscus injury
• Short-term results favorable
• Long-term results unfavorable due to degenerative changes in articular cartilage
Partial Menisectomy
• Removal of damaged portion of meniscus - try to maintain as much as possible to avoid degenerative changes
• Rehabilitation progression is symptoms driven - many able to return to high level activity in 2-3 weeks
Meniscus Repair
• Due to degenerative changes associated with total and partial menisectomies, repair is best option if available
• Depends on location of injury - peripheral 1/3 of meniscus has blood supply to allow healing of repair site
• Rehab progression is much more guarded than with menisectomy
• Progression from NWB to FWB over first 4 weeks - often placed in brace locked at full extension
– Loads repair site to approximate ends of repair
– Avoids weight bearing knee flexion which could damage ends of repair
• Full ROM exercises performed NWB outside of brace - cautious with flexion
• Aggressive flexion ROM exercises can be initiated at ~4 weeks
• Brace typically removed at 4-6 weeks
• FWB allowed if minimal effusion, normal extension ROM, flexion ROM to 90 degrees and good quadriceps control
• At 4-6 weeks, if no complications, aggressive strengthening and ROM exercises added to program
• Takes ~1-2 months for full strength and ROM to return
• At this time, functional activities added to program - lasts 4-6 weeks
• Total program lasts 4-6 months
Meniscus Transplant
• Relatively new procedure with little research at this time
– Early results encouraging, but long-term outcomes and efficacy of procedure not known at this time
• Uses either allograft or synthetic material for meniscal graft