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半月板损伤不同手术方式的康复要点
时间:2010/12/22 23:47:41

 

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


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