Rehabilitation following meniscal repair: a systematic review

Objective

To review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery.

Methods and data sources

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies.

Results

Seventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair.

Conclusions

There is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.

Closed Cephalomedullary Nailing with Patient in Lateral Decubitus Position for Repair of Peritrochanteric Femoral Fracture

Introduction

Closed repair of peritrochanteric fractures with cephalomedullary nail fixation with the patient in the lateral decubitus position on a flat table with manual traction may allow improved fracture reduction and fixation in comparison with what is possible in a supine setup.

Indications & Contraindications

Step 1 Operating Room Preparation

Perform sterile preparation, have the patient brought to the operating room, induce anesthesia, and place the patient in the lateral decubitus position before sterile draping.

Step 2 Fracture Reduction

Reduce the fracture using manual traction and slight internal or external rotation; confirm anatomic reduction radiographically.

Step 3 Nail Insertion

Determine the appropriate nail length, identify the nail entry point, open the femoral canal, insert a ball-tipped guide into the canal, insert the nail, and attach the aiming arm to the nail.

Step 4 Insertion of Cephalic Lag Screw

Attach the aiming arm to the insertion handle, pass a guidewire, drill over the guidewire to open the lateral cortex, and insert the cannulated screw with soft hammer blows.

Step 5 Insertion of Distal Interlocking Screw

Confirm fracture reduction on anteroposterior and lateral views, drill through the lateral cortex of the femur for the distal interlocking screw, measure the screw length, insert the screw, and remove the aiming arm if one was used.

Step 6 Final Radiographic Imaging

Obtain anteroposterior and lateral views to confirm maintenance of fracture reduction and appropriate placement and length of the nail and cephalic and distal locking screws.

Step 7 Wound Closure

Irrigate and close the wounds, and apply operative dressings.

Results

Intramedullary device technology has been altered to address the complication of periprosthetic fracture at the distal tip that made earlier intramedullary fixation less appealing compared with extramedullary fixation for stable fracture patterns.

Pitfalls & Challenges