Rehab after meniscal transplantation

Initially after meniscal transplantation surgery it is important to protect the knee and to offload the joint in order to protect the meniscal allograft and to give the graft the best possible chance of healing up successfully. With time, the patient’s blood vessels grow into the meniscal allograft and the new meniscus is seeded with new cells, and the graft becomes a living meniscus with the patient’s own living cells. However, this takes time, which is why initially it’s important to protect the joint.

The 1st 6-week period

THE FIRST 6-WEEK PERIOD

If isolated meniscal transplantation is performed (i.e. there are no other additional concomitant procedures) then the patient is normally kept minimal toe-touch partial weight-bearing with two crutches for the 1st 6-week period. This means that you can put your toes to the ground and rest the weight of your leg through your toes, but avoiding putting body-weight through the foot. (This is far easier and less risky than trying to hop around constantly with your foot up in the air, completely off the ground.) At the same time, the knee is also kept in a knee brace locked at 0 to 90 degrees flexion for the same 1st 6-week period. (When the knee is flexed past 90 degrees a large force is placed on the back of the meniscus.)

During this 1st 6-week period you will inevitably develop stiffness in the knee joint and significant muscle wasting in the whole leg. You can (and should) mitigate against this by performing very regular gentle exercises, with the following:

  • Static quads contractions
  • Straight leg raises against gravity
  • Regular unloaded range of motion exercises between 0 and 90 degrees
  • Very regular calf stretches and contractions.

In addition, it helps enormously to use a Game Ready machine for at least the first 1-month period, for regular icing and intermittent compression of the knee joint, which reduces post-op pain and swelling in the knee.

The 2nd 6-week period

At the end of the first 6-week period, patients are then advised to then work on the following:

  • The knee brace is discarded as soon as possible (as soon as the patient feels confident enough) and you then need to work hard on trying to get the full range of motion back in the joint as quickly as possible.
  • You will also then be encouraged to gradually increase the amount of weight that you put through the operated leg, gradually building back up to full weight-bearing and weaning yourself off the crutches as comfort, strength and confidence allow (which can take a couple of weeks or so).
  • At this stage you will also need to start regular physio rehab treatments to help you retrain your proprioceptive reflexes in/around the knee and to regain your strength in the muscles.
  • As soon as you can manage it, you will be encouraged to start using the exercise bike, with the seat up high and the resistance down low to start with.

Very importantly, it is vital that during this rehab you avoid any:

  • deep squats (past 60 degrees at the knee)
  • loaded squats (anything more than body-weight)
  • lunges
  • loaded twisting
  • heavy weights or
  • impact of any kind (such as jumping or jogging/running).

From 3 months post-op

From about the 3-month post-op mark, you should be able to start tailing off the frequency of your physio sessions and instead increasing the time that you spend in the gym on your own, doing the exercises that have been taught to you by your physio.

The important thing here to remember is that your new meniscus is still only part way through the process of healing in place, and therefore it still needs to be protected. This means sticking purely to just light non-impact cardio fitness work only, avoiding any heavy weights, loaded twisting or impact through the knee joint. The focus should very much be on just light fitness work only and not heavy strengthening work.