Pujol Nicolas, Giordano Airelle O, Wong Stephanie E, Beaufils Philippe, Monllau Juan Carlos, Arhos Elanna K, Becker Roland, Della Villa Francesco, Goodloe J Brett, Irrgang James J, Klugarova Jitka, Klosterman Emma L
Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France.
Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
Orthop J Sports Med. 2025 May 22;13(5):23259671251343088. doi: 10.1177/23259671251343088. eCollection 2025 May.
The aim of part one of this EU-US consensus was to combine literature research and expertise to provide recommendations for the usage of rehabilitation (including physical therapy) of patients undergoing surgical treatment for degenerative meniscus lesions or acute meniscus tears (including meniscectomy, repair, or reconstruction). Prevention programmes, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures will be presented in a part II article.
This consensus followed the (ESSKA)'s "formal consensus" methodology. For this combined ESSKA, and initiative, 67 experts (26 in the steering group and 41 in the rating group) from 14 countries (US and 13 European countries), including orthopaedic surgeons, sports medicine doctors and physiotherapists were involved. Steering group members established guiding questions, searched the literature and proposed statements. Rating group members assessed the statements according to a Likert scale and provided grades of recommendations, reaching a final agreement about rehabilitation of the knee after meniscus surgery. Final documents were then assessed by a peer review group to address the geographical adaptability.
The overall level of evidence in the literature was low. Of the 19 questions (leading to 29 statements), 1 received a Grade A of recommendation, 2 a Grade B, 9 a Grade C and 17 a Grade D. Nevertheless, the mean median rating of all questions was 8.2/9 (9 being the highest rating on a scale of 1-9). The global mean rating was 8.4 ± 0.2, indicating a high agreement. Rehabilitation depends on the type of lesion, the treatment performed and is the same after medial or lateral meniscus surgery. Rehabilitation after meniscectomy should follow a criterion-based rehabilitation protocol, based on milestones rather than a time-based protocol. After meniscus repair and reconstruction, rehabilitation should be progressed according to both time and criterion-based milestones.
Rehabilitation after meniscus surgery is a debated topic that may influence surgical outcomes if not optimally performed. This international formal consensus established clear, updated and structured recommendations for both surgeons and physiotherapists treating patients after meniscus surgery.
Level I, consensus.
本次欧美共识第一部分的目的是结合文献研究和专业知识，为接受退行性半月板损伤或急性半月板撕裂手术治疗（包括半月板切除术、修复或重建）的患者的康复（包括物理治疗）使用提供建议。预防方案、急性撕裂和退行性病变的非手术治疗、恢复运动以及患者报告的结局指标将在第二部分文章中介绍。
本共识遵循欧洲运动医学学会（ESSKA）的“正式共识”方法。对于ESSKA、[此处缺失相关组织名称]和[此处缺失相关组织名称]的联合倡议，来自14个国家（美国和13个欧洲国家）的67名专家（指导组26名，评级组41名）参与其中，包括骨科医生、运动医学医生和物理治疗师。指导组成员确定指导问题、检索文献并提出声明。评级组成员根据李克特量表对声明进行评估，并提供推荐等级，就半月板手术后膝关节的康复达成最终共识。然后由同行评审组评估最终文件，以解决地域适应性问题。
文献中的总体证据水平较低。在19个问题（产生29项声明）中，1项获得A级推荐，2项获得B级，9项获得C级，17项获得D级。然而，所有问题的平均中位数评分为8.2/9（9为1 - 9评分中的最高分）。全球平均评分为8.4±0.2，表明高度一致。康复取决于损伤类型、所进行的治疗，内侧或外侧半月板手术后的康复相同。半月板切除术后的康复应遵循基于标准的康复方案，基于里程碑而非基于时间的方案。半月板修复和重建后，康复应根据时间和基于标准的里程碑进行推进。
半月板手术后的康复是一个有争议的话题，如果执行不当可能会影响手术结果。这一国际正式共识为治疗半月板手术后患者的外科医生和物理治疗师建立了清晰、更新且结构化的建议。
I级，共识。
