Postoperative Rehabilitation Protocol After Isolated Meniscal Repair: A Systematic Review.

BACKGROUND

The meniscus plays a critical role in knee stability and load distribution, with meniscal tears often resulting from trauma or degeneration. Rehabilitation protocols after meniscal repair lack standardization, particularly regarding weightbearing restrictions and their effect on outcomes.

HYPOTHESIS/PURPOSE: This systematic review hypothesizes that accelerated weightbearing protocols after isolated meniscal repair would lead to improved patient-reported outcomes and comparable failure rates relative to restricted rehabilitation protocols. The purpose was to evaluate the influence of different postoperative rehabilitation strategies on failure rates and functional outcomes after isolated meniscal repair.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

Comprehensive searches of Embase, OVID Medline, and Emcare databases were conducted through November 2024. Studies were included if they reported on adult patients undergoing arthroscopic repair for isolated meniscal tears, described postoperative rehabilitation protocols, and had ≥10 months of follow-up. The primary outcome was repair failure (retears, revision surgery, or persistent symptoms). Secondary outcomes included patient-reported outcome measures (PROMs) and postoperative complications. Descriptive statistics summarized findings, with discrepancies resolved by a third investigator.

RESULTS

Ten studies (n = 313 patients) met the inclusion criteria. Most tears were medial (62%-93%) and primarily vertical or longitudinal, located in vascular zones. Rehabilitation protocols included accelerated/immediate weightbearing as tolerated (WBAT) (n = 7 studies), restricted weightbearing (n = 5 studies), and modified progressive programs (n = 1 study). Failure rates were 24.1% (accelerated WBAT), 28.3% (restricted), and 4.3% (modified progressive). PROMs (Lysholm and Tegner scores) were generally higher in accelerated WBAT protocols, with scores exceeding 85 and 7.2, respectively. Modified progressive rehabilitation yielded the lowest failure rate (4.3%) and favorable PROMs in the 1 study that utilized this method.

CONCLUSION

The relationship between meniscal tear characteristics, repair techniques, and postoperative rehabilitation protocols plays a pivotal role in determining outcomes after isolated meniscal repair. Accelerated rehabilitation protocols may offer benefits such as faster recovery and improved patient satisfaction; nonetheless, they must be balanced against the increased risk of repair failure, particularly in complex tear patterns. Individualized rehabilitation protocols, accounting for tear characteristics, patient health, and surgical techniques, may optimize outcomes.