Modern rehabilitation after meniscus repair

The menisci have a zonal structure. They reduce the contact pressures and stabilize the knee joint. An extensive loss of the meniscus increases the risk of developing osteoarthritis. An important surgical target is therefore to preserve the meniscus by suturing. The tear localization and morphology play a key role in this process. Suture systems and stitching techniques that have been biomechanically tested many times have improved the treatment options and increased primary stability; however, postoperative follow-up treatment is particularly important for successful suturing. Reruptures should be avoided by an overly forced rehabilitation and muscle loss and mobility deficits should be minimized as much as possible. Currently, there is a lack of evidence regarding standardized postoperative treatment protocols. This is also due to the fact that the diagnosis of reruptures cannot reliably be made clinically or by magnetic resonance imaging (MRI). Consideration of rupture morphology is nevertheless useful from a biomechanical point of view: while axial loading can compress vertical longitudinal tears, the ends of ruptures can dislocate in radial tears or root lesions. High degrees of flexion, especially under load, should be avoided postoperatively to prevent mechanical stress. Range of motion (ROM) training using continuous passive motion (CPM) splints is useful from the first postoperative day onwards. Transcutaneous electrical nerve stimulation (TENS) devices can safely stimulate the muscles, and blood flow restriction (BFR) training is a promising approach as a method to address postoperative muscle deficits at an early stage. Stabilizing orthoses protect the suture, and intra-articular application of platelet-rich plasma (PRP) can potentially increase the chances of healing.