She performs minimally invasive arthroscopic knee and shoulder surgery including ACL reconstruction, complex knee ligament reconstruction, meniscus repair, rotator cuff and labral surgery See wound care protocol for further detail. The primary goal of this protocol is to protect the reconstruction and while steadily progressing towards and ultimately achieving pre … ACL REHABILITATION PROTOCOL, OPERATIVE WITH MENISCUS REPAIR OR MICROFRACTURE . Now let’s talk about the option of doing the meniscus repair and the ACL reconstruction in one surgery. Post-operative Rehabilitation Protocol ACL Reconstruction with Meniscus Repair or Microfracture Phase I: Immediately postoperatively (weeks 0- 4) Goals: Protect graft and graft fixation Minimize effects of immobilization Control inflammation/swelling ROM: 0-90 when supine (such as heel slides). Supervised physical therapy takes place for 3-9 months. She serves as the Chief of Women’s Sports Medicine and her clinical interests are focused on preventing and providing care for sports injuries. It is not meant ACL Reconstruction Protocol-Brigham and Women’s Hospital Phase I: Immediately post-operatively to week 4 Goals: Protect graft, control inflammation, and patient education on rehab process and restrictions o Caution: avoid squatting and flexion for leg press beyond 90 degrees … If you have questions, contact the referring physician. University*of*Washington*Department*of*Orthopaedics*&*Sports*Medicine* Page1*of*8* InitialPostoperativeInstructions’ ACL’Reconstruction’+Meniscus’Repair’ TIMETABLES ARE ESTIMATES . Nurse visit day 2 post-op to change dressing and review home program. If you have questions, contact the referring physician. ACL Reconstruction Rehabilitation Protocol, ACL Reconstruction Protocol-Brigham and Women’s Hospital, Protect graft, control inflammation, and patient education on rehab process and restrictions, Gradually wean from crutches as tolerated, restore gait to level surfaces, This website is powered by SportsEngine's. Multiligament Knee Injury (ACL/PCL +/- MCL/PLC) Rehabilitation following surgery for multiligament knee injury (MLKI) or knee dislocation is an essential element of the treatment to achieve a full recovery. b. NSAID, pref. Rehabilitation Protocol for ACL Reconstruction This protocol is intended to guide clinicians and patients through the post-operative course of an ACL reconstruction. Icing and elevation every 2 hours for 15-20 min sessions. Here are some of the benefits: The ability to reduce the risk of scar tissue by minimizing the amount of surgery in the first stage. • For ACL reconstruction performed with meniscal repair or transplant, defer to ROM and weightbearing precautions outlined in the meniscal repair/transplant protocol. Anatomy and Biomechanics The knee is a hinge joint connecting the femur and tibia bones. U su a l l y i n 6 -8 w e e ks. ACL Non-Operative Protocol . It is no, means intended to be a substitute for one’s clinical decision making regarding the progression of. Tel: (646) 501-7223 option 4, option 2 Fax: (646) 501-7234 Web: newyorkortho.com orthosurgery.med.nyu.edu/sports-medicine. • For ACL reconstruction performed with meniscal repair or transplant, defer to ROM and weightbearing precautions outlined in the meniscal repair/transplant protocol. Dr. Levene (2/2015) I. Preoperative . GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING • No bathing/showering … Use professional judgment as patients progress. Week 1. The femur has a medial (inside) and a lateral (outside) condyle that forms a radial or rounded bottom that comes together, forming a trochlear groove for the patella to move. Anterior Cruciate Ligament (ACL) and Meniscus Repair Rehabilitation Protocol • HVPC for effusion reduction as needed Cryotherapy: • Six to eight times per day for 15 to 20 minutes each Progression to Phase III: • Knee ROM 0°-120° • No effusion • No … More aggressive rehabilitation may be … ACL Autograft Reconstruction with meniscus repair 2019-10-21T16:58:41-04:00 This protocol is intended to be a general outline only. LARGE OR UNSTABLE: Meniscal Repairs: SMALL AND STABLE: Maintain NWB with brace locked in extension for 4 weeks; After Week 4, WBAT with TROM locked in extension weaning from crutches. The purpose of this … d. Fit with functional brace, preop use … The ACL attaches from the front part of the tibia to the back part of the femur. Modified Brostrom-Gould Repair for Chronic Lateral Ankle Instability: Detailed Physical Therapy Post Op Protocol The following post-operative rehabilitation protocol is adapted from the one used at the Brigham and Women’s Hospital and the Hospital for Special Surgery (HSS), where the modified Brostrom-Gould procedure is the preferred anatomical surgical procedure for the … Do not do resisted long or short arc quads, to avoid adversely stressing the graft. ACL reconstruction with Meniscus repair Protocol Dr Bradley Bruner 01/01/2009 Guidelines: 1. Time frames for use of brace and crutches may be extended by the physician. http://www.brighamandwomens.org/Patients_Visitors/pcs/rehabilitationservices/Physical%20Therapy%20Standards%20of%20Care%20and%20Protocols/Knee%20-%20ACL%20Patella%20Tendon%20Autograft,%20protocol.pdf. Meniscus Repair Rehabilitation Dr. Walter R. Lowe This rehabilitation protocol was developed for patients who have isolated meniscal repairs. ANTERIOR CRUCIATE LIGAMENT (ACL) WITH MENISCUS REPAIR POST-OP REHABILITATION PROTOCOL The following is a protocol for postoperative patients following ACL reconstruction and meniscus repair (medial or lateral). o May progress to 120° at week 4 with physician approval. The medial and lateral condyle sit on top of … GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING ACL Reconstruction BPB with Meniscus Repair PHYSICAL THERAPY PROTOCOL P H A S E I I : I n te r m e d i a te P h a s e POST-OP WEEKS 6-10 C o n t i n u e a s a b o ve W i t h g o o d q u a d co n t ro l , ma y w e a n f ro m b ra ce . This preview shows page 1 - 2 out of 5 pages. a. Meniscus Repair Protocol Dr. Jonathon Henry The following document is an evidence-based rehabilitation protocol for knee arthroscopy with meniscus repair. … Rest, ice, compression, elevation . Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. Celebrex 200mg BID-2 if early surgery planned c. Bledsoe style brace for concomitant gr III MCL injury if present d. Fit with functional brace, CTi2 or … GENERAL PROGRESSION OF ACTIVITIES OF DAILY LIVING, Patients may begin the following activities at the dates indicated (unless otherwise specified by the, Bathing/Showering without brace: refer to your surgeon’s post-operative instructions, Sleep with brace locked in extension for 1 week, Driving: 1 week for automatic cars, left leg surgery, 4-6 weeks for standard cars, or right leg surgery, Brace locked in extension for 1 week for ambulation, Use of crutches, brace for ambulation for 6 weeks. a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of post-operative complications. Patient must demonstrate excellent quadriceps control. Find out when it helps, what to expect, and how long you’ll need to do it for. c. Bledsoe style brace for concomitant gr III MCL injury if present . COX-2 if early surgery planned . • Strength of the lower extremity: clam shells, prone hip flexion with knee flexion, side lying abduction, thera-band hip abduction, 6+ weeks • Resume protocol at Phase II as above allowing for a 4 week transition Phase IV (Advanced ACL Protocol) – No significant swelling/inflammation, Full pain free ROM, No evidence of patellofemoral joint irritation, sufficient strength and proprioception to initiate agility, normal running gait, 70% strength of uninvolved side Weeks 16+ please refer to the advanced ACL rehab protocol … ACL Patella Tendon Autograft Reconstruction Protocol. Rehabilitation Protocol: Arthroscopic Meniscus Root Repair. Therefore, crutches and brace are, ACL reconstruction performed with meniscal repair or transplant: follow the ACL protocol with, avoidance of open kinetic hamstring strengthening for 6 weeks. Considerations for the Post-operative Meniscal Repair Program It is held together by several important ligaments. Phase I: Immediately post-operatively to week 4, Heel slides, quad sets, hamstring curls, closed-chain quadriceps exercises, SLR in all planes, hamstring and calf stretching, Criteria to move to Phase II: Must be able to achieve full knee extension and minimum of 90° of flexion, normal gait on level surfaces, minimal swelling, and achieves a good quad set, Exercises: Progress with closed-chain exercises, continue hamstring and calf stretches, stationary biking and Stairmaster training, ROM and flexibility exercises as appropriate, and proprioceptive/balance activities, Criteria to move to Phase III: No patellofemoral pain, minimum of 120° knee flexion, sufficient strength and proprioception for running, minimal swelling, Continue flexibility/ROM exercises, hip/quad/hamstring/calf strengthening, CV endurance training, eccentric knee extension exercises, advanced proprioceptive activities, full WB running at 12 weeks, Criteria to move to Phase IV: No significant swelling, full and pain-free ROM, normal running gait, no patellofemoral joint irritation, sufficient strength/proprioception for agility exercises, Phase IV: Post-operative months 4 through 6, Progress with flexibility and strengthening as needed, initiate plyometrics, agility training progressions, and increase running distance as needed, Criteria to move to Phase V: No patellofemoral or soft tissue complaints, adequate ROM, strength, endurance, and proprioception to return to work/athletics, physician clearance for partial/full activity, HEP for strength and endurance, safe return to sports. GALLAND/KIRBY ACL RECONSTRUCTION WITH MENISCUS REPAIR POST-SURGICAL REHABILITATION PROTOCOL POST-OP DAYS 1 – 14 • Dressing: – POD 1: Debulk dressing, TED Hose in place – POD 2: Change dressing, keep wound covered, continue TED Hose – POD 7-10: Sutures out, D/C TED Hose when effusion resolved Inc; 2003:315-319. Knee - ACL Allograft.pdf - BRIGHAM AND WOMEN\u2019S HOSPITAL Department of Rehabilitation Services Physical Therapy ACL Allograft Reconstruction Protocol, The intent of this protocol is to provide the clinician with a guideline for the post-operative, rehabilitation course of a patient that has undergone an ACL allograft reconstruction. BRIGHAM AND WOMEN’S HOSPITAL Department of Rehabilitation Services Physical Therapy ACL Allograft Reconstruction Protocol The intent of this protocol is to provide the clinician with a guideline for the post-operative rehabilitation course of a patient that has undergone an ACL allograft reconstruction. ACL with Meniscus Repair | 2 Typically, after an anterior cruciate reconstruction surgery (ACL) with meniscal repair there is a protected range of motion and weight bearing period that can last up to 6 weeks. Multi-Ligament Repair/Reconstruction The knee joint is comprised of an articulation of three bones: the femur (thigh bone), tibia (shin bone), and patella (knee cap). This protocol is intended to guide clinicians and patients through the post-operative course for a meniscus repair. Return-to-Sport after ACL with Meniscal Repair Reconstruction Protocol - Weight-bearing in full extension (with a locking brace) with crutches is allowed, No weight-bearing in flexion >45° for 4 weeks - Immediate Post-op passive ROM is fine, No active ROM past 90° for the first 4 weeks o ROM: (Peripheral Tears) ROM: (Complex Tears) and crutches may be extended by the physician. The physician reserves the right to either advance or delay this protocol as deemed necessary. • AROM/PROM 0°- 90° to protect meniscus repair. • The physician may alter time frames for use of brace and crutches. ACL REHABILITATION PROTOCOL (with meniscus repair) (WITHOUT MICROFRACTURE, EXCEPT RADIAL TEARS OR ROOT AVULSION) Dr. Bienz (05/12) I. Preoperative a. No direct palpation to surgical portals x 4 weeks; consider the edges of the bandages as the “no-touch zone” approximately 2 inches from all portals. Weeks 0 to 2: Use crutches for 7 to 10 days to reduce swelling, the patient may discontinue with crutches when they can ambulate without a limp. • ACL reconstruction performed with meniscal repair or transplant: follow the ACL protocol with avoidance of open kinetic hamstring strengthening for 6 weeks. Center for Musculoskeletal Care• 333 East 38thStreet, New York, NY 1001 • (646) 501-7070 • cmc.med.nyu.edu. ACL Reconstruction Protocol (Allograft) Week one Week two Initial Evaluation Evaluate Range of motion Joint hemarthrosis Ability to contract quad/vmo Gait (generally WBAT in brace) Patella Mobility Inspect for infection/signs of DVT Assess RTW and sport expectations Range of Motion Joint Hemarthrosis Ability to contract quad/vmo Signs of infection or DVT Patella … Manual The protocol is both chronologically and criterion based for advancement through four post-operative phases: Phase 1 : Maximum protection Phase 2 : Progressive stretching and early strengthening Phase 3 : … However, the large hematoma produced during the ACL surgery is considered beneficial to the healing of the meniscal repair and some Meniscal repairs located in the vascular zones of the periphery or outer third of the meniscus are progressed more rapidly than those repairs that are more complex and located in that avascular zone of the meniscus. Once crutches have been discontinued, advance to unlocking TROM, then removing brace. Even if an exercise or activity is listed at a particular time frame, some patients may not be ready to perform it. • Supervised physical therapy takes place for 3-9 months. Begin passive/active knee range of motion to 90° of knee flexion and strong emphasis on full knee extension. Meniscal Repair: The intent of this protocol is to provide the clinician with a guideline of the post- Being able to evaluate the healing of the meniscus tear at the time of the ACL reconstruction. • The physician may alter time frames for use of brace and crutches • Supervised physical therapy takes place for 4-7 months • Use caution with hamstring stretching/strengthening based on donor site … The Department of Rehabilitation Services at Brigham & Women’s Hospital has accepted this protocol as our standard protocol for the management of patients s/p meniscal repair. The Department of Rehabilitation Services at Brigham & Women’s Hospital has accepted this protocol as our standard protocol for the management of patients s/p meniscal repair. Time frames for use of brace. Allograft revascularization is slower than for autografts. Brigham and Women's Hospital Web site. Physical therapy (PT) can be useful for a torn meniscus whether or not you have surgery. 1. 2. Specific intervention should be based on the needs of the individual and should consider exam findings and clinical decision making. Meniscal Repair: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone a meniscal repair. This protocol is intended to provide the user with instruction, direction, rehabilitative guidelines and functional goals. Course Hero is not sponsored or endorsed by any college or university. If a clinician requires assistance in the. The following is an approximate schedule for supervised physical therapy visits: Phase IV, V (6 months +): Discharge after completion of appropriate functional progression. The most important ligament to the knee’s stability is the A nterior Cruciate Ligament (ACL). ACL Reconstruction with Meniscal Repair Rehabilitation Protocol • Basic ACL protocol but no passive range of motion (PROM) greater than 90 degrees for four weeks; no squatting, hyperflexion for six months; no deep squats for 6 to 9 months; incorporate meniscal Rest, ice, compression, elevation b. NSAID, pref. progression of a post-operative patient they should consult with the referring Surgeon. • Supervised physical therapy takes place for 3-6 months.

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