Texas Medical Center

New Study has Surgeons Rethinking Knee Repair Protocols


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By Hannah Pietsch  |  Houston Methodist Hospital

A new study determined that putting the knee through a normal range of motion shortly after surgery to repair the meniscus speeds up the recovery process and gets people active faster.

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Patrick McCulloch, M.D.       

The meniscus is a rubbery shock absorber in the knee that helps reduce friction during movement. A meniscal tear is most often associated with a swollen, stiff knee and is the most common reason for arthroscopic knee surgery. A meniscal tear can occur in all sports and dance, but are most common in those sports that involve twisting and squatting, such as basketball or baseball. For many years, orthopedic surgeons believed that allowing the knee to bend before the meniscus was fully healed would cause gapping at the repair site.

“With my previous rehab protocol, my patients used a locking brace for several weeks after surgery to keep the knee straight,” said Patrick McCulloch, M.D., an orthopedic surgeon at Houston Methodist Orthopedics & Sports Medicine and the study’s lead investigator.

The study, published in the American Journal of Sports Medicine, was the first to use radiostereometric analysis, or RSA, to study the motion of the knee’s meniscus. RSA involves implanting small metallic beads into the soft tissues around the knee and taking X-rays of the knee at different angles. Researchers then combine the X-rays to create 3D images and measure the movement of the beads.

“In contrast to our original hypothesis, we found that meniscal repair sites did not gap when the knee was taken through high flexion, or bent at a 90 degree or higher angle,” said McCulloch. “In fact, we saw very small motions in the meniscus, and those we did see compressed the repair site together.”

Based on the evidence, McCulloch now allows his patients to undergo a supervised, non-weight bearing, unrestricted range of motion program during the rehabilitation process that could take anywhere from a few weeks to a couple of months.

“We strive to get our patients back to their normal activities as quickly as possible,” McCulloch said. “I believe this accelerated rehab process can help patients get moving several weeks faster than before.”