Create a Standardized Protocol to Avoid Disparities and Improve Patient Care, Study Authors Suggest

There are significant disparities in physical therapy protocols after meniscal repair surgery among those published online by academic orthopedic programs, according to a study in The Journal of Knee Surgery.

David P. Trofa, MD, and colleagues identified and assessed 20 web-based meniscal repair physical therapy protocols from 155 US academic orthopedic programs, as well as the first 10 protocols identified by searching “meniscal repair physical therapy protocol.”

Recommendations for bracing, range of motion restrictions, weight-bearing precautions and strengthening exercises were “extremely diverse” among online postoperative meniscal repair protocols, according to Trofa. Results showed 86.6% of protocols recommended immediate postoperative bracing. Researchers noted 40% of protocols permitted immediate weight-bearing as tolerated postoperatively. However, the remaining protocols permitted weight-bearing as tolerated at an average of 4 weeks.

Range of motion goals had considerable variation, with range of motion guidelines provided in 86.6% of protocols. Researchers found 73.3% of protocols initiated immediate passive flexion to 90° and permitted full range of motion at an average of 5 weeks. Results showed diverse recommendations for the types and timing of strength, proprioception, agility and pivoting exercises. Functional testing was employed by 16.7% of protocols as a marker for return to athletics, Healio Orthopedics explains.

“Furthermore, while meniscal tears come in a variety of shapes, sizes and complexity, only two of the 30 protocols identified differentiated rehabilitation by the type of meniscal tear repaired,” Trofa says, in the release.

“The authors believe that such disparities can lead to confusion among patients, therapists and surgeons and may result in longer recovery times and inferior results. Creation of a standardized postoperative protocol supported by evidence-based medicine would provide an opportunity for improved patient care following this increasingly common procedure.”

[Source: Healio Orthopedics]