The Formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT Initiative. Part I—Rehabilitation Management After Meniscus Surgery: Meniscectomy, Repair and Reconstruction

Authors:

Nicolas Pujol, Airelle O. Giordano, Stephanie E. Wong, Philippe Beaufils, Juan Carlos Monllau, Elanna K. Arhos, Roland Becker, Francesco Della Villa, J. Brett Goodloe, James J. Irrgang, Jitka Klugarova, Emma L. Klosterman, Aleksandra Królikowska, Aaron J. Krych, Robert F. LaPrade, Robert Manske, Nicky van Melick, Jill K. Monson, Marko Ostojic, Mark V. Paterno, Tomasz Piontek, Simone Perelli, Alexandre Rambaud, James Robinson, Laura C. Schmitt, Eric Hamrin Senorski, Thorkell Snaebjornsson, Adam J. Tagliero, C. Benjamin Ma, Robert Prill

Abstract:

Purpose

The aim of part one of this EU-US consensus was to combine literature research and expertise to provide recommendations for the usage of rehabilitation (including physical therapy) of patients undergoing surgical treatment for degenerative meniscus lesions or acute meniscus tears (including meniscectomy, repair, or reconstruction). Prevention programmes, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures will be presented in a part II article.

Methods

This consensus followed the European Society for Sports Traumatology and Arthroscopy (ESSKA)’s ‘formal consensus’ methodology. For this combined ESSKA, American Orthopedic Society for Sports Medicine and American Academy of Sports Physical Therapy initiative, 67 experts (26 in the steering group and 41 in the rating group) from 14 countries (US and 13 European countries), including orthopaedic surgeons, sports medicine doctors and physiotherapists were involved. Steering group members established guiding questions, searched the literature and proposed statements. Rating group members assessed the statements according to a Likert scale and provided grades of recommendations, reaching a final agreement about rehabilitation of the knee after meniscus surgery. Final documents were then assessed by a peer review group to address the geographical adaptability.

Results

The overall level of evidence in the literature was low. Of the 19 questions (leading to 29 statements), 1 received a Grade A of recommendation, 2 a Grade B, 9 a Grade C and 17 a Grade D. Nevertheless, the mean median rating of all questions was 8.2/9 (9 being the highest rating on a scale of 1–9). The global mean rating was 8.4 ± 0.2, indicating a high agreement. Rehabilitation depends on the type of lesion, the treatment performed and is the same after medial or lateral meniscus surgery. Rehabilitation after meniscectomy should follow a criterion-based rehabilitation protocol, based on milestones rather than a time-based protocol. After meniscus repair and reconstruction, rehabilitation should be progressed according to both time and criterion-based milestones.

Conclusion

Rehabilitation after meniscus surgery is a debated topic that may influence surgical outcomes if not optimally performed. This international formal consensus established clear, updated and structured recommendations for both surgeons and physiotherapists treating patients after meniscus surgery.

Level of Evidence

Level I, consensus.

You can download the study: The formal EU-US meniscus rehabilitation 2024 consensus: An ESSKA-AOSSM-AASPT initiative. Part I—Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction)

Robert LaPrade, MD PhD

Average rating:

27 reviews

Michael freimuth

Aug 1, 2021

by Michael freimuth on Robert LaPrade, MD PhD

So lucky

In 2007 i was playing soccer and as i planted my left foot the goalie kicked my left knee dislocating it 90° to the left. I was told i tore everything...mcl pcl lcl acl all tendons around my knee the minicus flipped over the knee cap tearing the patellar tendon and oh yeah i guess i broke my femur too. First surgeon i went to literally gave me 2 options.
1) he could remove part of my leg because he couldnt find a pulse in my foot
2) he would refer me to the expert.
Obviously i chose the second option. Upon meeting his team, my life changed. There was never any talk of removing my leg and immediately found a pulse in my foot. On top of that they asked if i was free the coming Wednesday to operate. Hearing reviews about the U of M and of dr laPrade i went ahead and let him try to help me. Best decision ever. Yes, it took a long time to recover. But as i was healing he would find ways to help me be able to see him. Even said my left knee was tighter than my right. I had to have my meniscus removed during my surgery and after 2 years i still didn't have arthritis. It is now 2021, yes thats 14 years after my injury havent seen or spoken to him in 12 years.what he doesn't know.....
I did manual labor the whole time grueling work, i snowboard....and i hit jumps, ice-skating and hockey are still fun and easy, i joined another soccer league and get this, im considered the fastest player....in the league! Im 36 now... took me 12 years to get on here just to say thank you..... feels like its to little and took to long compared to the gift he gave me. If nothing else, thank you!
Mike f

Sue Stanek

Jan 2, 2020

by Sue Stanek on Robert LaPrade, MD PhD

So glad I waited for the best

I struggled with my knee for 18 months - having gone from 10,000 steps a day to only walking as needed. Previous attempts to make it better provided only temporary relief. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. I am so glad I did! Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.
You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Hey - if he is good enough for Olympic and professional athletes…..he's good enough for me! Thank you, Dr. LaPrade, for treating me with the care, focus, and expertise as if I was an Olympic athlete!
- From your 63 year old very appreciative patent ~

Nancy S Stevenson

Aug 14, 2019

by Nancy S Stevenson on Robert LaPrade, MD PhD

Right Knee Surgery After Auto Bicycle Accident

Dr. Robert F. LaPrade operated on my right knee in May of 2010. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. I could not bear weight on my right side though I tried repeatedly, but finally I went and got an MRI and one of the orthopedic surgeons that I worked with was shocked when he saw the MRI result. My right knee was totally destroyed; ACL, MCL, PCL all severely torn; the patella was the only thing intact in my right knee. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. This was devastating news after being a top triathlete (3rd in the world in my age group in 1989 & 1st nationally in my age group) and a big marathon runner. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. I can run, bike, & climb mountains. In fact 2 years ago I finished climbing the top 100 peaks in CO.