Accelerated Vs Conservative Rehabilitation Following Meniscus Repair In Pediatric Pateints With Or Without Acl Reconstruction

Abstract

Background:

There are variations in postoperative restrictions following pediatric meniscus repairs, whether they are performed in isolation or at the time of an anterior cruciate ligament reconstruction (ACLR).

Hypothesis:

We hypothesized that there would be no difference in failure rates when comparing accelerated versus conservative post-operative management following both isolated meniscus repairs and meniscus repairs performed at the time of an ACLR.

Methods:

A retrospective chart review was performed to investigate pediatric patients who underwent an isolated medial or lateral meniscus repair with or without a combined primary ACLR from January 2010 to January 2019 within a large children’s health system among eight different surgeons who all utilized different rehabilitation protocols. Patient outcomes of a need to return to the operating room secondary to failure of meniscus repair were analyzed with regard to accelerated versus conservative rehabilitation. Accelerated management included early unrestricted weightbearing within 3 weeks, unrestricted range of motion in a brace within 6 weeks, less than 6 weeks of brace use, initiation of outpatient physical therapy within 6 weeks, and returning to play sports earlier than 16 weeks for the isolated meniscus group or earlier than 30 weeks for the combined group.

Results:

138 patients aged 14.1 + 2.9 years had an isolated meniscus repair with 24.6 + 16.8 weeks of follow-up and a 17% failure rate, and 190 patients aged 15.5 + 1.6 years had a meniscus repair at the time of an ACLR with follow-up of 42.9 + 27.4 weeks and a 13% failure rate. A binomial logistic regression showed no differences in failure rates for accelerated versus conservative weightbearing restrictions, brace immobilization, physical therapy timing, or return to play timing (Table 1).

Conclusion:

These findings demonstrate that pediatric meniscus repair failure rates remain similar despite wide variations in postoperative management, whether performed in isolation or at the time of an ACLR. Further investigation should be directed towards determining optimal post-operative management protocols that attempt to strike a balance between protecting the surgical repair and avoiding measures that may be overly burdensome to the patient or add unnecessary treatment costs.

Table 1.

Results of binomial logistic regressions used to predict failure rates