Ericsson, Y., Dahlberg, L. and Roos, E. Scandinavian Journal of Medicine and Science in Sports; 2009: 19, 156 – 165.
http://www.ncbi.nlm.nih.gov/pubmed/18397193
Meniscectomy is one of the most commonly
used surgical procedures in case of degenerative meniscal tears. Despite it is
considered that one will fully recover within 3 months after meniscectomy, knee
symptoms and functional limitations are reported by a lot of patients, years after
the procedure. It can be due to impairment of the sensorimotor control
associated with meniscal tear and/or removal. Rehabilitation programs focusing
on functional exercises and neuromuscular training have been designed to
counteract these changes. Due to lack of evidence, this study was conducted to
examine the effect of functional exercise training on functional performance
and isokinetic thigh muscle strength in middle-aged patients subsequent to
meniscectomy for a degenerative tear.
Four years after meniscectomy, 45 patients
(29 men, 16 women) were randomized to functional exercise training, three times
weekly for 4 months or to no intervention. The exercise session consisted of
four parts: warming up, flexibility and coordination exercises, stretching
exercises, and a circuit program that emphasized neuromuscular control and
functional strength. Thirty patients (16 exercisers/14 controls) completed the
study. Primary outcome measures were: functional performance tests (one-leg hop
for distance, one-leg rise, square hop) and the secondary outcomes were the
results of the isokinetic strength tests (quadriceps and hamstrings muscle
strength). Results have shown that compared with the controls, the subjects in
the exercise group showed a greater improvement, with significant differences
regarding one-leg hop distance, hamstrings strength 60°/s and quadriceps endurance 180°/s. Conclusion was that a
4-month functional exercise program had a positive effect on functional
performance as well as thigh muscle endurance and strength in middle-aged
post-meniscectomy patients.Authors advocate that each part of the training session had its influence on the observed improvement in the exercise group. Flexibility and stretching exercises were aimed at restoring full ROM which is a prerequisite for a normal movement pattern. Functional strength exercises were included because adequate muscle strength and endurance is a prerequisite for functional and postural stability, and a movement pattern without compensations. Balance exercises stimulate proprioceptive input, enhance muscular joint stabilization and postural function. Rationale for implementing functional stability exercises was that muscles can provide dynamic joint stabilization that protects the joint from impulsive loading that can be harmful to the cartilage. Moreover, muscular coactivation helps distribute pressure evenly over the joint surfaces. Finally, a muscular imbalance may result in an abnormal movement pattern and altered joint loading.
What are your experiences with patients who had undergone partial meniscectomy? In your opinion, what aspects are the most important in the rehabilitation regimen in those patients?
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Journal of Medicine and Science in Sports.
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