Rehabilitation protocol after suturing the medial meniscus of a stable knee, a retrospective series of the Francophone Arthroscopy Society

Introduction: Surgical meniscal lesions are common and 80% of cases involve the medial meniscus of a stable knee. There is a lack of consensus regarding postoperative rehabilitation protocols and a wide variation between restrictive and accelerated rehabilitation protocols exists. The main objective of this study was to report the functional results and the failure rate of the various rehabilitation protocols of the retrospective series of the French Society of Arthroscopy (SFA) after suturing the medial meniscus of a stable knee, considering whether the tear is stable or unstable. Hypothesis: Our hypothesis was that accelerated rehabilitation was not associated with an increased risk of failure. Materials and methods: This retrospective, multicenter study was conducted across 10 centers (6 private hospitals and 4 public hospitals) including all patients tested for a medial meniscus suture in a stable knee between January 1, 2005 and November 31, 2017 for a minimum follow-up of 5 years. Demographic, imaging, suturing, rehabilitation protocol, and functional TEGNER and KOOS scores were collected. Failure was defined as performing a secondary meniscectomy. Results: Three hundred and sixty-seven patients were analyzed with an average follow-up of 82 months. Immediate weight bearing was allowed in 85% of cases, the wearing of a brace was present in almost 74% of cases and flexion was limited in 97% of cases. Inter-group comparisons found a higher suture failure rate in the group with immediate weight bearing (35.6% vs. 20%, p = 0.011) and in the group with a brace (36.9% vs. 22.4%, p < 0.001). There was no difference in the 90. flexion group. The TEGNER score was higher in the non-weight bearing group (6.5 vs. 5.4, p = 0.028) and the KOOS QOL score was higher in the group without a brace (82.2 vs. 66.8, p = 0.025). According to a multivariate analysis, immediate weight bearing (OR = 3.6, [1.62; 7.98], p = 0.0016) and wearing a brace (OR = 2.83, [1.54; 5.02], p < 0.001) were associated with a higher failure rate. In the group of stable lesions, the use of a brace (OR = 3.73, [1.62; 8.56], p = 0.0019) was associated with a higher failure rate. Conclusion: No consensus regarding rehabilitation protocols has been established to date and the results of this retrospective series of the SFA affirm the great variability of practices at a national level. Although accelerated rehabilitation protocols are presently favored, the resumption of immediate full weight bearing should be considered with caution, being associated with a higher risk of failure in this series. Deferring weight bearing for 1 month can be considered in the event of a large tear or in the event of damage to the circumferential fibers. Wearing a brace does not seem to have any influence, while limited flexion achieved a consensus. (c) 2023 Elsevier Masson SAS. All rights reserved.