Physical therapy treatment of patient s/p ACL reconstruction with bilateral meniscus repairs: a case report
Background and Purpose: ACL (anterior cruciate ligament) reconstruction is a common orthopedic surgery with an average of 100,000 performed in the states each year.1 However, concomitant medial and lateral meniscus repairs along with ACL reconstruction is less common. A single surgeon in the busiest, most efficient practice would likely perform around 100 to 150 ACL reconstructions yearly and from that number only ~20% would undergo meniscus repair.2 The purpose of this case study is to present PT (physical therapy) examination and management strategies for a patient who underwent ACL reconstruction with bilateral meniscus repairs. Case Description: A 38-year-old male underwent ACL reconstruction surgery with bilateral meniscus repairs and was referred to PT. He presented with decreased ROM (range of motion), decreased strength, increased edema, increased pain, abnormal posture, and abnormal gait. PT plan of care was based on a 6-week NWB (non-weight bearing) protocol and focused on therapeutic exercises per patient tolerance, NMES (neuromuscular electrical stimulation) facilitation to increase quad activation, and gait training. Outcomes: The outcome measures that were used demonstrated the patients made significant improvements at 9 weeks post-operation and furthermore at 13 weeks. He demonstrated increased ROM, increased strength, decreased edema, demonstrated WNL (within normal limits) posture, and WNL gait mechanics all in this time frame. Discussion: PT treatment found to be helpful for this patient and contributed to his positive outcomes. Addressing gait limitations and providing verbal and tactile cues found to be beneficial for return to WNL gait. Additional research is needed to address what WB progression and duration of immobilization would be most effective long term for treating patients who undergo ACL reconstruction with bilateral meniscus repairs.