Medial Menisectomy-Fellow physio's opinion

[KiwiDPT]

Hi all. So I wanted to get some opinions on this patient. Pt is approx 50 yo male who had a partial medial menisectomy 4 weeks ago. The patient has some residual pain and some quad atrophy. The pt just returned from vacation and reported 3 days of prolonged walking with minimal increase in sx's. His primary pt has the pt performing SAQ, SLR flex, and ending with NMES with ice. He does other exercises as well, including terminal knee ext in standing. So today I saw the pt and he has a good quad contraction, no extension lag, minimal pain after the intensity if his vacation walking. So i DC'd SLR to HEP, and DC'd NMES. I added knee ext from 90-40 degrees and partial range squats. The primary PT had a meltdown as I wanted to progress the pt to more functional activities. Tell what you think. Should I have left him with SAQ, SLR, and NMES? I did talk to the other physios before I did it,
I appreciate your opinions.

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[Physio Dace]

No, at 4 weeks post-op the patient should only be performing functional exercises/activities and not open chain exercises - by this stage I personally do not think "home exercises" are necessary anyway. Walking/cycling/swimming/household chores are enough for most people to regain quads control.

[KiwiDPT]

Thank you for your response. I tried explaining my reasoning to the other physio (ie there is functional activity that perform either knee ext or SLR, benefit of concontraction of quads and hams for stability and decreased risk of reinjury. He just did not want to hear it, oh well. The pt is on the right path now.

[naveenedin]

hi
if some one has no lag, then there is no huge point in keeping doing SLR. U r doing slr ex's to progress to a functional activity. there is no huge technical restrictions wth the surgery. inform the pt, tat he can expect early 0A as a potential complication. I vl make him do lunges, proprioceptive exs, wobble board squats, progess to single leg squat.

[KiwiDPT]

Thank you for your response. I tried explaining my reasoning to the other physio (ie there is functional activity that perform either knee ext or SLR, benefit of concontraction of quads and hams for stability and decreased risk of reinjury. He just did not want to hear it, oh well. The pt is on the right path now.

oops i meant NO functional activity the involves knee ext, SLR. Thanks to your responses.

[mIrAge]

KiwiDPT,
I think you were on the right track 4 weeks down. I don't see the point of using NMES and/or SLR once the patient achieves IRQ. Maybe your principal PT was being cautious for other reasons which are not entirely clinically related. Just my two cents.

Good luck in the U.S. of A.

M.

[Hallamshire Physiotherapy]

kiwi
You did the right thing, I would only suggest you do it earlier and forget about the SLR. Patients can ofton struggle doing this strange and pointless exercise, but can walk without any problem. Your primary PT I assume has always done the same protocol and was afraid the patient might actually get better!

Hallamshire Physiotherapy

[tailoool]

I think the point is about the minimal pain after walking,. you are right that there is no hugh technical restrictions with the surgery. if the pian consisted, while there is too much closed chain exercise (loading) on the injury meniscus, that may cause more serious condition in my pointview.

hi
if some one has no lag, then there is no huge point in keeping doing SLR. U r doing slr ex's to progress to a functional activity. there is no huge technical restrictions wth the surgery. inform the pt, tat he can expect early 0A as a potential complication. I vl make him do lunges, proprioceptive exs, wobble board squats, progess to single leg squat.

[smshaffe]

what was the rationale for the meltdown? what was the patient's opinion? what was the response of the pt to your intervention?

[KiwiDPT]

what was the rationale for the meltdown? what was the patient's opinion? what was the response of the pt to your intervention?

Sorry for the delay. His issue was that I have only been practicing for a year and a half, and he had been practicing for 20 years. He was adamant about SLR as a strengthening exercise. I tried to discuss that SLR we mostly working on hip flexion (of course isometric of 3/4 quads) which he graded 5/5. Essentially he just did not want to hear any of my rational and flew off the handle about knee extension having the highest MVC (although some studies show the squat with highest MVC). The patient was fine with my alterations however the issue came when the primary PT went against everything I talked to the patient about and went back to his old program.