What is the recommended duration of post-operative non-weight bearing and immobilization for a 16-year-old male runner with a history of patellar dislocation undergoing meniscus surgery?

Post-Operative Weight Bearing and Mobilization Protocol for Adolescent with Patellar Dislocation Undergoing Meniscus Surgery

Early progressive weight bearing and mobilization should begin within 1-2 weeks post-operatively for this 16-year-old male runner with patellar dislocation undergoing meniscus surgery. 1

Initial Post-Operative Phase (0-2 Weeks)

• Weight Bearing Status:

  • Begin protected weight bearing as early as possible (within first 1-2 weeks) 2, 1
  • Use crutches initially to maintain correct gait pattern 1
  • Progress to weight bearing as tolerated if no pain, effusion, or increased temperature when walking 1

• Immobilization/Bracing:

  • Use a knee brace that limits range of motion for the first 2-4 weeks 2, 1
  • Avoid complete immobilization as immediate knee mobilization is recommended 2
  • For patellar dislocation specifically, most surgeons recommend a knee brace for 3-4 weeks 3

• Early Exercises:

  • Begin isometric quadriceps exercises in the first post-operative week if not causing pain 2, 1
  • Implement straight leg raises and static quadriceps contractions during first 2 weeks 2
  • Apply cryotherapy in the first post-operative week to reduce pain 2, 1

Intermediate Phase (2-4 Weeks)

• Weight Bearing Progression:

  • Progress to full weight bearing by 2-4 weeks if no complications 2
  • Continue using protective device that allows controlled mobilization 2

• Exercise Progression:

  • Begin closed kinetic chain exercises at 2 weeks post-op 2, 1
  • Prioritize closed kinetic chain exercises over open kinetic chain exercises in early rehabilitation 2
  • Focus on quadriceps and hamstring strengthening 1

Advanced Phase (4-8 Weeks)

• Exercise Advancement:

  • Add open kinetic chain exercises at 4 weeks post-op in a restricted range of motion (90-45°) 2, 1
  • Progress to full range of motion exercises by 6 weeks 1
  • Incorporate neuromuscular training with strength training 2, 1

• Return to Activities:

  • Begin gradual increase in activity intensity at 6-8 weeks 1
  • For runners, sport-specific training can begin around 8 weeks if meeting functional criteria 1
  • Monitor for symptoms (pain, swelling) that may indicate need for activity modification 1

Important Considerations

• Adolescent-Specific Factors:

  • Adolescents often heal faster than adults but require careful monitoring to prevent re-injury 1
  • Growth plate considerations may affect rehabilitation protocols in this 16-year-old patient

• Patellar Dislocation Considerations:

  • Rehabilitation after patellar dislocation with meniscus surgery tends to follow a more accelerated protocol compared to conservative treatment of patellar dislocation alone 4
  • Early functional rehabilitation is more common after surgical intervention 4

• Monitoring Progress:

  • Assess for Limb Symmetry Index (LSI) >90% before return to general activities 1
  • For return to running/sports, aim for LSI of 100% 1
  • Monitor for signs of recurrent patellar instability throughout rehabilitation

Common Pitfalls to Avoid

• Prolonged immobilization can lead to muscle atrophy, joint stiffness, and delayed recovery 2
• Premature return to high-impact activities can increase risk of re-injury or surgical site complications 1
• Neglecting neuromuscular training alongside strength training can lead to suboptimal outcomes 2
• Ignoring pain or swelling during rehabilitation can indicate overaggressive progression 1

This protocol balances the need for protecting the surgical repair while preventing the negative consequences of prolonged immobilization, which is particularly important for a young athlete looking to return to running.