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Chmielewski TL, Stackhouse S, Axe MJ, Snyder-Mackler L. A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture. I have met many tennis players who have had meniscus tears. A meniscectomy is typically performed when you have a torn meniscus, which is a common knee injury. Most often, the meniscus tears during a sudden motion in which your knee twists while your foot stays planted on the The two menisci of the knee (the white crescents) act as a cushion between the femur and WebA torn meniscus causes pain, swelling and stiffness. Meniscal tears can cause a range of symptoms, including pain localizing to the joint line, swelling, clicking, catching, locking, and the classic giving away of the knee. Conservative treatment such as rest, ice and medication is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own. (Recommendation based on weak evidence. 2011;93(12):1096-103. doi:10.2106/JBJS.J.00929, Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. However, the study did not describe the randomization process. Once youve had your operation and your doctor says you can get back to your usual activities, you should check with your surgeon about any changes you should make to prevent future injuries. All Rights Reserved. Degrees 1 and 2 can be treated conservatively. Richard C. Ritter, UCSF/SFSU Graduate Program in Physical Therapy, San Francisco, CA 94143, ten.tsacmoc@rettircr. Tears may lead to degenerative, arthritic changes if not already present. This promise didnt come with its share of setbacks. Most people can still walk on their injured knee, and many athletes are able to keep playing with a tear. It is well-established that meniscus root tears lead to decreased femorotibial contact area, increased peak contact pressures, and increased stress on the articular cartilage. Effectiveness of physiotherapy after meniscectomy. Some Bakers cysts cause no symptoms and are only discovered incidentally during a physical exam or when an MRI scan is performed for some other reason. The presence of tenderness is recorded. Gordons brother and former NBA player Drew and sister and former Harvard University basketball star Elise noticed a difference in focus from their brother last offseason. Quadriceps strength in the surgical knee improved to presurgical levels by 4 to 6 weeks but continued to remain 12% to 14% lower than the uninvolved side. All subjects underwent the same surgical procedure and postoperative rehabilitation. They evaluated 3 different knee girth circumferences, knee range of motion, gait, quality of quadriceps contraction, and 3 IKDC questionnaires preoperatively, and at day 1, weeks 1 and 2, and months 1 and 3 postoperatively. A meniscus rupture means an injury to the cartilage discs in the knee joint (menisci). Meniscus root tears are associated with chondral injury, early degenerative change, and a high conversion rate to total knee arthroplasty. Loss of extension following anterior cruciate ligament reconstruction: analysis of incidence and etiology using IKDC criteria. A prospective outcome study. Palmieri-Smith RM, Thomas AC, Wojtys EM. A common symptom in both forms is a severe pain in the knee, especially under stress and during certain movements (e.g. Autologous osteochondral grafting--technique and long-term results. A layer of this cartilage covers the end of the thigh bone, the top of the shin bone, and the back of the kneecap. For younger patients, permanent knee pain, blockages in the knee, and injuries in the inner area of the meniscus are operated on relatively quickly and have a good chance of recovery. In principle, acute, injury-related meniscal tears have a higher chance of healing than degenerative or wear-related tears. Arthroscopy. ), Clinicians may utilize early progressive knee motion following knee meniscal and articular cartilage surgery. Measurement of activity limitation, climbing, A physical performance measure, which assesses how well a person, can ascend and descend a flight of stairs. Most meniscus ruptures require surgery. Knee pain, swelling, catching, popping, locking, and A meniscus rupture is an injury to the crescent-shaped and wedge-shaped cartilage discs of the knee joint. If you are a physician or therapist and are interested in further training in functional electrical stimulation or would like to organise STIWELL training in your institute, please contact us. Haapala J, Arokoski J, Pirttimaki J, et al. While knee meniscus tears are common in athletes, older people are particularly at risk too. A meniscus tear results in pain in the front of the knee, either in the middle of the knee (from a medial meniscus tear, which is more common) or the side of the knee (from a lateral meniscus tear). The patient stands on the uninvolved limb, with the toes on the starting line. SLS declares that he has no competing interests. Thirty-one subjects (11 men, 20 women) were divided into a control and interventional group (using a cycle ergometer). S2k-Leitlinie der Deutschen Gesellschaft fr Orthopdie und Unfallchirurgie: Meniskuserkrankung. A modified neuromuscular electrical stimulation protocol for quadriceps strength training following anterior cruciate ligament reconstruction. In a retrospective study, Eskelinen and colleagues38 reviewed the records of 88 young male patients. First State Orthopaedics, 4745 Ogletown-Stanton Road, Suite 225, Newark, DE 19713. immobilisation after surgery of the menisci. sharing sensitive information, make sure youre on a federal Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Bakers cysts typically result from a problem inside the knee joint, such as osteoarthritis or a meniscus tear. For younger patients, permanent knee pain, blockages in the knee, and injuries in the inner area of the meniscus are operated on These parameters of practice should be considered guidelines only. Thigh muscle weakness in ACL-deficient knees persists without structured rehabilitation. This limitation is designed to control high compressive and shear forces that could disrupt the healing meniscus repair or transplant.50. Clinical results in the knee. Marx RG, Connor J, Lyman S, et al. Articular cartilage and osteoarthritis. The distance traveled by the patient is measured to the nearest meter. Ramos J, Perrotta C, Badariotti G, Berenstein G. Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy. Good to excellent outcomes were found in 76% (45/55) of the knees. In older patients (greater than 40 years), the presence of a cartilage lesion increased the odds of having a meniscal tear, whereas previous knee surgery and being a woman decreased the odds. A method for grading health care recommendations. Clinicians should consider age and greater time from injury as predisposing factors for having a meniscal injury. Like all interventions, this procedure involves certain risks. must actively tense the muscle. Matthews and St-Pierre90 investigated isokinetic knee extension and flexion strength following arthroscopic partial meniscectomy. As a library, NLM provides access to scientific literature. Log in or subscribe to access all of BMJ Best Practice. Orthopaedic Knowledge Update: Sports Medicine 2. repaired. The .gov means its official. Barber7 studied the effects of accelerated rehabilitation in individuals who underwent meniscal repair at a minimum of 12-month follow-up. The time from the initial ACL injury to the first-time arthroscopy was used to indicate time from initial injury. The camera displays images on a video screen and your doctor uses these images to guide miniature surgical instruments. The examiner grasps the ankle of the tested limb with 1 hand. The healing process can be even more effective when the treatment is combined with electrotherapy. Average age of the patient was 35 years. However, no significant differences were seen between the 2 groups at day 28 for either jump height (P = .47) or jump distance (P = .22). Meredith DS, Losina E, Mahomed NN, Wright J, Katz JN. A doctor can help determine if surgery is necessary. You have four main ligaments in your knee: the lateral collateral ligament, medial collateral ligament (MCL), posterior cruciate ligament, and anterior cruciate ligament (ACL). It may become too painful or the knee may lock. It is thus more frequently exposed to the damaging effects of external rotary movements than the more flexible outer meniscus. 1,2 The meniscus can tear from acute injury or trauma to Accelerated rehabilitation for meniscus repairs. Tears can be caused by injury, arthritis, or chronic overuse. 2020 Apr;28(4):1177-94. The purposes of these clinical guidelines are to: This guideline is not intended to be construed or to serve as a standard of clinical care. 2015). Hurd WJ, Axe MJ, Snyder-Mackler L. A 10-year prospective trial of a patient management algorithm and screening examination for highly active individuals with anterior cruciate ligament injury: Part 2, determinants of dynamic knee stability. entire meniscus is removed and replaced with an implant. Thorough rehabilitation is essential for the recovery of a meniscal tear. The Marx Activity Level Scale is a patient-reported activity assessment. Low to moderate correlations were found between hop test performance and lower extremity muscular strength, and between hop test performance and self-report outcome measures.39. While acute tears cause sudden and piercing pain with swelling, wear-induced meniscus tears cause gradually increasing pain. But if you need a major reconstruction of a torn ligament, it can take 6 months or so to get you back to full strength, Bush-Joseph says. Hop testing has frequently been proposed as a practical, performance-based outcome measure that reflects the integrated effect of neuromuscular control, strength, and confidence in the limb.107. Your doctor will then perform a careful examination of your affected knee, comparing it to your normal knee. WebHow common is a bucket handle meniscus tear? Additional gains in quadriceps strength may not be attainable without focused quadriceps strength training. If you have a torn meniscus, you might feel like your knee is locked in place. Kennedy DM, Stratford PW, Wessel J, Gollish JD, Penney D. Assessing stability and change of four performance measures: a longitudinal study evaluating outcome following total hip and knee arthroplasty. Patients showed significant improvement from presurgery to postsurgery based on Lysholm scores (61/100 preoperatively to 74/100 postoperatively). Buckwalter JA, Mankin HJ. The electrical stimulation was delivered at a 2500 Hz sinusoidal current at 50 pulses per second 5 times per week for 3 weeks, for 15 seconds on with 3.5 second ramp and 50-second rest period for 10 minutes each session. Wright RW, Boyce RH, Michener T, Shyr Y, McCarty EC, Spindler KP. Articular cartilage forms the smooth layer of the joint that covers the ends of bones. 2017;25(5):365-374. doi:10.5435/JAAOS-D-15-00464, Maher SA, Rodeo SA, Warren RF. In the accelerated group, an 83% success rate in acute tears that were repaired (n = 23), 100% in chronic tears (n = 16), 50% success in unstable knees (n = 2), 75% in knees with intact ACLs (n = 4), and 94% success rate in knees that were stabilized after ACL reconstruction (n = 34). The SEM was 0.4 and MDC95 was 1 point for isolated meniscal lesions. Meniscus Tears: Symptoms, Diagnosis, and Treatment, 7 Things That Can Make Your Knee Give Out, 5 Long-Term Problems After Meniscus Surgery, Water on the Knee (Effusion) Causes and Treatments, Meniscectomy: What to Know About Removal of the Meniscus, The basic science of human knee menisci: structure, composition, and function, Change in cartilage thickness, posttraumatic bone marrow lesions, and joint fluid volumes after acute ACL disruption: a two-year prospective MRI study of sixty-one subjects, Treatment of meniscal tears: an evidence based approach, Meniscus tears: Why you should not let them go untreated, Physical examination of the knee: meniscus, cartilage, and patellofemoral conditions, The injury happened as a result of a hard impact, You experience sudden swelling of the joint. Physical examination of the knee: meniscus, cartilage, and patellofemoral conditions. FOIA They concluded that no significant differences existed in outcomes between ACI and other chondral lesion surgical interventions. Please check your email for a confirmation. Orthopaedic Section Independent Study Course. A variety of interventions have been described for the treatment of knee pain and mobility impairments associated with meniscal or cartilage tears. Test-retest reliability of 4 single-leg horizontal hop tests. Research to date on validity, sensitivity, and reliability of the Lysholm scale is inconclusive.142 The Lysholm scale may prove to be more meaningful when combined with an activity rating scale.116 Two studies have examined the test-retest reliability of the Lysholm Knee Scale and have demonstrated the overall ICC for test-retest reliability of 0.70 to 0.93.13,70. Strength measurements were performed preoperatively and 3 weeks postsurgery at 30/s and 180/s on an isokinetic dynamometer. There are two types of ligaments: collateral and cruciate. However, randomization and statistical analysis were not reported in the clinical results. The 3 SF-36 scales related to musculoskeletal injury were analyzed: physical function, role physical, and bodily pain. From day 7 to day 28, significant improvement was seen in the supervised exercise in jump height (P = .04) and jump distance (P = .02). Bush-Joseph calls this cleaning out the knee. Shapiro et al117 investigated the use of the SF-36 to determine if this assessment tool could identify patients who required ACL reconstruction, could detect changes with treatment over time, and was correlated with the IKDC knee evaluation form, Lysholm scoring scale, and the Tegner activity scale at baseline and at 3 follow-up periods. It can be hard to know when you should see a healthcare provider for knee pain. The patient is permitted to use his regular walking aids if needed. Although no correlations were found between SF-36 and physicians recommendation for surgical treatment with either acute or chronic ACL injuries, the authors found changes greater than 10 points in many of the physical health-based scales, indicating that this difference may be meaningful and may be significant with a larger sample size. Coping with the pain brought on by a meniscus tear may be challenging. By: HoopsHype. Patients were reviewed by clinical assessment and MRI at a mean follow-up of 28 months. The patient can use upper extremity support by holding the clinicians hands during the test. In this modified system, the typical A, B, C, and D grades of evidence have been modified to include the role of consensus expert opinion and basic science research to demonstrate biological or biomechanical plausibility (Table 2). Regular overloading causes degeneration of the menisci and leads to subsequent meniscus Despite the limited quality of the included randomized controlled trials, NMES is effective in increasing quadriceps strength. Mariani PP, Santori N, Adriani E, Mastantuono M. Accelerated rehabilitation after arthroscopic meniscal repair: a clinical and magnetic resonance imaging evaluation. Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. This type acts as a shock absorber between bones. A tear that occurs in the knee cartilage may be called a "cartilage tear" or a "meniscus tear," but the terms are not always interchangeable. The opposite hand is placed on the tested knee with the thumb over the lateral joint line and the middle finger over the medial joint line. Home exercise program consisted of edema management, quadriceps setting, straight leg raises, and knee flexion range of motion exercises. Progressive chondrocyte death after impact injury indicates a need for chondroprotective therapy. WebSymptoms and Causes What causes a meniscus tear? What are the possible treatments and therapies? Interrater reliability of a clinical scale to assess knee joint effusion [abstract]. Drew Gordon said his brother worked out with people that had a different work ethic., Kawhi Leonard underwent a cleanup on his torn meniscus and it will be an eight-week, What intrigues the most about the Wizards new setup is that each of Washingtons new top executives have been central parts of rapid buildups in three completely different markets with three completely different sets of advantages and challenges, One NBA source said Aaron Gordon worked out in Denver with Murray, teammate Michael Porter, Jr., and even Los Angeles Clippers star Kawhi Leonard last summer. Podsiadlo D, Richardson S. The timed Up & Go: a test of basic functional mobility for frail elderly persons. Meniscal repair was successful in managing symptoms in 88% of the standard group and in 90% of the accelerated group. It was designed as a 6 dimension scale based on a total of 100 points: symptoms (20 points), daily and sports activities (15 points), physical examination (25 points), knee stability testing (20 points), radiographic findings (10 points), and functional testing (10 points).8 Portions of the rating scale have been validated.142 The ICC value for test-retest reliability in patients with ACL reconstruction was greater than 0.75.8 The MDC95 for pain, swelling, partial giving way, and full giving way factors was 2.45, 2.86, 2.82, and 2.30, respectively. In a multicenter retrospective study, Tandogan and associates128 investigated meniscal and chondral lesions that may accompany ACL tears and the relationship of age, time from initial injury, and level of sports participation with these lesions. The authors concluded that caution is warranted in recommending any treatment to patients based on the low methodological quality of the reviewed studies.59. Also, single-limb single-hop test for distance was normal in 70% of the patients, but remained abnormal or severely abnormal in the remaining 30%. Small fluid-filled sacs called bursa cushion the joint and help reduce friction between the muscles and other surrounding structures. When someone hears that he has a meniscus tear, hell usually assume he needs surgery, Bush-Joseph says. Matthews P, St-Pierre DM. AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. Rehabilitation in the standard group consisted of limited range of motion and weight bearing until 6 weeks after repair. Comparison of the reliability of the Orthoranger and the standard goniometer for assessing active lower extremity range of motion. A cyst forms when excess synovial fluid travels to the popliteal bursa at the back of the knee. Each subscale is summed and transformed to a score of 0 (worst) to 100 (best). The effect size for responsiveness for change for pain, swelling, partial giving way, full giving way, symptoms average, ACL function average, sports function average, and overall rating score was 1.4, 1.18, 1.87, 1.49, 1.74, 0.69, 1.91, and 3.49, respectively (effect size greater than 0.80 is considered a large effect). This is used to adhere to range of motion limitations after complex meniscal repairs and transplants. A study of the incidence of meniscal and cartilage injuries in an ACL-deficient athlete and non-athlete population: an Indian experience. Or maybe it was that spill you took skiing last winter that still gives you problems today. The greater a patients age and longer time from initial ACL injury are predictive factors of the severity of chondral lesions, and time from initial ACL injury is significantly associated with the number of chondral lesions. Snyder-Mackler L, Delitto A, Bailey SL, Stralka SW. 2010 Jun; 40(6): A1A35. At 28 days postsurgery, the supervised exercise group was significantly better than the home-based group regarding Sports Activity Rating scale (P = .04). While watching the medial joint area, the hand over this area is taken and used to press quickly along the lateral (ie, opposite) aspect of the knee, looking for a fluid wave to present medially. Normal sports activities are only possible after up to 6 months. Depending on the type Tell Me About. pain when bending, stretching, or turning the knee. The accuracy of magnetic resonance imaging scanning and its influence on management decisions in knee surgery. Clinicians may utilize early progressive return to activity following knee meniscal repair surgery. 2023 MED-EL Medical Electronics. The mean SD time for subsequent injury in patients with a medial meniscus tear was 26.1 39.3 months after the initial ACL injury, whereas the time for those who did not tear their medial meniscus was 11.4 17.8 months after the initial ACL injury. About OrthoInfoEditorial Board Our ContributorsOur Subspecialty Partners Contact Us, Privacy PolicyTerms & Conditions Linking Policy AAOS Newsroom Find an FAAOS Surgeon. It can take roughly 8 weeks to recover from surgery to repair a ligament tear. Median Tegner activity scores were 7 (range, 5/10 to 7/10) preinjury and at peak improvement, with a slight decrease to a median of 6 (range, 5/10 to 7/10) at follow-up greater than 10 years. The accelerated rehabilitation group (n = 40 meniscal repairs) consisted of no bracing, no limits in range of motion, and full weight bearing as tolerated. In a retrospective study, Rodrigo et al111 investigated the use of continuous passive motion (CPM) devices in patients following debridement with microfracture. A healthcare provider will be able to determine which type of tear you have, since it is very difficult to differentiate the two based on symptoms alone. They reported significant improvements in Lysholm and Tegner scores and good to excellent results based on the modified SF-36 and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Time from initial ACL injury and age were predictive of lateral meniscal tears. Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF. The meniscus is a different type of cartilage. Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Patients were not randomized into groups, but usually placed into groups based on insurance coverage for the use of CPM. Moffet et al97 conducted a randomized controlled trial on the efficacy of an early, intensive, supervised rehabilitation program on knee strength recovery in the first 3 weeks postmeniscectomy. of the knee joint. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus. The cartilage is found between the bones in the A meniscus can either be torn or severed due to external force, or may degenerate due to age or predisposition. Surgery is necessary in the case of degenerative meniscal injuries of degrees 3 and 4, and for traumatic meniscal injuries (Becker et al. The pain, sport and recreation, and quality of life domains have been determined to be the most responsive to change, with the largest effect size for active, young patients.142 The KOOS has been demonstrated to contain items regarding symptoms and disabilities important to patients with an ACL tear, isolated meniscal tears, or knee osteoarthritis.129, The International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) is a joint-specific outcome measure for assessing symptoms, function, and sports activity pertinent to a variety of knee conditions.142 The form contains 18 questions, in which the total scores are expressed as a percentage. Forty-two athletes underwent 45 meniscal repairs, including repairs of bucket-handle, radial, and complex meniscal tears. The patient is instructed to stand on the tested limb. The patient sits in a chair with arm rests and is asked to stand up from the chair and walk as quickly and safely as possible to a point 3 m away, turn, walk back to the chair, and sit down again. Is it OK to walk on a knee with torn knee cartilage? Functional electrical stimulation helps rebuild muscles after a meniscus rupture or surgery. Isokinetic peak torque and total work and subjective questionnaire scores were assessed at 2, 4, and 8 weeks postoperatively. Test-retest reliability in patients with total knee and hip arthroplasty, Measurement of impairment of body structure, knee joint, The amount of fluid in the knee joint measured by visual inspection by clinician. Kawhi Leonard will be fully healthy for training camp. [1]Kopf S, Beaufils P, Hirschmann MT, et al. WebInjuries to the menisci are the second most common injury to the knee, with an incidence of 12% to 14% and a prevalence of 61 cases per 100 000 persons. The initial assessment is made based on the patients medical history. Consequently, menisci can tear due to traumatic injury or degenerative wear (e.g., in knee joint arthritis), and can compromise force distribution across the knee joint. Results of the Kentucky high school football knee injury survey. WebWhen Will My Knee Feel Better? They reported that the average (SD) postoperative Lysholm score was 80.8/100 (6) and the average Tegner score was 4.8/10 (0.8) at the last follow-up. At final follow-up (mean, 72 months), knee pain and swelling had improved in 70% of the patients. Postoperatively, the home-based group had 40% deficit at 30/s and 42% deficit at 180/s, whereas, the supervised group had 15% deficit at 30/s and 16% deficit at 180/s. The weakened knee must be slowly rebuilt through adapted training plans and physiotherapy. The studies reviewed demonstrated the higher success rates were present in investigations of lesser quality. Surgery is usually required from degree 3. Alternatives to Surgery Meniscus tears may be treated with rest, physical therapy, and/or surgery. In order to alleviate or completely eliminate pain and to restore the knee function, a meniscus rupture is treated. Surgical procedures such as OATS and ACI are designed to return individuals to normal activities of daily living function, although some may return to high level activities. In a cohort study based on the Norwegian National Knee Ligament registry, Granan et al44 reported that the odds of meniscal tears increased for each month that elapsed from the initial ACL injury date to the ACL-reconstruction surgery date. Jurvelin J, Kiviranta I, Saamanen AM, Tammi M, Helminen HJ. The likelihood of a meniscus rupture is affected by genetic predispositions, such as the anatomical variant of discoid meniscus where the meniscus is round rather than sickle-shaped and may thus cause a pathological load distribution and discomfort. Like a lot of knee injuries, a meniscus tear can be painful and debilitating. The meniscus is a different type of cartilage. Thirteen subjects were randomly assigned to the experimental group and 8 subjects were assigned to the control group. Each knee has two menisci (plural of meniscus)one at the outer edge of the knee and one at the inner edge. A recent systematic review and meta-analysis by Bax and associates9 investigated the effectiveness of neuromuscular electrical stimulation (NMES) as a treatment modality for strengthening of the quadriceps muscles. Failure of a meniscal repair was defined as incomplete healing noted at second-look arthroscopy or objective signs of meniscal tear. Psychometric properties of measurement tools for quantifying knee joint position and movement: a systematic review. Stronger quadriceps (muscles at the front of the thigh), for example, will help keep your knee stable. The knee joint is filled with a clear fluid (synovial fluid) that acts as a lubricant to help reduce friction within the joint. Shelbourne and associates118 reported on clinical results of accelerated rehabilitation including no bracing after isolated meniscal repair. The https:// ensures that you are connecting to the The diagnosis of meniscus tears: the role of MRI and clinical examination. Elise Gordon credited her younger brothers focus on wanting to reach his dreams for himself, his family and the Nuggets and said he was a gym rat last offseason, Among all players with at least 1,000 career playoff shot attempts, Jokic ranks second with 57 percent effective field goal accuracy (behind only Dwight Howard, at 59 percent), and he ranks third with a 61 percent true shooting mark, Lakers extend qualifying offers to Rui Hachimura and Austin Reaves, both become restricted free agents, Pistons planning to pick up Alec Burks option, Woj: Hawks' veterans outside of Trae Young available in trade talks. Clinicians may need to delay return to activity depending on the type of articular cartilage surgery. Although, a moderate to high number of patients had a decrease in function between 18 and 36 months, all functional scores were greater than those obtained preoperatively. WebWhat is a meniscus tear? In a randomized controlled trial, Goodwin et al43 randomly assigned 84 patients to either a supervised program with a home program or a home program alone. Frobell RB. The Medical Outcomes Study 36-item Short Form (SF-36) is currently the most popular general health outcome measure.142 The measure was designed to improve on the ability to measure general health outcomes without significantly lengthening the questionnaire and could be completed in less than 10 minutes. Strength measurements were performed preoperatively and 3 weeks postsurgery at 30/s and 180/s on an isokinetic dynamometer. Rehabilitation in the standard group consisted of limited range of motion and weight bearing until 6 weeks after repair. Lewis PB, McCarty LP, 3rd, Kang RW, Cole BJ. Bhosale AM, Richardson JB. (Recommendation based on conflicting evidence.

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