Optimization of rehabilitation strategies after different types of meniscal tears

• Applicant: Privatdozent Dr. Andreas Martin Seitz
• Subject Area: Orthopaedics, Traumatology, Reconstructive Surgery
• Term: since 2020
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 437847923

An average of 217,000 arthroscopic interventions on the knee cartilage and the menisci are performed in Germany every year - and the trend is rising. With around 37,000 cases surgically treated meniscus injuries represent a significant proportion of this health-care-system relevant group. The cause of such meniscal injuries may be degenerative or traumatic. While degenerative meniscal injuries can often occur as early as 40 years of age during normal daily activities, traumatic meniscal tears are more likely to occur in younger, physically active people. Depending on the location and the shape of the tear treatment gold standards have been developed. Degenerative and asymptomatic meniscal tears are usually treated conservatively. Until a few years ago, partial meniscectomy was the gold standard in symptomatic tears in the transitional and avascular meniscal portions. Due to poor prognoses and correspondingly poor long-term clinical results, there was a paradigm shift in the surgical treatment of meniscal tears. Although asymptomatic tears are still conservatively treated, all other tears are nowadays surgically treated with different refixation techniques. However, no uniform rehabilitation strategies exist to date, neither after surgical meniscal tears nor after refixed posterior horn avulsions. The latest clinical guidelines about meniscal injury conclude that there is currently insufficient scientific data on the effectiveness of rehabilitation after surgical treatment of meniscal tears. Therefore, further basic biomechanical work is urgently needed.Within a previous DFG project we developed a novel knee joint simulator allowing, for the first time, to apply physiological motion and loading conditions to knee joint specimens. The proposed project is intended to significantly expand and improve this existing simulator. For example, the influence of different meniscal tears before and after refixation on tibiofemoral pressure distribution, anchoring forces, peripheral strains and gapping behaviour of meniscal tears before and after fixation under different rehabilitation-relevant exercises and everyday movements will be examined in controlled biomechanical in vitro studies. The results of these in vitro experiments will provide realistic biomechanical data for optimizing rehabilitation programs after meniscal repair. In combination with future clinical trials, this could be used to develop guidelines that could ultimately lead to less downtime for workers and thus to essential savings in the healthcare system. In addition, home training programs for patients could be developed to support physiotherapeutic rehabilitation.

• DFG Programme: Research Grants