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Disability, impairment, and physical therapy utilization after arthroscopic partial meniscectomy in patients
1Occupational Orthopedics, LLC, 6464 S.W. Borland Road, Suite C-4, Tualatin, OR 97062, USA. johndipaola@occortho.com
Background:
The treatment of meniscal tears in injured workers is associated with less favorable outcomes and higher utilization of clinical services. It was hypothesized that patients receiving Workers' Compensation who undergo arthroscopic meniscectomy can have excellent outcomes with physical therapy utilization below the national best-practices benchmarks.
Methods:
The records of 155 injured workers who had undergone 164 primary arthroscopic meniscectomies were reviewed at least one year following claim closure. The time to release to unrestricted full work duty and the number of postoperative physical therapy visits were compared between the study group (managed with a protocol-driven, independent exercise program) and the control group (managed with traditional outpatient physical therapy). The traditional therapy regimen was implemented by means of a written referral stating general goals (knee range of motion, strength, and function) and recommending a range or a maximum number of visits to be attended. Patients in the study group received a written referral specifying the exact number of visits that were approved, a kit containing exercise equipment with a booklet illustrating twenty-five exercises, and a prescribed rehabilitation protocol outlining the philosophy, expected subjective and functional outcomes, and specific objective weekly goals.
Results:
The median number of physical therapy visits per patient was 40% lower in the study group than in the control group (six compared with ten; p < 0.001). There was no difference between the study group and the control group with regard to the permanent partial disability rate (0% compared with 4.3%; p = 0.076). Following arthroscopic meniscectomy, there was no significant difference between the study group and the control group in terms of the time to release to light duty, the time to release to full duty, the time to claim closure, or the rate of impairment.
Conclusions:
The implementation of a structured, independent exercise protocol appears promising as a method to reduce physical therapy utilization to levels below the national best-practices benchmarks without negatively impacting impairment and disability rates for patients receiving Workers' Compensation who undergo arthroscopic meniscectomy.
