Meniscus Repair Rehabilitation Protocol

General Considerations:
• Weight-bearing as tolerated. Walk with crutches.
• Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks post-op.
• Regular assessment of gait to avoid compensatory patterns.
• Regular manual mobilizations to surgical wounds and associated soft tissue to decrease the incidence of fibrosis.
• No resisted leg extension machines (isotonic or isokinetic).
• No high impact or cutting/twisting activities for at least 4 months post-op.
• MD follow-up visits at Day 1, Day 8 - 10, 1 month, 4 months, 6 months, and 1 year post-op.

During the first 4 weeks:
TWICE PER DAY: Without brace, allow GRAVITY ONLY to bend knee back as tolerated BUT NO MORE THAN 90° for a good knee stretch without increase in pain. Relax knee and stretch for 60 seconds.

Week 1:
• MD visit Day 1 post-op to change dressing and review home program.
• Icing and elevation regularly. Aim for 5x per day, 15-20 minutes each time.
For ice machine, use as directed.

Exercises:
1) Quad-sets - 10 sec. holds every 30 minutes.
2) Straight leg raise exercises (lying, seated, and standing): quadriceps/adduction/abduction/gluteal sets.
3) Ankle pumps throughout the day.
4) Well-leg stationary cycling.
5) Upper body conditioning and core strengthening.

• Pool/deep water workouts after the first 8 - 10 days once surgical wounds are healed and with the use of a brace.
• Soft tissue treatments for edema/pain control and to posterior musculature, patella, and incisions.
• Knee extension range of motion should be full.

Weeks 2 - 4:
• MD visit at 8 - 10 days for suture removal and check-up.
• Manual-resisted exercises (i.e. PNF patterns) of the foot, ankle, and hip. Trunk stabilization program. Single leg balance exercises.
• Continue with pain control, range of motion, soft tissue treatments, and proprioception exercises.
• Non-weightbearing aerobic exercises (i.e. unilateral cycling, UBE, Schwinn Air-Dyne with uninvolved leg and arms only, pool workouts).

Weeks 4 - 6:
• MD visit at 4 weeks post-op; will wean off the use of rehab brace.
• Stretching, exercises and manual treatments to improve range of motion (especially flexion).
• Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, proprioception).
• Stationary bike and progressing to road cycling as tolerated.
• Slow walking on treadmill for gait training (preferably a low-impact treadmill).

Weeks 6 - 8:
• Increase the intensity of functional exercises (i.e. cautiously increase depth of closed-chain exercises, Shuttle/leg press). Do not overload closed or open-chain exercises.
• Patients should be progressing to walking without a limp and flexion range of motion should be at 80%.

Weeks 8 - 12:
• Add lateral training exercises (side-step-ups, Theraband resisted side-stepping, lateral stepping).
• Introduce more progressive closed chain and agility leg exercises.
• Patients should be pursuing a home program with emphasis on sport/activity-specific training.
• Knee flexion range of motion should be equal to other knee.

 Weeks 12 - 16:
• Low-impact activities until 16 weeks.
• Increase the intensity of strength and functional training for gradual return to activities.

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.