ACL Reconstruction with Meniscus Repair Post-operative Physical Therapy Protocol

This protocol outlines The Stone Clinic's rehabilitation framework after ACL reconstruction with meniscus repair. Because the meniscus repair must be protected while the ACL graft and knee function are rebuilt, recovery follows a careful, criteria-based progression.

At The Stone Clinic, we encourage patients to see themselves not as patients in rehab, but as athletes in training. The goal is to use the recovery process to reduce swelling, restore motion, rebuild strength, and return sports fitter, faster, and stronger than before injury.

Learn how The Stone Clinic approaches ACL reconstruction and return to sport

ACL Reconstruction and Meniscus Repair Recovery: What to Expect

Dr. Stone and the StoneFit team explain how ACL recovery begins with swelling control, range of motion, quad activation, and gait mechanics to help progress your strength, balance, running, agility, and return-to-sport training.

ACL Reconstruction with Meniscus Repair Recovery Timeline at a Glance

Use the links below to jump to each phase of the protocol.

• Weeks 1-2: Max Protection Phase
• Weeks 3-4: Moderate Protection Phase
• Weeks 5-12: Endurance Phase
• Weeks 13-18: Strength Phase
• Weeks 19-24: Power Phase
• Weeks 25-30: Agility Phase
• Weeks 30+: Return-to-Sport Phase

Progress is not a straight line, especially when returning to cutting, pivoting, and dynamic sports. The path back is built through clear phases, objective testing, and sport-specific progression.

Important Guidelines Before Starting ACL Reconstruction with Meniscus Repair Rehab

The following guidelines apply to The Stone Clinic's ACL reconstruction with meniscus repair rehabilitation protocol.

• Partial weight-bearing, less than 50% body weight, for 4 weeks with crutches.
• Surgical knee will be in a hinged brace locked in full extension for 4 weeks.
• Avoid direct palpation of surgical portals for 4 weeks.
• No resisted lateral movements for 12 weeks.
• No high-impact activities, cutting, or twisting for at least the first 6 months.
• No resisted knee extension machines, wall squats, wall sits, or hamstring curl machines.
• Patients are given a Fitness Test at 3 months, 6 months, and 1 year.
• All timelines and recommendations are subject to change, as each individual case is different.

ACL Reconstruction with Meniscus Repair Recovery Weeks 1-2: Max Protection Phase

The first two weeks focus on protecting the repair, controlling pain and swelling, restoring early motion, and maintaining quadriceps activation.

Weight-Bearing

• Up to 50% weight-bearing with two assistive devices.

Range of Motion

• Days 1-7: 0-70 degrees.
• Days 7-14: 0-90 degrees.

Manual Therapy

• Patellofemoral mobilization.
• Soft tissue mobilization to lower limb musculature.
• Avoid direct palpation of surgical portals.

Recommended Exercises

• Knee hangs.
• Quad sets.
• Gluteal sets.
• Terminal knee extension.
• Multi-directional straight leg raises.
• Calf raises.
• Knee range-of-motion exercises.
• No loaded knee flexion for 4 weeks.

Goals for Progression

• Minimal pain.
• Minimal swelling.
• Able to tolerate full weight-bearing.
• Normal extension and 90 degrees of flexion compared to the other knee.

ACL Reconstruction with Meniscus Repair Rehab Weeks 3-4: Moderate Protection Phase

This phase continues protection of the meniscus repair while maintaining motion, soft tissue mobility, and controlled weight-bearing.

Weight-Bearing

• Up to 50% weight-bearing with two assistive devices.

Range of Motion

• 0-90 degrees.

Manual Therapy

• Patellofemoral mobilization.
• Soft tissue mobilization to lower limb musculature.
• Avoid direct palpation of surgical portals.

ACL Reconstruction with Meniscus Repair Recovery Weeks 5-12: Endurance Phase

The endurance phase progresses toward full weight-bearing, improved range of motion, gait training, functional strength, and preparation for the first Stone Fitness Test.

Weight-Bearing

• Full weight-bearing as tolerated.

Range of Motion

• Weeks 5-6: 0-120 degrees.
• After week 6: unrestricted as symptoms allow.

Manual Therapy

• Patellofemoral mobilization.
• Soft tissue mobilization to lower limb musculature.
• Initiate gentle scar mobilization if portals are closed.

Recommended Exercises

• Gait training.
• Calf raises.
• Straight leg raises.
• Mini squats.
• Double leg press.
• Single-leg balance.
• Progress to higher-volume, lower-load functional exercises, including double-leg and single-leg squats, step-ups, and step-downs.
• Stationary cycling program after 4 weeks.

Goals for Progression

• Range of motion from 0-120 degrees.
• Able to squat to 90 degrees without pain.
• Able to ascend and descend stairs pain-free.
• Pass Stone Fitness Test I at approximately 12 weeks.

ACL Reconstruction with Meniscus Repair Rehab Weeks 13-18: Strength Phase

The strength phase increases load, walking tolerance, and closed-chain strength while continuing to prepare the knee for higher-level athletic activity.

Weight-Bearing

• Slowly continue to increase tolerance to longer walking and light hiking distances.
• Distance and terrain progress as strength and symptoms allow.

Range of Motion

• Unrestricted as symptoms allow.

Manual Therapy

• Continue soft tissue and scar mobilization as needed.
• Manual therapy may be used as a means of recovery.

Recommended Exercises

• Higher-load, lower-volume strength training.
• Progressive closed-chain resistance training for all lower extremity muscle groups.
• Initiate resisted lateral movements.
• Released for high-impact activities by MD on an individual basis.

Goals for Progression

• Symmetrical single-leg squat with good mechanics.
• Symmetrical thigh girth measurements.

ACL Reconstruction with Meniscus Repair Recovery Weeks 19-24: Power Phase

The power phase increases speed and activity-specific strength while preparing for running progression and Stone Fitness Test II.

Weight-Bearing

• Distance and terrain progress as strength and symptoms allow.

Range of Motion

• Unrestricted as pain allows.

Manual Therapy

• For recovery purposes.

Recommended Exercises

• High-load, low-volume strength training.
• Increase speed of exercises.
• Activity-specific training.

Goals for Progression

• Symmetrical single-leg hop.
• Symmetrical single-leg landing mechanics.
• Pass Stone Fitness Test II at approximately 24 weeks.
• Complete return-to-running program.

ACL Reconstruction with Meniscus Repair Rehab Weeks 25-30: Agility Phase

The agility phase progresses toward cutting, pivoting, unplanned movement, and activity-specific training when cleared.

Weight-Bearing

• Distance and terrain progress as strength and symptoms allow.

Range of Motion

• Unrestricted as pain allows.

Manual Therapy

• As needed.

Recommended Exercises

• Focus changes to ballistic movements, change of direction, cutting, pivoting, and unplanned movements.
• Activity-specific training.
• Released for high-impact activities by MD on an individual basis.

Goals for Progression

• Pass Agility T-test.
• Symmetrical single-leg cross-over hop test.

ACL Reconstruction with Meniscus Repair Return to Sport: Weeks 30+

Return to sport is the goal, but it is earned through testing, strength, sport-specific progression, and the demands of the patient's activity.

Weight-Bearing

• Distance and terrain progress as strength and symptoms allow.

Range of Motion

• Unrestricted as symptoms allow.

Manual Therapy

• For recovery purposes.

Recommended Exercises

• Exercises should be specific to the demands of the activities and sports the individual participates in.
• Continue cutting and pivoting exercises as needed.

Goals for Progression

• Competitive or professional athletes should be able to train 100% without complications before clearance for competitive play.
• Complete return-to-running program.
• Patient goal.