Meniscus Repair Rehab Protocol Guidelines
The amount of limitation and weight-bearing depends on the complexity and location of the repair.
- Partial weight-bearing status (<50%) for most repairs unless otherwise ordered by MD. Walk with crutches. Heel lift in opposite shoe to normalize gait.
- Use of a brace depends on type of repair. Complex repairs will be in a hinged rehab brace locked in full extension when walking for 4 weeks postop. Not worn at night and out of brace for range of motion exercises.
- 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 direct palpation to surgical portals x 4 weeks. Consider the edge of the bandages as the "no touch zone" (approximately 2 inches in all directions). See Wound Care Protocol for full details.
- No resisted leg extension machines (isotonic or isokinetic) at any time.
- No high-impact or cutting/twisting activities for at least 4 months postop.
- No resisted lateral movement for 3 months.
- M.D./nurse follow-up visits requested at Day 2, Day 14, 1 month, 3 months, 6 months, and 1 year postop if possible.
- During the first 4 weeks: TWICE PER DAY: Without brace, allow GRAVITY ONLY (passive only) to bend knee back as tolerated BUT NO MORE THAN 90 DEGREES for a good knee stretch without increase in pain. Relax knee and stretch for 60 seconds.
Meniscus Repair Rehab Timeline
Meniscus Repair Rehab: Week 1
- Nurse visit day 1 post-op to change dressing and review home program.
- Ice and elevation as much as reasonable when awake.
Manual
- Soft tissue treatments for edema/pain control and to posterior musculature, ITB, adductor, quad, calf. No direct palpation of surgical portals x 4 weeks.
Exercises
- Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/gluteal sets, ankle pumps.
- Well-leg stationary cycling, upper body ergometer for cardio. Add upper body and core conditioning.
- Daily edge-of-bed dangle for passive knee flexion (allow knee to hang in pain-free range with light stretch).
Goals
- Decrease pain/edema.
- Passive range of motion 0-70 degrees.
- Gait: partial weight bearing (<50%) with brace locked in extension for some repairs. See guidance from MD for other repairs. Crutches used for gait support.
Meniscus Repair Rehab: Weeks 2-4
- Nurse visit on day 14 for suture removal and check-up.
Manual
- Continue with soft tissue treatment for edema/pain, posterior musculature, iliotibial band, adductor, quadriceps, calf.
Exercises
- Continue with previous, manual resisted exercises (i.e. PNF patterns) of the foot, ankle, and hip. Trunk stabilization program, three-limb plank. Single-leg balance and proprioceptive exercises.
- Aerobic exercises (i.e. unilateral cycling, upper body ergometer, Schwinn Air-Dyne with uninvolved leg and arms only, well body bike, single leg row machine).
Goals
- Decrease pain/edema.
- Passive range of motion 0-90 degrees.
- Gait: Partial-weight bearing (<50%) with brace locked in extension. Crutches used with gait.
Meniscus Repair Rehab: Weeks 4-6
- M.D. visit at 4 weeks post-op, will wean off the use of rehab brace.
Manual
- Stretching, exercises, and manual treatments to improve range of motion (especially flexion). Initiate surgical portal scar mobilization if portals are completely closed.
Exercises
- Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, proprioception).
- Stationary bike low cadence, low resistance.
- Slow walking on treadmill for gait training (preferably a low-impact treadmill).
- Initiate out-of-brace pool exercises if incisions are closed and dry.
Goals
- Gait: unlock brace; wean off brace and crutches. Emphasize proper gait mechanics.
- Passive range of motion 0-120 degrees.
Meniscus Repair Rehab: Weeks 6-8
Manual
- Continue as needed for ROM, decrease pain, and muscle guarding.
Exercises
- 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.
- Advance pool running and core exercises.
Goals
- Gait: no limp present, good mechanics.
- Passive range of motion 0-135 degrees.
- Tolerate 90/90 squat.
Meniscus Repair Rehab: Weeks 8-12
Manual
- Continue with soft tissue, joint mobilizations as needed.
Exercises
- Add lateral training exercises (side-step ups, 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.
- Consider road cycling in saddle.
Goals
- Full range of motion.
- Initiate lateral training with no resistance.
Meniscus Repair Rehab: Weeks 12-16
- Complete 3-month sports test and initiate return to running program.
- Low-impact activities until 16 weeks.
- Increase the intensity of strength and functional training for gradual return to activities.
- Initiate resisted lateral training (Theraband-resisted side-stepping).
Goals
- Preparedness for Sports Test I for s/p 3-month checkup with Dr. Stone.
- Complete and pass Sports Test 1.
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.
Learn More About Meniscus Repair and Preservation
Preserving the natural meniscus whenever possible is central to Kevin R. Stone, MD's approach to treating meniscus injuries. The Stone Clinic focuses on repairing, regenerating, or replacing meniscus tissue to help protect the knee and support an active lifestyle.
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