Meniscus Repair (Peripheral/Vertical)

Post-Operative Protocol

Phase I – Maximum Protection

Weeks 0 to 3:

• Brace - locked in full extension during all ambulation for 3 weeks
  • Can unlock brace to allow 0-90°  for unloaded range of motion only
• Use two crutches with touch-down weight bearing (<25% body weight) at all times for 3 weeks
• Limit knee flexion to 90° for 3 weeks

Goals

• Reduce inflammation and pain
• 0 degrees of knee extension

Exercise progression

• Emphasize patellofemoral mobilizations
• Passive/active knee range of motion with 90 flexion limit
• Quadriceps setting emphasize VMO function
• Multi-plane straight leg raising
• Open chain hip strengthening
• Gait training

Weeks 3-6:

• Brace – open to 0-90 degrees for ambulation
• Continue using two crutches, with gradual progression of weight bearing
  • Increase WB to FWB over next 2 weeks
• Progress as tolerated past 90 degrees of knee flexion

Goals

• Reduce inflammation and pain
• Maintain 0° of knee extension

Phase II – Progressive Stretching and Early Strengthening

Weeks 6 to 8:

• Discontinue brace

Goals

• Full knee extension/hyperextension
• Gradual progression to full knee flexion
• No swelling
• Normal gait

Exercise progression

• Continue to emphasize patella mobility
• Begin bilateral closed kinetic chain strengthening (limited range initially)
• Step-up progression
• Begin stationary bike with light resistance initially
• Proprioception drills

Phase III – Advanced Strengthening and Proprioception

Weeks 8 to 12:

Goals

• Full knee range of motion

Exercise progression

• Avoid rotational movements until 14 weeks
• Begin gym strengthening program
• Advance stationary biking program (increase intensity)
• Introduce treadmill walking and elliptical trainer
• Begin unilateral closed kinetic chain program
• Gym strengthening progression (leg press above 90-degrees, hamstrings curls etc.)

Phase IV – Advanced Strengthening and Plyometric Drills

Weeks 12 to 16:

• Follow-up examination with the physician

Goals

• Pass return-to-sport functional test at > 90% (involved vs uninvolved limb) by 16 weeks

Exercise progression

• Plyometric drills from bilateral to unilateral at 12 weeks
• Linear running progression at 12 weeks
• Progress to lateral and rotational stresses at 14 weeks
• Multi-directional drills at 14 to 16 weeks