Meniscus Repair Rehab Protocol

Meniscus Repair Rehab Protocol

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The goal of this protocol is to provide a clinical guideline for the post-surgical course of physical therapy for a patient who has had a knee meniscal repair surgery.  This is not intended to substitute clinical decision making regarding the patient’s proper progression based on evaluation findings, individual progress, and if/when post-operative complications arise.  If a clinician requires assistance in the progression of a post-surgical patient the surgeon should be consulted. 

GENERAL GUIDELINES:

  • Partial weight-bearing (PWB) status (<50%) or Non-Weightbearing (NWB) per MD orders.
  •  Walk with crutches. Heel lift in opposite shoe to normalize gait.
  • 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 high impact or cutting / twisting activities for at least 6 months post-op.
  • No resisted lateral movement for 12 weeks.
  • 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.
  • Pass VTFC Knee Functional Performance Test 1 at 3 months
  • Pass VTFC Knee Functional Performance Test 2 at 6 months
  • Return to work as directed by PT/MD based on work demands

Rehabilitation Progression

PHASE I: Week 0 – 4:

Goals:

  • Protect meniscus and minimize effects of immobilization 
  • Decrease pain, promote an optimal healing environment, and control inflammation/swelling.
  • Re-establish quadriceps control 
  • Full passive and active knee extension/hyperextension range of motion.  
    • Avoid hyperextension greater than 10 degrees. 
  • Week 1: Passive range of motion 0-70 degrees.  Week 2-4: Passive range of motion 0-90 degrees.
  • Gait: Partial-weight bearing (<50%) with brace locked in extension. Crutches used with gait.
  • Educate patient on rehabilitation progression.
    • Keep knee straight when sitting or lying down.  Do not place a towel behind knee. 
    • Do not actively bend your knee; support surgical leg with transfers.
    • Do not pivot on your surgical leg.

Brace:

  • Surgical knee will be in a hinged rehab brace locked in FULL EXTENSION for 4 weeks post-op.

Weight Bearing Status:

  • Non-weightbearing or partial weightbearing status (<50%), unless otherwise ordered by MD. Walk with crutches. Heel lift in opposite shoe to normalize gait.

Exercises:

  • Game Ready / Ice and elevation every 2 hours for 15-20 min each session.
  • Soft tissue treatments for edema/pain control and to posterior musculature, ITB, add, quad, calf. 
  • No direct palpation of surgical portals x 4 weeks.
  • Straight leg raise exercises (lying, seated, and standing), quadriceps/adduction/ gluteal sets, ankle pumps.
  • NMES supine knee extensions
  • 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).

PHASE II: Weeks 4-8:

Criteria to advance to Phase II:

  • Full extension
  • Good quad set, SLR, without extension lag
  • Flexion to 90°
  • Minimal swelling/inflammation
  • Normal gait on level surfaces

Goals:

  • Gait- unlock brace; wean off brace and crutches. Emphasize proper gait mechanics.
  • Passive range of motion 0-120 degrees.

Brace/Weight Bearing Status:

  • Wean off the use of rehab brace.

Exercises:

  • Stretching, exercises and manual treatments to improve range of motion (especially flexion). 
  • Initiate surgical portal scar mobilization if portals are completely closed.
  • Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups, proprioception).
  • Stationary bike low cadence, low resistance.
  • Aquatic Treadmill: Slow walking on treadmill for gait training 

Phase III:  Week 6 to 12:

Criteria to advance to Phase III:

  • No patellofemoral pain
  • Minimum of 90° of flexion
  • Sufficient strength and proprioception to prepare for higher-level closed chain exercises(aquatic treadmill)
  • Minimal swelling/inflammation

Exercises:

  • Complete VTFC Knee Functional Performance Test 1
  • Continue with soft tissue, joint mobilizations, as needed for ROM, decrease pain, muscle guarding.
  • 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.
  • 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.

Goals:

  • Gait- no limp present, good mechanics.
  • Week 8: Passive range of motion 0-135 degrees.
  • Tolerate 90/90 squat.
  • Week 12: Full range of motion.
  • Initiate lateral training with no resistance.

Phase IV: Week 12 to 16:

Criteria for advancement to Phase IV:

  • Gait- no limp present, good mechanics.
  • Full range of motion.

Goals:

  • Prepare for VTFC Knee Functional Performance Test 1 at 3 months post-surgery
  • Complete and Pass VTFC Knee Functional Performance Test 1
  • Return to sports clearance.

Exercises:

  • Low-impact activities until 16 weeks.
  • Increase the intensity of strength and functional training for gradual return to activities.
  • Initiate resisted lateral training.