1. Rehabilitation Protocol
After Menisci Repair
Key factors determining
progression
• Anatomic site of tear.
• Suture fixation
• location of tear
(anterior or posterior).
• Other pathology
(PCl, MCl, or ACl injury).
(too vigorous
rehabilitation
can lead to
failure).

2. REHAB CONSIDERATIONS

3. Weight-bearing and Motion
Rehabilitation Considerations
•
Although weight-bearing has
little effect on displacement
patterns of the meniscus and may
be beneficial in approximating
longitudinal tears,
• weight-bearing may place a
displacing force across radial tears.

4. EARLY MOTION
• Several studies have confirmed the benefits
of early motion by demonstrating meniscal
atrophy and decreased collagen content in
menisci after immobilization.
• ROM of the knee before 60 degrees of flexion
has little effect on menisci displacement, but
flexion angles greater than 60 degrees
translate the menisci posteriorly. This
increased translation may place detrimental
stresses across a healing meniscus.

5. Rehabilitation Considerations
• Weight-bearing and Motion
• EARLY MOTION
• As knee flexion increases, compressive loads across
the meniscus also increase.
• The combination of weight-bearing and increasing
knee flexion must be carefully balanced in the
development of a rehabilitation protocol.

6. Axial Limb Alignment
• Varus malalignment tends to overload the
medial compartment of the knee, with
increased stress placed on the meniscus, and
valgus malalignment has the same effect on
the lateral compartment and lateral
meniscus.

7. Axial Limb Alignment
• These increased stresses may interfere
or disrupt meniscal healing after repair.
The use of an "unloader" brace has
been recommended to help protect the
healing meniscus, although no scientific
data exist to support this approach.

8. Rehabilitation after Meniscal Repair
• Current studies support the use of unmodified accelerated ACL
rehabilitation protocols after combined ACL reconstruction and
menisci repair.
• In tears with decreased healing potential (such as white-white
tears, radial tears, or complex pattern tears), limiting weight
bearing and limiting flexion to 60 degrees for the first 4 weeks
have been suggested to better protect the repair and increase
the healing potential of these difficult tears.
• However, we are unaware of any published studies that support
these measures.

9. Rehabilitation after Meniscal Repair
• Rehabilitation after
isolated menisci
repair remains
controversial.
• The healing environment
clearly is inferior to that with
concomitant ACL
reconstruction, but good
results have been obtained
with accelerated
rehabilitation protocols after
isolated meniscal repairs.

10. Phase 1: Maximum Protection-Weeks 1-6
Stage 1: Immediate Postoperative Day
1-Week 3
• Ice, compression, elevation.
• Electrical muscle stimulation.
• Brace locked at 0 degrees.
• ROM 0-90 degrees.
• Motion is limited for the first 7- 21
days, depending on the development
of scar tissue around the repair site.
Gradual increase in flexion ROM is
based on assessment of pain
(0-30, 0-50, 0-70, 0-90 degrees).

11. Phase 1: Maximum Protection-Weeks 1-6
• Stage 1: Immediate Postoperative Day
1-Week 3
• Patellar mobilization.
• Scar tissue mobilization.
• Passive ROM.
• Exercises
• Quadriceps isometrics.
• Hamstring isometric!t if posterior hom
repair, no hamstring exercises for 6 wk).
• Hip abduction and adduction.
• Weight-bearing as tolerated with crutches
and brace locked at 0 degrees.
• Proprioception training.

12. Phase 1: Maximum Protection-Weeks 1-6
• Stage 2: Weeks 4-6
• Progressive resistance exercises
(PREs) -1-5 pounds.
• Limited-range knee extension (in
range less likely to impinge
or pull on repair).
• Toe raises.
• Mini-squats.
• Cycling (no resistance).
• Surgical tubing exercises (diagonal
patterns).
• Flexibility exercises.

13. Phase 2: Moderate Protection-Weeks 6-10
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Criteria for Progression to Phase II
• ROM 0-90 degrees.
• No change in pain or effusion.
• Quadriceps control ("Good MMT").
Goals
• Increase strength, power, endurance.
• Normalize ROM of knee.
• Prepare patients for advanced exercises.
Exercises
• Strength- PRE progression.
• Flexibility exercises.
Lateral step-ups (30 sec X 5 sets --> 60 sec
X 5 sets).
• • Mini-squats.
• • Isokinetic exercises.

14. Phase 2: Moderate Protection-Weeks 6-10
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Endurance Program
• Swimming (no frog kick).
• Cycling.
• Nordic-Trac.
• Stair machine.
• Pool running.

15. Phase 2: Moderate Protection-Weeks 6-10
• Coordination Program
• Balance board.
• High-speed bands.
• Pool sprinting.
• Backward walking.
• Plyometric Program

16. Phase 3: Advanced Phase-Weeks 11-15
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Criteria for Progression to Phase 3
• Full, nonpainful ROM.
• No pain or tenderness.
• Satisfactory isokinetic test.
• Satisfactory clinical examination.
Goals
• Increase power and endurance.
• Emphasize return-to-skill activities.
• Prepare for return to full untestricted activities.
Exercises
• Continue all exercises.
• Increase tubing program, plyometrics, pool program.
• Initiate running program.
Return to Activity: Criteria
• Full, nonpainful ROM.
• Satisfactory clinical examination.
• Satisfactory isokinetic test.

17. ACCELERATED REHAB FOR
MENISCAL REPAIR

18. PHASE 1
• Phase 1:
Weeks 0-2
Goals
• • Full motion.
• • No effusion.
• • Full weight-bearing./
Weight-bearing As tolerated.
Treatment
• • ROM as tolerated (0-90
degrees).
• • Cryotherapy.
• • Electrical stimulation as
needed.
• • Isometric quadriceps sets.
0-2 WEEKS

19. Phase 2: Weeks 2-4
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Criteria for Progression to Phase 2
• Full motion.
• No effusion.
• Full weight-bearing.
Goals
• Improved quadriceps strength.
• Normal gait.
Therapeutic Exercises
• Closed-kinetic chain resistance exercises 0-90 degrees.
• Bike and swim as tolerated.
• Early-phase functional training

20. Phase 3: Weeks 4-8
Criteria for Progression to Phase 3
• • Normal gait.
• • Sufficient strength and proprioception for advanced
• functional training.
Goals
• • Strength and functional testing at least 85% of
contralateral side.
• • Discharge from physical therapy to full activity.
Therapeutic Exercises
• • Strength work as needed.
• • Sport-specific functional progression.
• • Advanced-phase functional training.

21. Questions?