What is the recommended post-operative visit schedule and rehabilitation protocol following a meniscectomy?

Post-Operative Rehabilitation Protocol Following Meniscectomy

Early mobilization with progressive weight-bearing and a structured rehabilitation program is recommended following meniscectomy, with a typical recovery period of 2-6 weeks for most patients, extending to 6-8 weeks for return to sports activities. 1

Immediate Post-Operative Phase (Days 1-7)

Weight-Bearing and Mobility

• Progress to weight-bearing as tolerated within the first week if there is:
  • No pain
  • No effusion
  • No increased temperature when walking
  • Correct gait pattern (using crutches if necessary) 1
• Avoid full weight-bearing on the operated leg for the first 2-7 days 1
• Use crutches to maintain proper gait mechanics until normal walking pattern is achieved

Pain and Swelling Management

• Apply cryotherapy in the first postoperative week to reduce pain 1, 2
• Monitor for symptoms (pain, swelling) that may indicate need for activity modification 1
• Elevate the limb when resting to reduce swelling

Early Rehabilitation Phase (Weeks 1-2)

Range of Motion and Strengthening

• Focus on achieving full knee extension to prevent complications 1
• Begin isometric quadriceps exercises in the first week to reactivate muscles (if no pain) 2
• Start gentle range of motion exercises as tolerated
• Begin straight leg raises if quadriceps control is adequate

Functional Activities

• Patients with sedentary jobs may return to work within 1-2 weeks 1, 3
• Begin gentle walking program as tolerated
• Avoid strenuous activities during this phase 1

Intermediate Rehabilitation Phase (Weeks 2-4)

Strengthening Progression

• Progress from isometric to concentric and eccentric exercises as tolerated 2
• Begin closed kinetic chain exercises from week 2 post-operative 2
• Add open kinetic chain exercises from week 4 in a restricted range of motion (90-45°) 2
• Focus on quadriceps and hamstring strengthening 1

Functional Activities

• Resume athletic training by 2-4 weeks for uncomplicated cases 3
• Gradually increase walking distance and speed
• Begin stationary cycling with minimal resistance

Advanced Rehabilitation Phase (Weeks 4-8)

Return to Work and Activities

• Patients with physically demanding jobs require at least 6 weeks before return 1
• Return to competition typically possible in 3-4 weeks for uncomplicated cases 3
• Full return to sports usually possible after 6-8 weeks 1

Advanced Strengthening

• Progress to full range of motion in open kinetic chain exercises 2
• Add neuromuscular training to strength training 2
• Focus on quality of movement patterns to prevent reinjury 2

Return to Sport/Full Activity Criteria

Testing Battery

• Perform an extensive test battery assessing:
  • Strength (quadriceps and hamstring)
  • Functional hop tests
  • Quality of movement 2
• Aim for Limb Symmetry Index (LSI) >90% for general activities 2
• For pivoting/contact sports, an LSI of 100% is recommended 2

Important Considerations

Factors Affecting Recovery

• Female gender and lateral meniscal tears are associated with longer recovery times and potentially worse outcomes 4
• Pre-operative function level significantly impacts post-operative outcomes 4
• Full recovery typically occurs within 6 weeks if pain and swelling are controlled 3

Rehabilitation Variations

• Professional athletes may benefit from more intensive supervised physical therapy to accelerate return to play 3
• Outpatient physical therapy plus home exercise program improves function and knee flexion range of motion compared to home program alone 5
• Patients with no pre-operative strength deficits and normal post-surgery evolution may not require formal physiotherapy 3

Long-Term Outcomes

• Most patients (78.1%) have excellent or good results 12 years after arthroscopic partial meniscectomy 6
• Cartilage damage at the time of surgery has the greatest impact on long-term outcomes, becoming increasingly symptomatic after 5+ years 6

By following this structured rehabilitation protocol and adjusting based on individual patient response, optimal outcomes following meniscectomy can be achieved with minimal complications and efficient return to normal activities.