What is the typical rehabilitation protocol for a meniscus repair?

Rehabilitation Protocol After Meniscus Repair

Begin immediate knee mobilization with progressive flexion restrictions, initiate quadriceps exercises on postoperative day one, allow early weight-bearing as tolerated, avoid routine bracing, and prioritize closed kinetic chain exercises—progressing to full activity based on objective criteria rather than time alone. 1

Weight-Bearing Protocol

• Immediate weight-bearing as tolerated is safe and recommended following meniscal repair, with no evidence that early weight-bearing increases failure rates or compromises healing 1, 2, 3
• Accelerated protocols allowing full weight-bearing from day one show equivalent or superior outcomes compared to restricted weight-bearing approaches 4, 3
• When meniscus repair is performed with concurrent ACL reconstruction, the same accelerated weight-bearing protocol can be safely applied 4

Range of Motion Progression

The key distinction from ACL rehabilitation is the need for progressive flexion restrictions to protect the meniscal repair. 1

The recommended flexion progression is:

• Weeks 0-4: Restrict to 90-45° of flexion 1
• Week 5: Progress to 90-30° 1
• Week 6: Progress to 90-20° 1
• Week 7: Progress to 90-10° 1
• Week 8: Full ROM 1

This graduated approach protects the healing meniscus while preventing stiffness complications. Early motion within these restrictions does not compromise healing and may improve outcomes 2, 3.

Bracing

Do NOT use postoperative knee bracing routinely—this is a critical evidence-based recommendation that contradicts common practice. 1

• Routine bracing is associated with a 2.83-fold increased failure rate and lower quality of life scores 1
• The evidence strongly argues against immobilization, which was historically common but is now contraindicated 1, 3

Exercise Progression

Early Phase (Weeks 0-4)

• Initiate quadriceps strengthening exercises on postoperative day one with modifications to protect the meniscus 1, 5
• Prioritize closed kinetic chain exercises (leg press, squats, step-ups) over open kinetic chain movements 1
• Include neuromuscular training combined with strength work from the outset 1

Intermediate Phase (Weeks 4-12)

• Open kinetic chain exercises (90-45°) may begin at week 4, but add no extra weight for the first 12 weeks to prevent excessive stress on the repair 1
• Continue progressive closed kinetic chain strengthening 1
• Advance neuromuscular and proprioceptive training 1

Advanced Phase (Weeks 12+)

• Progress to sport-specific training once objective criteria are met 1
• Full resistance training can be incorporated after 12 weeks 1

Return to Sport Criteria

Return to sport must be based on objective functional criteria, not time alone—this is essential to prevent re-injury. 1

Minimum criteria include:

• No pain or swelling 1
• Full knee ROM 1
• Limb symmetry index (LSI) >90% for strength and hop tests 1
• For pivoting/contact sports, LSI of 100% is recommended 1
• Completion of sports-specific training program 1

The typical timeline is 9-12 months when combined with ACL reconstruction, though individual progression varies 1. When meniscus repair is performed in isolation, return to sport typically occurs between 3-6 months post-surgery 2.

Critical Success Factors

Success rates are significantly influenced by ligament stability:

• 92% success rate when meniscus repair is performed with concurrent ACL reconstruction 4
• Only 67% success rate in ACL-deficient knees 4
• Only 67% success rate in stable knees without ACL injury 4

This dramatic difference underscores the importance of addressing ligament instability when present.

Common Pitfalls to Avoid

• Do not immobilize the knee—this increases failure rates and complications 1, 3
• Do not restrict weight-bearing unnecessarily—early loading is safe and beneficial 2, 3
• Do not use routine bracing—it worsens outcomes 1
• Do not allow return to sport based on time alone—require objective functional testing 1
• Do not apply the same unrestricted flexion protocol used for ACL reconstruction alone—meniscus repair requires progressive flexion restrictions 1

Surgeon Communication

Direct communication with the operating surgeon is essential, as the protocol must be adapted based on tear characteristics (location, pattern, complexity) and surgical technique used 1, 5. The above protocol represents the evidence-based framework, but individual modifications may be necessary based on intraoperative findings.