What is the best evidence-based rehabilitation protocol after partial meniscectomy?

Rehabilitation After Partial Meniscectomy

For isolated meniscal tears without osteoarthritis, begin immediate weight-bearing as tolerated with a home-based exercise program focused on quadriceps strengthening, progressing to return-to-sport criteria by 3-4 weeks in most cases. 1, 2

Immediate Postoperative Phase (Days 1-7)

Weight-bearing and mobilization:

• Begin full weight-bearing immediately as tolerated without crutches within 1-3 days 1
• No immobilization or bracing is required—routine postoperative knee bracing increases failure rates 2.83-fold and should be avoided 3

Pain management:

• Acetaminophen as first-line analgesia is sufficient and equally effective as anti-inflammatory protocols (betamethasone injection or celecoxib) 4
• Ice application in the first postoperative weeks may be used for symptom control 5
• Tramadol consumption is negligible when acetaminophen is used appropriately 4

Initial exercises:

• Start isometric quadriceps exercises on postoperative day 1 when pain-free 3
• Prioritize closed kinetic-chain exercises (leg press, squats, step-ups) over open kinetic-chain exercises initially 5

Early Recovery Phase (Weeks 1-4)

Exercise progression:

• Combine neuromuscular training (balance, proprioception) with strength training—one cannot replace the other 5
• Open kinetic-chain exercises (90-45° knee flexion) may be introduced as early as 4 weeks postoperatively 5
• Add no extra weight during open kinetic-chain exercises for the first 12 weeks 3

Functional milestones:

• Return to work: 1-2 weeks for sedentary jobs 1
• Resume athletic training: 2-4 weeks 1
• Return to competition: 3-4 weeks for isolated meniscal lesions without cartilage damage 1

Supervised vs. Home-Based Rehabilitation

The evidence does not support routine supervised physical therapy for uncomplicated cases. 5, 2

• Supervised rehabilitation shows minimal extra benefit over home-based programs in young, athletic populations 5
• Home-based exercise programs are sufficient when patients demonstrate no preoperative strength deficits and normal post-surgery evolution 1, 2
• Consider supervised therapy only for: professional athletes requiring accelerated return, patients with preoperative quadriceps deficits >20%, or those with concomitant injuries 5, 1

Return-to-Sport Criteria (Weeks 3-6)

Use objective criteria rather than time-based progression alone:

• No pain or swelling 5, 3
• Full knee range of motion 5, 3
• Limb symmetry index (LSI) >90% for quadriceps strength 5, 3
• LSI >90% for hop tests (countermovement jump, drop jump) 5
• For pivoting/contact sports: achieve 100% symmetry for isokinetic quadriceps peak torque at 60°/s 5
• Patient-reported outcomes normalized (KOOS, IKDC) 5
• Psychological readiness confirmed (ACL-RSI, Tampa Scale of Kinesiophobia) 5

Critical Caveats

Presence of osteoarthritis fundamentally changes the approach:

• Patients with concomitant knee osteoarthritis are unlikely to benefit from meniscectomy and should have attempted nonsurgical treatment (physical therapy, corticosteroid injections) first 5
• Only patients with mild-to-moderate osteoarthritis who have truly obstructing displaced meniscal tears causing mechanical symptoms may benefit from surgery 5

Cartilage damage significantly impacts outcomes:

• Isolated meniscal tears achieve 94.8% good/excellent results at 12 years, but this drops to 62% when cartilage damage is present 6
• Cartilage damage becomes increasingly symptomatic after 5 years post-surgery 6

Full recovery timeline:

• Expect full recovery within 6 weeks when pain and swelling are controlled in uncomplicated cases 1
• Long-term results at 4 years (91.7% excellent/good) remain stable at 12 years (78.1% excellent/good) for isolated meniscal lesions 6