What is the recommended rehabilitation protocol for a 6-month post-operative patient following an anterior horn repair?

Rehabilitation Protocol at 6 Months Post-Anterior Horn Repair

At 6 months post-operative from anterior horn meniscus repair, your patient should be engaged in advanced-phase rehabilitation focusing on plyometric training, sport-specific agility drills, and progressive return-to-sport preparation, provided they have met specific functional criteria including full range of motion, minimal effusion, and limb symmetry index >90% on strength testing. 1

Current Rehabilitation Phase

At 6 months post-op, your patient should be in the advanced rehabilitation phase, which typically spans from 4-9 months after surgery. 1 This phase emphasizes:

• Plyometric exercises including jumping, hopping, and landing mechanics training, which demonstrate additional benefits for subjective function and functional outcomes without increasing laxity or pain 1
• Agility training with cutting, pivoting, and directional change exercises 1
• Sport-specific drills tailored to the patient's intended return-to-sport goals 1

Specific Exercise Recommendations

Strength Training

• Continue both open and closed kinetic chain exercises for quadriceps and hamstring strengthening, as both are effective without differences in outcomes 1
• Eccentric training combined with plyometrics shows superior results for balance, subjective function, and functional activities compared to either modality alone 1
• Isokinetic training can be incorporated if available, as mixed isokinetic-isotonic programs achieve better strength outcomes 1

Neuromuscular Training

• Combine strength training with neuromuscular exercises including balance, proprioception, and coordination drills 1
• Core stability exercises should be integrated, as they improve gait, subjective knee function, and range of motion 1

Plyometric Progression

• 8-week plyometric programs (which your patient can now initiate or continue) improve knee function, impairments, and psychosocial status regardless of intensity level 1
• Progress from low-intensity (double-leg jumps, box steps) to high-intensity (single-leg hops, depth jumps) activities 1

Return-to-Running Criteria

If not already running, your patient should meet these criteria before initiating:

• Minimum 12 weeks post-operative (already met at 6 months) 1
• Full knee range of motion without pain or effusion 1
• Quadriceps strength with limb symmetry index >85-90% 1
• Normal gait pattern without compensations 1

Return-to-Sport Preparation

Functional Testing Battery

Your patient should undergo comprehensive testing including:

• Strength assessment: Limb symmetry index >90% for quadriceps and hamstring strength (>100% for pivoting/contact sports) 1
• Hop testing: Single-leg hop for distance, triple hop, crossover hop with LSI >90% 1
• Patient-reported outcomes: IKDC, KOOS, or similar validated measures 1
• Psychological readiness: ACL-RSI or similar questionnaire to assess fear of re-injury 1

Minimum Time Criteria

• Do not clear for return to sport before 9 months post-operative, even if functional tests are passed, as biological graft remodeling requires this minimum timeframe 1
• Most patients are not ready for return to play even at 8 months despite meeting functional criteria 1

Critical Monitoring Parameters

Signs Requiring Modification

• Pain or effusion during or after activities indicates excessive loading; reduce intensity and volume 1
• Increased temperature in the knee joint warrants activity modification 1
• Compensatory movement patterns during functional activities require neuromuscular re-education 1

Progression Criteria to Final Phase

Your patient can advance to the final return-to-sport phase (typically 9-12 months) when they demonstrate:

• No pain or swelling with high-intensity activities 1
• Full range of motion equal to contralateral side 1
• Strength LSI ≥90% (≥100% for contact/pivoting sports) 1
• Successful completion of sport-specific functional testing 1
• Psychological readiness with ACL-RSI score indicating confidence 1

Common Pitfalls to Avoid

Do not rush return to sport based solely on time—the 6-month mark does not indicate readiness for full sport participation, as tissue healing and neuromuscular adaptation require 9-12 months minimum. 1

Do not neglect psychological assessment—fear of re-injury significantly impacts outcomes and should be formally evaluated with validated questionnaires. 1

Do not progress plyometrics if basic strength criteria are not met—ensure quadriceps LSI >85% before initiating high-intensity jumping activities to prevent compensatory patterns and overload. 1

Do not use postoperative bracing routinely—functional knee braces should not be used unless there are associated ligament injuries or specific patient preferences, as they do not improve outcomes. 1