Recommended Rehabilitation for Meniscus Tear
Start with structured physical therapy as first-line treatment for at least 3-6 months before considering any surgical intervention, focusing on quadriceps and hamstring strengthening, with surgery reserved only for truly obstructing displaced tears causing objective mechanical locking after conservative treatment fails. 1
Initial Conservative Management Approach
The rehabilitation strategy depends critically on whether the tear is degenerative or traumatic, and the patient's age and activity level.
Core Rehabilitation Components
Structured physical therapy should begin immediately with supervised sessions emphasizing quadriceps strengthening exercises, hamstring strengthening, balance and proprioception training, and functional exercises to improve knee stability 1, 2, 3
Activity modification is essential, avoiding high-impact pivoting and cutting movements during the acute healing phase 3
Weight control to reduce mechanical stress on the injured knee joint 2, 3
Pain management with NSAIDs and cryotherapy for controlling pain and swelling 1
Rehabilitation Timeline and Progression
Immediate ROM and weight bearing as tolerated can be implemented safely without compromising clinical results, contrary to older restrictive protocols 4
Progressive weight bearing and joint stress are necessary to enhance meniscal function, though excessive shear forces should be avoided 5
Aquatic therapy may be ideal during all phases of rehabilitation, providing controlled weight bearing and mobility progressions 5
Continue conservative management for at least 3-6 months before considering surgical options 1
When Surgery Becomes Appropriate
Surgery should only be considered in specific circumstances after failed conservative treatment:
Surgical Indications
Truly obstructing displaced meniscus tears causing objective mechanical locking (not just clicking or catching) 1, 2
Young, active patients with acute traumatic tears in the vascular zone where repair is technically feasible 1
Significant functional instability despite adequate nonsurgical treatment trial 2, 3
Important Caveat About Degenerative Tears
Most degenerative meniscus tears in patients over 35 are unlikely to benefit from surgical treatment, as the tear is typically a result of the degenerative process rather than an independent cause of symptoms 6
The British Medical Journal explicitly recommends against arthroscopic knee surgery in patients with degenerative knee disease, even when mechanical symptoms like clicking, catching, or "locking" are present, as these symptoms respond equally well to conservative treatment 1
Post-Surgical Rehabilitation (If Surgery Performed)
If meniscal repair is performed (which is superior to partial meniscectomy with better long-term outcomes):
Immediate ROM and weight bearing as tolerated can be safely implemented, allowing shorter interval to return to activities compared to restrictive protocols 4
Initial recovery from arthroscopic procedures takes 2-6 weeks 1
Weight-bearing restrictions for 2-7 days only 1
Return to sedentary work within 1-2 weeks 1
Return to physical labor/sports at minimum 6 weeks 1
Common Pitfalls to Avoid
Do not rush to surgery for degenerative tears or mechanical symptoms like clicking and catching—these respond equally well to physical therapy 1
Do not underestimate the importance of supervised rehabilitation in the initial treatment phase rather than self-directed programs 2
Avoid prolonged knee immobilization after any procedure, as this results in rapid muscular atrophy and delays functional recovery 5
Do not perform arthroscopic partial meniscectomy in patients with knee osteoarthritis, particularly advanced osteoarthritis, as there is no negative effect of trying nonsurgical treatment first 6
Expected Outcomes
Pain tends to improve over time after initiating conservative treatment 1
Most patients with meniscal tears respond well to conservative management, with successful return to modified activities in 60-70% of cases 3
Physical therapy and exercise programs are effective for managing symptoms and improving function 1
When repair is necessary, meniscal repair is superior to partial meniscectomy with better functional outcomes and less severe degenerative changes over time 7, 8