Meniscal Repair

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

NWB in locked brace in extension x2 wks Phase I, then WBAT with immobilizer locked in extension and bilateral crutches; brace discontinued Phase II when cleared by surgeon

Key Restrictions

No loaded knee flexion, no PROM past 90 deg, no resisted hamstring strengthening Phase I; avoid forceful knee flexion if posterior knee pain, avoid rotational movements on planted foot Phase II; avoid post-activity swelling Phase III

Timeline & Phases

Phase I (0-6 wks): NWB in locked brace in extension x2 wks, reduce swelling with cryocuff/compression, restore quad activation, progress to WBAT with immobilizer locked in extension and bilateral crutches, no loaded knee flexion, no PROM past 90 deg, no resisted hamstring strengthening, ROM 0-90 deg only, PROM/AAROM, quad sets and prone TKE, clamshells, prone knee hangs, 4-way SLRs, ankle TheraBand, calf stretching, gentle knee mobilizations, patellar mobilization 5-10 min/day; progress to Phase II after 3 wks if 0-90 deg and zero-to-trace effusion; Phase II (6-10 wks): normalize gait mechanics, gradually restore knee ROM 0-140 deg progressing as tolerated, avoid forceful knee flexion with posterior pain, avoid rotational movements on planted foot, brace discontinued per surgeon; wks 6-8: loaded knee flexion 45-60 deg, mini squats, modified leg press (double/single), 4in step-ups forward/lateral, DL bridges, mini-lunges, fire hydrants, balance/proprioception training, plank holds, standing TKE, upright bike low resistance; wks 8-10: loaded knee flexion to 75 deg, isolated hamstring strengthening, LE/core progression, 6-8in step-ups/step-downs/side-steps, monster walks, single leg bridge holds, wobble board squats, upright bike increasing resistance; progress to Phase III after 10 wks if normal gait, knee PROM >=120 deg, zero reactive effusion; Phase III (10-16 wks): improve functional strength/dynamic control, avoid post-activity swelling; wks 10-12: 6-day/week strengthening/cardio program, plyometric program bilateral-to-single leg, walk/jog program; wks 12-16: plyometric progression straight-plane to diagonal/rotational, continued jogging progression; progress with full knee ROM, 8in step-downs with proper mechanics, 80% limb symmetry on hop testing, no pain/reactive swelling with plyometrics/jogging; Phase IV (20+ wks): forward running program, emphasis on quad/hamstring/trunk dynamic stability, initiate agility drills and cutting activities, continue LE strengthening/flexibility/proprioceptive/agility programs, advance agility/sport-specific programming, maintenance exercise program

Notes

OSMS Rehabilitation Guidelines; healing meniscal tissue is delicate but critical for long-term knee function/cartilage integrity; may take 6+ months to regain full knee use