Rehabilitation Protocol for Arthroscopic Partial Meniscectomy

This protocol is intended to guide clinicians through the post-operative course for Arthroscopy Partial Meniscectomy.
This protocol is time based (dependent on tissue healing) as well as criterion based. Specific intervention should be
based on the needs of the individual and should consider exam findings and clinical decision making. The timeframes for
expected outcomes contained within this guideline may vary based on surgeon’s preference, additional procedures
performed, and/or complications. If a clinician requires assistance in the progression of a post-operative patient, they
should consult with the referring surgeon.

The interventions included within this protocol are not intended to be an inclusive list. Therapeutic interventions should
be included and modified based on the progress of the patient and under the discretion of the clinician.

Post-operative considerations
Post-operative considerations If you develop a fever, intense calf pain, excessive drainage from the incision,
uncontrolled pain or any other symptoms you have concerns about you should call your doctor.

PHASE I: IMMEDIATE POST-OP (Day 0-7 AFTER SURGERY)

Rehabilitation • Reduce swelling, minimize pain
Goals • Restore knee range of motion (ROM)
• Re-establish quadriceps activation
• Patient Education:
o Keep your knee straight and elevated when sitting or laying down. Do not rest with a
towel placed under the knee
o Avoid painful activities
o Limit excessive walking
Weight Bearing Walking
• Weight bearing as tolerated with crutches
• Weaning from crutches may occur in the first several days depending on appropriate resolution
of edema, achievement of excellent quad activation (evidenced by ability to perform SLR), and
proper gait pattern under the guidance of the physical therapist
• When climbing stairs, lead with non-surgical limb and when going down the stairs, lead with the
surgical limb
Interventions Swelling Management
• Ice, compression, elevation
• Ankle pumps
• Retrograde massage

Range of motion/Mobility
• Patella mobilizations: superior/inferior and medial/lateral
• Heel slides with towel
• Low intensity, long duration extension stretches: prone hang, heel prop
• Seated gastrocnemius and hamstring stretch
• Stationary bike

Strengthening
• Calf raises
• Quad sets
• Hip abduction
• Straight leg raise
• Sidelying Clamshell
 • Include NMES as needed: NMES high intensity (2500 Hz, 75 bursts) supine knee extended 10
sec/50 sec, 10 contractions, 2x/week during sessions—use of clinical stimulator during session,
consider home units distributed immediate post op, can also include functionally into above
Criteria to • Knee ROM of 0->90 deg
Progress • Ability to perform SLR (straight leg raise) with appropriate quadriceps activation

PHASE II: INTERMEDIATE POST-OP (Day 8 – WEEK 2 AFTER SURGERY)

Rehabilitation • Achieve full pain free ROM
Goals • Restore muscular strength and endurance
• Gradual return to functional activities while monitoring symptoms response
• Restore normal gait without assistive device
• Improve balance and proprioception
Weight Bearing • Weight bearing as tolerated
o Goal to discharge assistive devices
Additional Range of motion/Mobility
Intervention • Stretching of all muscle groups: prone quad stretch, standing quad stretch, standing hip flexor
*Continue with stretch
Phase I Strengthening
interventions • Standing hamstring curls
• Step ups and step ups with march
• Partial squats
• Wall slides, ball squats
• Lumbopelvic strengthening: bridge & unilateral bridge, bridges on physioball, bridges on
physioball with roll-in
• Heel raises
• Leg press/shuttle press machine

Balance/proprioception
• Single leg standing balance (knee slightly flexed) static progressed to unsteady surface
Criteria to • Full and pain free knee ROM
Progress • No swelling (Modified Stroke Test)
• Symmetrical, non-antalgic gait pattern without assistive device

PHASE III: LATE POST-OP (2-8 WEEKS AFTER SURGERY)

Rehabilitation • Maintain full and pain free knee ROM
Goals • Enhance muscle strength and endurance
• Avoid post exercise pain/swelling
• Promote proper movement patterns
Weight Bearing FWB

Additional Range of motion/Mobility

Intervention • Patella mobilizations: superior/inferior and medial/lateral
*Continue with • Stretching of all muscle groups: prone quad stretch, standing quad stretch, standing hip flexor
Phase I-II stretch
Interventions • Stationary Bicycle

Cardio
• 4-6 weeks, as tolerated: Elliptical, stair climber, flutter kick swimming, pool jogging

Strengthening
• Gym Machine usage: Leg press, seated hamstring curl machine, hip abductor and adductor
machine, and seated calf machine
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 • Progress intensity (strength) and duration (endurance) of exercises

**The following exercises to focus on proper control with emphasis on good proximal stability
• Lateral step down
• Squat to chair
• Lateral lunges
• Romanian deadlift and Single leg deadlift
• Single leg progression: partial weight bearing single leg press, slide board
lunges: retro and lateral, step ups and step ups with march, split squats, lateral step-ups, step
downs, single leg squats, single leg wall slides

Balance/proprioception
• Progress single limb balance including perturbation training
• Lower quarter reaches (Y-Balance and Star drill)

**When Quadriceps index > 80% strength:

• Interval running program
o Return to Running Program
• Progress to plyometric and agility program
o Agility and Plyometric Program

Criteria to • No swelling/pain after exercise

Progress • Ability to perform ADLs pain free

**If patient is returning to impact activities:

• 10 repetitions single leg squat proper form through at least 60 deg knee flexion
• Drop vertical jump with good control
• Completion of jog/run program without pain/swelling
• Functional Assessment
o Quadriceps index >80%; HHD mean preferred (isokinetic testing if available)
o Hamstring, glut med,glut max index ≥80%; HHD mean preferred (isokinetic testing for HS if
available)
o Single leg hop test ≥75% compared to contra lateral side

PHASE IV: UNRESTRICTED RETURN TO SPORT (9-12 WEEKS AFTER SURGERY)

Rehabilitation • Maintain full ROM
Goals • Safely progress strengthening
• Promote proper movement patterns
• Avoid post exercise pain/swelling
• Return to all necessary and desired functional activities, work duties, and athletic activities
Additional • Multi-plane sport specific plyometrics program
Interventions as • Multi-plane sport specific agility program
applicable to athlete • Include hard cutting and pivoting depending on the individuals’ goals
*Continue with Phase
I-III interventions

Criteria for • Last stage, no additional criteria

Discharge

Return-to-Sport • Functional Assessment

o Quadriceps index >95%; HHD mean preferred (isokinetic testing if available)
o Hamstring, glut med, glut max index ≥95%; HHD mean preferred (isokinetic testing for HS if
available)
o Single leg hop test ≥95% compared to contra lateral side with proper landing mechanics
• KOOS-sports questionnaire >90%, or other PRO as indicated
Revised 4/2021
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 Contact Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol

References:

1. Brelin AM, Rue JP. Return to Play Following Meniscus Surgery. Clin Sports Med. 2016;35(4):669–678. doi:10.1016/j.csm.2016.05.010.
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0278591916300254?returnurl=null&referrer=null
2. Dias JM, Mazuquin BF, Mostagi FQ, et al. The effectiveness of postoperative physical therapy treatment in patients who have undergone
arthroscopic partial meniscectomy: systematic review with meta-analysis. J Orthop Sports Phys Ther. 2013;43(8):560–576.
https://www.jospt.org/doi/10.2519/jospt.2013.4255
3. Hall M, Hinman RS, Wrigley TV, et al. The effects of neuromuscular exercise on medial knee joint load post-arthroscopic partial medial
meniscectomy: 'SCOPEX', a randomised control trial protocol. BMC Musculoskelet Disord. 2012;13:233. Published 2012 Nov 27. doi:10.1186/1471-
2474-13-233. https://pubmed.ncbi.nlm.nih.gov/23181415/?from_term=arthroscopic+meniscectomy+rehabilitation&from_filter=years.2003 -
2020&from_page=12&from_pos=9
4. Herrlin S, Hallander M, Wange P, Weidenhielm L, Werner S. Arthroscopic or conservative treatment of degenerative medial meniscal tears: a
prospective randomized trial. Knee Surg Sports Traumatol Arthrosc. 2007;15(4):393-401. https://link.springer.com/article/10.1007/s00167-006-
0243-2

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