Phase 1: Postop phase
Goals
• Protect healing of repair
• Decrease pain
• Manage effusion
• Increase weight-bearing tolerance per procedure
• Gradually improve knee ROM to 0–90° by week 2 and 0–120° by week 4
• Restore quadriceps control
Weeks 1–2
Brace
Long-leg postoperative brace
ROM goals
0–90°
Weight-bearing
Peripheral: TTWB—50 % WB
Complex: TTWB—25 % WB
Interventions
Patella mobilizations
LE flexibility
Quad set/SLR/knee extension AROM
NMES
Ankle pumps
Ice/compression/elevation
Weeks 3–4
Brace
Long-leg postoperative brace
ROM goals
0–120°
Weight-bearing
Peripheral, 75 % FWB; complex, 50–75 % WB
Interventions
Patella mobilizations
LE flexibility
Quad set/SLR/knee extension AROM
NMES
Ankle pumps
HR/wall sits (peripheral)
Ice/compression/elevation
Phase 2: Early rehab phase
Goals
• Gradually improve knee ROM to full
• Minimal to no effusion
• Decrease pain
• Progress weight-bearing tolerance per procedure
• Increase strength
• Improve balance and proprioception
• Minimal to no gait deviations
Weeks 5–6
Brace
Long-leg postoperative brace
ROM goals
0–135°
Weight-bearing
Peripheral, FWB; Complex, 75 % FWB
Interventions
Patella mobilizations
LE flexibility
Quad set/SLR
NMES
Knee extension 90–30°
Leg press 70–10° (peripheral)
Mini squats/HR/wall sits
Ice/compression/elevation
Phase 2: Early rehab phase
Weeks 7–8
ROM goals
Full ROM
Weight-bearing
FWB
Interventions
LE flexibility
Quad set/SLR
Knee extension 90–30°
Multi-hip (Flex/ABD/ADD/Ext)
Ham curls
Leg press 70–10° (peripheral)
Mini squats/HR/wall sits
Lateral step-ups
Proprioception
Stationary bike
Ice/compression/elevation
Phase 3: Functional progression
Goals
• Improve lower extremity strength
• Enhance proprioception, balance, and neuromuscular control
• Improve muscular endurance
• Restore limb confidence and function
Weeks 9–12+
Interventions
LE flexibility
Quad set/SLR
Knee extension 90–30°
Multi-hip (Flex/ABD/ADD/Ext)
Ham curls
Leg press 70–10°
Mini squats/HR/wall sits
Lunges
Sports cord/band walks
Proprioception
Perturbation training
Stationary bike
Swimming
Stair climber
Ice/compression/elevation
Phase 4: Return to activity
• Normalize lower extremity strength
• Enhance muscular power and endurance
• Improve neuromuscular control
• Completion of running program
• Perform selected sport-specific drills
• Gradual return to full unrestricted sports
4–6+ months
Interventions
LE flexibility
Knee extension 90–30°
Multi-hip (Flex/ABD/ADD/Ext)
Ham curls
Leg press 70–10°
Mini squats/HR/wall sits
Phase 4: Return to activity
Proprioception
Stationary bike
Swimming
Stair climber
Running program
4 months peripheral
6 months complex
Plyometrics (peripheral tears 4–6 months/complex tears 6–9 months)
Phase 1: Postoperative (Weeks 1–4)
The immediate postoperative phase begins following surgery and lasts approximately 1 month. Initially, patients ambulate with bilateral axillary crutches in a postoperative long-leg brace locked in full extension. Limited weight-bearing for the first 4 weeks may protect the repair and increase the healing potential. Generally, for a peripheral repair, patients will be toe-touch weight-bearing to 50 % weight-bearing during this time interval. For complex and radial tears, patients will be toe-touch weight-bearing to 25 % weight-bearing. For radial tears, it has been reported that weight-bearing may place a displacing force across the repair of a radial meniscus tear; thus weight-bearing precautions will be similar to a complex tear [3]. However, early physiological loading can be beneficial to the menisci in a manner similar to fractures and may help overall healing [4]. The knee brace is opened from 0° to 90° for ROM exercises and kept locked in extension for all other activities. Flexion beyond 90° is discouraged for the first month since motion beyond this leads to “femoral rollback” and therefore increased tensile forces across the repair site. Ice, compression, and elevation are important for controlling knee effusion and pain control. Patients are instructed to utilize ice for 10–15 min every 1–2 h during the first 10–14 days postoperatively.