Knee Arthroscopy (Partial Meniscectomy, Plica Excision, Lateral Release, Synovectomy, Chondroplasty)

Arthroscopic Knee Rehabilitation (Meniscal Debridement, Chondroplasty, or Meniscectomy)

Phase 1 · 0–6 weeks after surgery

Goals

• Normal gait and stair ambulation
• ROM: full knee extension and > 120° knee flexion

Precautions

• WBAT with crutches as needed
• D/C crutches when the patient has a normal gait pattern

Brace

• Typically no brace is required

Wound care

• Post-op dressing remains intact until post-op day #2 (~48 hours after surgery)
• Shower after post-op day #2 (no need to cover the incision site)
• DO NOT SUBMERGE knee in water until incisions have healed
• Suture removal @ 10–14 days post-op per Ortho

Cryotherapy

• Cold with compression/elevation (ice with compression wrap)

Rehabilitation

• Begin scar massage after incisions have healed and scar is formed
• Perform the following rehabilitation exercises; progress as tolerated
• ~Weeks 1–2
  • Knee AROM/PROM to prevent stiffness
  • Patellar mobilizations after suture/staple removal
  • Ankle pumps as needed for swelling
  • LE stretching as needed
  • Quad sets (use e-stim until patient is able to do 10 SLRs without extension lag)
  • Open/closed chain strengthening of hip, thigh, and leg musculature
  • Gait training as needed (i.e. cone walking, marching, retrowalking, cariocas, and shuffles)
  • Core and UE training as needed
• ~Weeks 2–4
  • DL squats or leg press in tolerable range, progress to SL squats
  • Progress loading in LE strengthening of hip, thigh, and leg musculature
  • Balance and proprioceptive exercises; bilateral to unilateral
  • Non-impact cardio
• ~Weeks 5–6
  • Aquatic therapy if desired when incisions have fully healed

Follow-up

• Supervised rehab: 2–3x per week
• PT re-eval: every 1–2 weeks
• Ortho re-eval: ~4–6 weeks post-op

Phase 2 · 7–12 weeks after surgery

Goals

• Symmetrical knee ROM
• > 90% quadriceps and HS strength compared to the uninvolved limb
• Hop without pain using good form
• Meet occupational requirements at 3 months

Precautions

• Sport-specific training initiated when quadriceps strength is at least 80% of uninvolved limb

Rehabilitation

• Continue Phase 1 exercises as needed
• Progress to the following exercises and increase intensity gradually (i.e. no increase in knee pain or effusion since the previous exercise session)
• Agility drills and plyometrics; bilateral to unilateral; progress gradually in intensity
• Begin progressive jogging program when no effusion is present
• Gradually increase intensity and decrease reps of LE strengthening

Follow-up

• Supervised rehab: 1–2 x per week as needed
• PT re-eval: 6 weeks, 12 weeks, then as needed
• Ortho re-eval: ~12 weeks post-op

Testing

• Y-balance, hop testing, and isokinetic where available

Miscellaneous

• After 3 months post-op, Phase 2 exercises are continued and gradually increased in intensity and duration as tolerated
• Pass a return-to-sport / fitness test at 4–6 months
• Progress activities for return to sport/collision sports or aggressive physical training (e.g. tactical or military training) based on the patient's functional performance and endurance. This time period will be directed by the Ortho Surgeon and the Physical Therapist. This may require between 6 months before cleared without restrictions.

References

• Cavanaugh JT, Killian SE. Rehabilitation following meniscal repair. Curr Rev Musculoskelet Med. 2012; 5(1): 46–58.
• Frizziero A, Ferrari R, Giannotti E, Ferroni C, Poli P, Masiero S. The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures. Muscles Ligaments Tendons J. 2013; 2(4): 295–301.
• Glatthorn JF, Berendts AM, Bizzini M, Munzinger U, Maffiuletti NA. Neuromuscular function after arthroscopic partial meniscectomy. Clin Orthop Relat Res. 2010; 468(5): 1336–1343.
• Goodwin PC, et al. Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Phys Ther. 2003; 83(6): 520–535.
• Kelln BM, et al. Effect of early active range of motion rehabilitation on outcome measures after partial meniscectomy. Knee Surg Sports Traumatol Arthrosc. 2009; 17(6): 607–616.
• Moffet H, et al. Impact of knee extensor strength deficits on stair ascent performance in patients after medial meniscectomy. Scand J Rehabil Med. 1993; 25(2): 63–71.

Abbreviations

AROM / AAROM / PROM: active / active-assisted / passive range of motion. ROM: range of motion. ER / IR: external / internal rotation. ABD / ADD: abduction / adduction. FLEX / EXT: flexion / extension. WBAT / PWB / TTWB / NWB: weight bearing as tolerated / partial / toe-touch / non-weight bearing. SLR: straight leg raise. HS: hamstrings. ITB: iliotibial band. UE / LE: upper / lower extremity. UBE: upper body ergometer (arm bike). BAPS: balance board. BFR: blood flow restriction training. PREs: progressive resistance exercises. D/C: discontinue. prn: as needed. POD: post-operative day. TENS: transcutaneous electrical nerve stimulation. ADLs: activities of daily living.

Source

Adapted from Defense Health Agency, Tri-Service Post-Operative Rehabilitation Guidelines, "DHA Arthroscopic Knee Rehab", May 2020, published by William Beaumont Army Medical Center (a work of the U.S. Government in the public domain). Original: DHA Arthroscopic Knee Rehab.pdf. Army-specific wording in the original (Service fitness test, military training, airborne school) was replaced with civilian equivalents.

This protocol is general guidance for the rehabilitation team and does not replace the specific plan, restrictions and follow-up we set together. Your own situation may differ: if anything here does not match what we talked about, what we talked about wins, so please ask me.

Current version and every other protocol: aaronweymd.com/post-op-protocols