Knee Rehabilitation – Post Meniscal Root Repair

PHASE I (Surgery to 8 weeks after surgery)

Rehabilitation Goals	Protection of the post-surgical knee Eliminate effusion (swelling) Restore leg control
Precautions	Weightbearing: touch down weight bearing (TDWB) with crutches Brace: post-operative extension brace for 6 weeks. Wean from brace locked to unlocked to no brace after 6 weeks and as patient establishes leg control, pain control and safe gait mechanics. Range of Motion (ROM): Goal of 0-90°
Passive and Assisted Range of Motion Exercises	Knee extension on a bolster Prone hangs Supine wall slides with no push into wall Knee flexion off the edge of the table assisted by other leg or person
Suggested Therapeutic Exercise	Quadriceps sets Hamstring sets Straight leg raises 4 way leg lifts in standing with brace on for balance and hip strength Heel slides to 90° Abdominal isometrics
Cardiovascular Exercise	Upper body circuit training or upper body ergometer
Progression Criteria	8-10 weeks after surgery Pain-free gait without crutches No effusion (swelling)

PHASE II (begin after meeting Phase I criteria, usually 8 weeks after surgery)

Rehabilitation Goals	Single leg stand control Normalize gait Good control and no pain with functional movements, including step up/down, squat, partial lunge (between 0° and 60° of knee flexion)
Precautions	No forced flexion with passive range of motion with knee flexion or weight bearing activities that push the knee past 60° of knee flexion Avoid post-activity swelling No impact activities

Suggested Therapeutic Exercise	Non-impact balance and proprioceptive drills Stationary bike Gait drills Hip and core strengthening Stretching for patient-specific muscle imbalances Quadriceps strengthening, making sure that closed chain exercises occur between 0° and 60° of knee flexion
Cardiovascular Exercise	Non-impact endurance training: stationary bike, Nordic track, swimming, deep water running or cross trainer
Progression Criteria	Normal gait on all surfaces Ability to carry out functional movements without unloading affected (injured) leg or pain, while demonstrating good control Single leg balance greater than 15 seconds

PHASE III (begin after meeting Phase II criteria, usually 12-16 weeks after surgery)

Rehabilitation Goals	Good control and no pain with sport and work specific movements, including impact
Precautions	Post-activity soreness should resolve within 24 hours Avoid post-activity swelling Avoid posterior knee pain with end range knee flexion
Suggested Therapeutic Exercise	Low amplitude low velocity agility drills: forward and backward skipping, side shuffle, skater’s quick stepping, carioca, cross overs, backward jog, forward jog Closed chain strengthening for quadriceps and glutes - progressing from double leg strengthening to single leg strengthening: lunge progressions and single leg squat progressions Single leg balance exercises and progressions, progressing from stationary to deceleration in to holding posture and position At approximately 12-14 weeks initiate low amplitude landing mechanics: med ball squat catches, shallow jump landings, chop and drop stops, etc Hip strengthening - especially oriented at neuromuscular control in prevention of hip adduction at landing and stance Core strength and stabilization - especially orientated at preventing frontal plane trunk lean during landing and single leg stances
Cardiovascular Exercise	Replicate sport or work specific energy demands
Return To Sport/Work Criteria	Dynamic neuromuscular control with multi-plane activities without pain or swelling

PHASE IV (begin after meeting Phase III criteria, usually 20-24 weeks after surgery)

Rehabilitation Goals	Normal multi-planar high vel without side to side differences or compensations. Normal double leg landing control without side to side differences or compensations. Adherence to home exercise program
Precautions	No active reactive swelling or joint pain that lasts more than 12 hours
Suggested Therapeutic Exercise	Progressive agility drills: forward and backward skipping, side shuffle, skater’s quick stepping, carioca, cross overs, backward jog, forward jog Landing mechanics - progressing from higher amplitude double leg to single leg landing drills. Start uni-planar and gradually progress to multi-planar Movement control exercise beginning with low velocity, single plane activities and progressing to higher velocity, multi-plane activities Unanticipated movement control drills, including cutting and pivoting Agility ladder drills Strength and control drills related to sport specific movements Sport/work specific balance and proprioceptive drills Hip strengthening - especially oriented at neuromuscular control in prevention of hip adduction at landing and stance Core strength and stabilization - especially orientated at preventing frontal plane trunk lean during landing and single leg stance Stretching for patient specific muscle imbalances
Cardiovascular Exercise	Progressive running program. Design to use sport specific energy systems
Return To Sport/Work Criteria	Patient may return to sport after receiving clearance from the orthopedic surgeon and the physical therapist/athletic trainer. Progressive testing will be completed. The patient should have less than 15% difference in Biodex strength test, force plate jump and vertical hop tests, and functional horizontal hop tests