U W H E A LT H S P O R T S R E H A B I L I T A T I O N

Rehabilitation Guidelines for

Meniscal Repair
There are two types of cartilage
in the knee, articular cartilage
and meniscus cartilage. Articular
cartilage is made up of collagen,
proteoglycans and water and lines
the end of the bones that meet to
form a joint. The primary function
of the articular cartilage is to provide
a smooth gliding surface for joint
motion. Rubbing articular cartilage
on articular cartilage is approximately Lateral Medial
5 times more smooth, or with less meniscus meniscus
friction, than rubbing ice on ice.1
Figure 1 Meniscus cartilage (shown here from
The meniscus cartilage in the knee above the knee, without the femur)
includes a medial (inside) meniscus Image property of Primal Pictures, Ltd., primalpictures.com. Use of this Tibia Medial Femur
and a lateral (outside) meniscus. image without authorization from Primal Pictures, Ltd. is prohibited. meniscus
Together they are referred to as Figure 2 Medial (inside) view of the knee
menisci. The menisci are wedge occur through repetitive stresses Image property of Primal Pictures, Ltd., primalpictures.com. Use of this
image without authorization from Primal Pictures, Ltd. is prohibited.
shaped, being thinner toward the to the menisci over time, which
center of the knee and thicker severely weakens the tissue. This
toward the outside of the knee process of tissue degeneration makes
joint (Figures 1–3). This shape is it very unlikely that a surgical repair
very important to its function. The will heal or that the surrounding
primary function of the menisci is meniscus will be strong enough to
to improve load transmission. A hold the sutures used to repair it.
relatively round femur sitting on a One report showed that less than
relatively flat tibia forms the knee 10% of meniscal tears occurring in
joint. Without the menisci the area patients greater than forty years of
of contact force between these two age were repairable. Symptoms of a
bones would be relatively small, degenerative meniscus tear include
increasing the contact stress by 235- swelling, pain along the joint line,
335% (Figure 4). The menisci also catching and locking. Most often
provide some shock absorption, degenerative tears are surgically
lubrication and joint stability. removed. Occasionally a patient may
be able to regain function through Femur Tibia Medial
There are two categories of meniscal meniscus
rehabilitation without surgery.
tears: acute traumatic tears and
degenerative tears. Degenerative Acute traumatic tears occur most Figure 3 Normal MRI (saggital view) of the
tears most commonly occur in frequently in the athletic population knee, lateral (outside) view
middle-aged people. They typically as a result of a twisting injury to

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 Rehabilitation Guidelines For Mensical Repair

without with
meniscus meniscus

Figure 5 MRI (saggital view) of a lateral

meniscus tear (yellow arrows)

the inner portion has a very poor

blood supply. Figure 6 shows the
Figure 4Schematic representation of the meniscal effect on contact pressure in the blood vessels (perimeniscular capillary
knee. Contact area is increased by 50% with addition of menisci. This reduces contact pressures.
plexus) entering the outer portion
of the meniscus.3 This blood supply
is necessary for a tear or a repair to
heal. Without an adequate blood
supply, the area of torn meniscus will
Femur have to be removed.
After mensical surgery, rehabilitation
with a physical therapist or athletic
trainer is needed to restore range of
motion, strength, movement control
Meniscus and guide the athlete’s return to sport.
When the meniscus is repaired there
may be a period of restricted knee
Tibia flexion, especially during weight
bearing, to protect the repair sutures
and the meniscus. The rehabilitation
Figure 6Perimeniscular capillary plexus (thick arrow) providing blood supply to the guidelines are presented in a criterion
outer third of the meniscus. based progression. Specific time
frames, restrictions and precautions
are given to protect healing tissues
the knee when the foot is planted. include: non-operative rehabilitation,
and the surgical repair/reconstruction.
Symptoms of an acute meniscus tear surgery to trim out the area of torn
General time frames are also given for
include swelling, pain along the joint meniscus, or surgery to repair (stitch
reference to the average individual ,
line, catching, locking and a specific together) the torn meniscus. The
but individual patients will progress at
injury. Often times these tears can treatment chosen will depend on
different rates depending on their age,
be diagnosed by taking a thorough the location of the tear, the athlete’s
associated injuries, pre-injury health
history and completing a physical sport, ligamentous stability of the
status, rehabilitation compliance and
examination. An MRI may be used knee and any associated injury.2 The
injury severity. The size and location
to assist in making the diagnosis. If location of tear is important because
of the meniscal tear may also affect
an athlete suffers a meniscal tear, the outer portion of the meniscus
the rate of post-operative progression.
the three options for treatment has a good blood supply whereas

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 Rehabilitation Guidelines For Mensical Repair

PHASE I (Surgery to 4 weeks after surgery)

Note: The physician may extend this phase to 6 weeks for large repairs.

Appointments •  Rehabilitation appointments begin 3-5 days post-operatively and then

approximately 1 time per week

Rehabilitation Goals •  Protection of the post-surgical knee

•  Restore normal knee extension
•  Eliminate effusion (swelling)
•  Restore leg control

Precautions •  The patient may gradually wean from two crutches to one crutch to no crutches
as long as the knee is in the locked knee brace, and there is no increase in pain
or swelling for 4 weeks.
•  Knee brace locked for all weight bearing activities for 4 weeks
•  Do not flex the knee past 90°

Range of Motion Exercises •  Knee extension on a bolster

•  Prone hangs
•  Supine wall slides
•  Heel slides (caution with posterior medial meniscus repair secondary to the
semimembranosus insertion)
•  Knee flexion off the edge of the table

Suggested Therapeutic Exercise •  Quadriceps sets

•  Straight leg raises
•  4 way leg lifts in standing with brace on for balance and hip strength
•  Abdominal isometrics

Cardiovascular Exercise •  Upper body circuit training or upper body ergometer

Progression Criteria •  4 weeks after surgery

•  Pain-free gait without crutches
•  No effusion (swelling)

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 Rehabilitation Guidelines For Mensical Repair

PHASE II (begin after meeting Phase I criteria, usually 4 weeks after surgery)

Appointments •  Rehabilitation appointments are once every 1-2 weeks

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

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 Rehabilitation Guidelines For Mensical Repair

PHASE III (begin after meeting Phase II criteria, usually 3 months after surgery)

Appointments •  Rehabilitation appointments are once every 1 to 2 weeks

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 •  Impact control exercises beginning 2 feet to 2 feet, progressing from 1 foot to
the other and then 1 foot to the same foot
•  Movement control exercises beginning with low velocity, single plane activities
and progressing to higher velocity, multi-plane activities
•  Strength and control drills related to sport specific movements
•  Sport/work specific balance and proprioceptive drills
•  Hip and core strengthening
•  Stretching for patient specific muscle imbalances

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

These rehabilitation guidelines were developed collaboratively by Marc Sherry, PT, DPT, LAT, CSCS and the
UW Health Sports Medicine physician group.
Updated 11/2017

REFERENCES
1. Ulrich GS and Aronczyk SP. The basic 2. Fowler PJ and Pompan D. Rehabilitation 3. Arnoczky SP and Warren RF.
science of meniscus repair. Tech in Ortho, after mensical repair. Tech in Ortho, 8(2): Microvasculature of the human meniscus.
8(2): 56-62, 1993. 137-139, 1993. Am J Sport Med, 1982.

At UW Health, patients may have advanced diagnostic and /or treatment options, or may receive educational materials that vary from this information. Please be aware that this information is not intended to replace
the care or advice given by your physician or health care provider. It is neither intended nor implied to be a substitute for professional advice. Call your health provider immediately if you think you may have a medical
emergency. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any question you may have regarding a medical condition.

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