Knee Arthroscopy (Meniscectomy)

Anatomy and Biomechanics

The knee is a hinge joint at the connection point between the femur and
tibia bones. It is held together by several important ligaments. The
knee is also cushioned during weight bearing by two cartilaginous discs,
called the medial (inside) and lateral (outside) menisci. These menisci
provide shock absorption for the knee during weight bearing. Because
they are soft and rubbery these structures are vulnerable to tearing
when the knee is forcefully twisted during activity. This is known as a
traumatic tear. The meniscus can also break down and tear as a result
of repetitive loading stress over time. This type of tear is called a
degenerative tear.

Both traumatic and degenerative tears can create pain, swelling and locking in the knee. Meniscal tears
come in many shapes and sizes. There are many different categories or names to describe the specific
location or type of tear in the meniscus. Small tears can make it difficult to pivot, run or move laterally.
The larger a tear gets though, the more restrictive it is. Large tears can create a great deal of pain in the
knee making it difficult to walk normally. They occasionally even create a locking in the joint that will
not allow the knee to straighten or bend fully.

Treatment Options
No matter what type of meniscal tear is present your physician
will work with you to determine what the best course of
treatment will be. Small, degenerative meniscal tears are often
treated conservatively with rest, anti-inflammatory measures,
activity modification and Physical Therapy. Many times when the
inflammation is resolved and the patient is agreeable to reducing
the load bearing activity affecting the joint, surgery can be
avoided. If a non-surgical approach is taken the patient must
understand that it is imperative that he or she maintain good
strength in his or her leg and avoid sports or activities that require
pivoting or cutting. If the tear is large or if conservative measures
fail to alleviate the associated pain and joint dysfunction than the surgeon may elect to remove the tear
surgically with the use of an arthroscope.

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 Surgery
When the meniscal tear is removed the surgeon uses an
arthroscopic technique. Two small incisions are made in the front
part of the knee below the knee cap. Through one incision a
camera is inserted so that the surgeon can see the inside of the
knee joint on a monitor. The other incision is used to place a tool
into the joint that will clip and remove the torn piece of cartilage.
While the camera is inside the joint the surgeon uses this
opportunity to examine the rest of the knee to make sure it is
otherwise healthy.

Recovery/Time off Work

It is very important that the patient knows that the recovery process after surgery requires that he or
she be an active participant, performing daily exercises to ensure there is proper return of range of
motion and strength to the knee. There is a large amount of variability in the time it takes to fully
recover from this procedure. It is usually estimated that it will take at least 4-6 weeks for the patient to
feel as though he or she has completely returned to a pre-injury level of activity. Some cases may take
as long as 2-3 months to make a full recovery. People with desk jobs should plan to take at least a few
days off from work. Manual laborers will likely be out of work for at least 4-6 weeks. Recovery is
different in each case. Your individual time table for return to activities and work will be discussed by
your surgeon during post operative office visits.

Post Operative Visits

Your first post-op visit to the doctor’s office will be approximately 7-10 days after the operation. At this
visit your stitches will be removed and you will review the surgery with the surgeon or his/her staff. At
this time you may be asked to make an appointment to begin Physical Therapy. Your surgeon will also
discuss a plan for subsequent post operative office visits at this time, and will have you schedule them
accordingly.

At Home
You should replace your post-op dressing 1 day after the operation. The dressing is no longer necessary
after two days as long as the incisions are dry. Do not remove the strips of tape (steri-strips) that are
across your incision. Allow them to fall off on their own or to be removed at your doctor’s office visit.
You may shower after 2 days, but use a water-tight dressing until your sutures are removed. Bathing
without getting the knee wet or sponge baths are a good alternative.

Medication
Your surgeon will prescribe pain medicine for you after the operation. Please call the doctor’s office if
you have any questions regarding medication.

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 Ice
You must use ice on your knee after the operation for management of pain and swelling. Ice should be
applied 3-5 times a day for 10-20 minutes at a time until pain and swelling are minimized. Always
maintain one layer between ice and the skin. Putting a pillow case over your ice pack works well for
this.

Crutches
After meniscectomy surgery you will need to use crutches to help you walk for a several days. Starting
right after surgery you may put as much weight as you can tolerate on your operated leg while using
both crutches for support. After a few days if you can maintain proper heel toe gait you should switch
to using one crutch while walking. This crutch should be used on the opposite side of the operated
knee. After a few more days you may walk without crutches, but it is very important that you walk with
a normal gait and not limp. If you can not walk normally continue using your crutch or crutches until
you see your doctor or physical therapist.

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 Rehabilitation
**The following is an outlined progression for rehab. Time tables are approximate. Advancement
from phase to phase, as well as specific exercises performed, should be based on each individual
patient’s case and sound clinical judgment on the part of the rehab professional. **

Phase 1 (0-2 Weeks)

Goals
Control Pain and Swelling
Protect Healing Tissue
Restore Joint Range of Motion
Establish Normal Gait Pattern
Establish Hip and Knee Muscle Activation, Especially Quadriceps

Precautions
WBAT with Crutches until normal gait pattern is established
Limit time spent on feet standing or walking
No restrictions in ROM

Recommended Exercises
Range of Motion
Heel Slides 2 Sets of 20 Repetitions
Assisted Knee Flexion/Extension in Sitting 2 Sets of 20 Repetitions
Heel Prop (passive extension) or Prone Hang 5 Minutes
Belt Stretch (Calf/Hamstring) Hold 30 Seconds 3-5 Repetitions
Cycle (minimal resistance) 10-15 Minutes Daily
Strength
Quad Sets 2-3 Sets of 20 Repetitions
SLR *(no Lag)* 2-3 Sets of 10-20 Repetitions
Hip Abd/Add/Extension (against gravity) 2-3 Sets of 10-20 Repetitions
Standing or Prone Hamstring Curls 2-3 Sets of 10-20 Repetitions
T-Band Ankle Pumps 2-3 Sets of 20-25 Repetitions

Guidelines
Use exercise bike daily if possible for 10-15 minutes. Perform Range of Motion exercises 3-5 times a
day. Perform Strengthening exercises 1 time a day.

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 Phase 2 (2-6 Weeks)

Goals
Continued Protection of Healing Tissue
Continue to Improve ROM
Continue to Stress Proper Gait Mechanics
Transition to Weight Bearing/Closed Chain Strengthening
Improve Lower Extremity Flexibility

Precautions
Continue to limit swelling in joint by limiting weight bearing activity
Must continue to stress proper gait
No running or sports until cleared by physician

Recommended Exercises
Range of Motion
Continue ROM exercises from Phase 1 until normal ROM is achieved
Cycle with increased resistance
Add Lower Extremity stretching (Hamstring, Quadriceps, Calf, Glutes, Adductors, ITB, etc)
Cardio
Cycle with progressive resistance
Elliptical at 4 Weeks
Swimming at 4 Weeks
Strengthening
Continue 4 way SLR program (add ankle weight as needed)
Standing T-band TKE
Mini Squat and/or Wall Slide
Heel Raises
Gym Equipment at 2-4 weeks post op if pain free (Leg Press, Ham Curl, Multi-Hip)
Step Up Progressions at 4-6 Weeks post op if pain free (Forward Step Ups) *Forward Step Downs are not
recommended due to increased patella femoral load*

Guidelines
Perform all ROM and Strengthening exercises (except gym equipment) once a day. Do 2-3 sets of 15-20
repetitions. Cycle daily if possible.

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 Phase 3 (6-12 Weeks)

Goals
Avoid excessive joint stress and joint pain
Continue to maximize return of ROM and flexibility
Continue closed chain strength and proprioception

Precautions
Must avoid excess joint stress and keep closed chain exercises pain free
Begin lateral movement and return to activity progression per physician clearance
Begin return to running progression per physician clearance

Recommended Exercises
Range of Motion and Flexibility
Continue Lower Extremity Stretching (Hamstring, Quadriceps, Calf, Glutes, Adductors, ITB, etc)
Cardio
Cycle with progressive resistance
Elliptical
Swimming
May begin return to running progression at 6 weeks post op (outlined by P.T. or Physician)
Strengthening
Continue Progression of 4 way SLR with Ankle Weights
Continue Gym Equipment with progressive loads
Squats to 90⁰
Progressive Single Leg Strengthening (Squat and Lunge Variations)
Step Up Progressions (Forward and Lateral Step Ups) *Forward Step Downs are not recommended due to
increased patella femoral load*
Static Forward/Backward Lunge
Proprioception
Static and Dynamic Balance on Bosu/Wobble Board/Foam/Etc
Star Drill (single leg stance with reach)
Dynamic Progressions
May Begin Plyometric/Jumping Progression (see page 6) at 6 Weeks if approved by P.T. and
Physician
May Begin Speed/Agility Progression (see page 7) at 6 Weeks if approved by P.T. and Physician

Guidelines
Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each.
Cardio program is recommended 3-5 times a week for 20-45 minutes
Perform strengthening/proprioception exercises 3 times a week. Do 2-3 sets of 15-20 Reps.
Perform plyometric/jumping/agility exercises 2 times a week
Perform return to sport activities as directed by P.T. or Doctor

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 Jumping/Plyometric Progression

Simple Double Limb (6 Weeks Post Op) *Limit 60 foot contacts per workout
Double Leg Hops (forward and backward over line)
Box Jump (6-8 inches max)

*Focus on sticking each landing with good form in frontal and sagital planes. Stress a soft landing with
good eccentric control.*

Complex Double Limb (7 Weeks Post Op) *Limit 90 foot contacts per workout
Double Leg Jump (for distance)
Double Leg Jump (for height)
Double Leg Jump (with 90⁰ or 180⁰ turn)
Double Leg Lateral Jump/Lateral Box Jump (side to side)
Depth Jump (6-8 inches max)

*Focus on sticking each landing with good form in frontal and sagital planes. Stress a soft landing with
good eccentric control.*

Combination Jumps (begin at 18-20 weeks post op)

Repetitive Double Leg Jumps (distance, height, lateral, turns)
Jump for Distance into Jump for Height
Box Jump to Depth Jump
Depth Jump to Jump for Distance/Height

*String jumps together. Focus on quickly moving from jump to jump.*

Single Limb (8 Weeks Post Op) *Limit 100-120 foot contacts per workout
Heiden Hop
Bounding
Single Leg Jumps (distance, height, lateral, 90⁰/180⁰ turn)
Single Leg Box Jumps (6-8 inches max)
Single Leg Depth Jumps (6-8 inches max)

*Focus on sticking each landing with good form in frontal and sagital planes. Stress a soft landing with
good eccentric control.*

Combination Jumps (Single Leg)

Repetitive Single Leg Jumps (distance, height, lateral, 90⁰/180⁰ turn)
Jump for Distance into Jump for Height
Box Jump to Depth Jump
Depth Jump to Jump for Distance/Height

*String jumps together. Focus on quickly moving from jump to jump.*

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 Speed/Agility Progression

*Work with P.T. to establish proper warm-up and cool down before and after each agility workout
session.*

Forward/Backward Sprinting (6 Weeks)

Sprint 50-100 yards at ½ speed 10 reps.
Sprint 50-100 yards at ¾ speed 10 reps
Backpedal 50 yards at ½ speed 5 reps.

Basic Change of Direction (7 Weeks)

*Begin each workout with sprinting and backpedaling 50 yards (2 reps at ½ speed, 5 reps at ¾ speed)

T drill 3 reps at ½ speed

Forward/backpedal shuttle 5/10/20 yard 3 reps at ½ speed
Box drill with shuffling or cutting 3 reps at ½ speed

Advanced Drills (8 Weeks and Beyond)

*Begin each workout with sprinting and backpedaling 50 yards (3 reps at ½ speed, 2 reps at ¾ speed and
5 reps at full speed)

Work with P.T. to develop sport specific drills. Perform drills from previous weeks with use of ball, stick,
etc. Perform drills seen in typical sports practice with supervision.

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 Weight
Time Bearing and Recommended
Focus Range of Motion Precautions
Gait Exercises

Phase 1 *WBAT *Wound Healing *Emphasize 0⁰ ROM *Minimize Joint

0-2 Weeks *D/C *Protect Joint Extension Heel Slides, Seated Assisted Effusion and
crutches *Establish Early *Goal to Achieve Knee Flexion, heel prop, prone Edema
When Gait ROM 120-135⁰ of hang, cycle *Monitor for Gait
Pattern in *Establish Good Flexion Strengthening Abnormalities
Normal Quadriceps *May Have Quad Sets, SLR (no lag), Hip
Contraction and Specific ROM Abd/Add/Extension, Standing or
proper gait Instructions if Prone Hamstring Curl, T-band
mechanics Meniscal Repair Ankle Pump

Phase 2 *Continue *Normalize Gait *Continue to ROM *Must Continue

2-6 Weeks to Stress Mechanics Stress Normal Continue Phase 1 Exercises until to Stress Proper
Proper Gait *Progressive ROM if Still normal ROM is achieved. Start Gait
Weight Bearing Limited Lower Extremity Stretching *Avoid Joint
Strengthening *Begin Lower Program all Muscle Groups. Stress and
Extremity Cycle with increased Resistance Swelling
Stretching Cardio *Emphasize No
Program Cycle with Progressive Joint Pain with
Resistance Exercise
Elliptical at 4 Weeks Progressions
Swimming at 4 Weeks
Strengthening
Progress Open Chain SLR/Hip
Program with Ankle Weights,
Gym Equipment (Leg Press,
Ham Curl, Etc) Squats to 90⁰,
Begin Transition to Single Leg
Strengthening, Step Ups, Static
Forward/Backward Lunge, Etc
Proprioception
Static and Dynamic Balance
with Bosu/Foam/Etc
Phase 3 *Straight *Continue *Continue Lower ROM/Stretching *Must have MD
6-12 Weeks Ahead Preparation for Extremity Continue Lower Extremity and P.T.
Jogging per Return to Sport and Stretching Stretching Program all Muscle Clearance for
Groups Daily
MD Physical Activity Program Daily Return Return to
Cardio
Approval *Progressive Cycle with Progressive Resistance Jogging, Dynamic
*Lateral Strengthening and Elliptical Progressions and
Movement Jumping Swimming Return to Sport.
per MD *Begin Progressive Begin Return to Run Program at 6
Approval Agility Drills Weeks
*Sport Strengthening
Specific Continue SLR Program and Gym
Equipment, Progressive Single Leg
Training
Strengthening, Dynamic Lunge,
Progression Lateral Lunge, Step Up Progressions
per MD Proprioception
Approval Static and Dynamic Balance with
Bosu/Foam/Etc
Dynamic Progressions
Begin Plyometric/Jumping and
Agility Progressions
Progress to Sport Specific Drills
*Reviewed by Michael Geary, MD

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