 
 
Massachusetts General Brigham Sports Medicine  
 
Rehabilitation Protocol for Arthroscopic Meniscal Repair  
 
This protocol is intended to guide clinicians through the post-operative course for meniscal repair. This protocol is time 
based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs of the 
individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes 
contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or 
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with 
the referring surgeon. 
The interventions included within this protocol are not intended to be an inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient and under the discretion of the 
clinician.  
  
Considerations for the Post-operative Meniscal Repair 
Many different factors influence the post-operative meniscal repair rehabilitation outcomes, including type and location 
of the meniscal tear and repair. Consider taking a more conservative approach to range of motion, weight bearing, and 
rehab progression with more complex tears or all-inside meniscal repairs. Additionally, this protocol does not apply to 
meniscus root repairs or meniscus transplants. It is recommended that clinicians collaborate closely with the referring 
physician regarding intra-operative findings and satisfaction with the strength of the repair.  
  
Post-operative considerations  
If you develop a fever, intense calf pain, excessive drainage from the incision, uncontrolled pain or any other symptoms 
you have concerns about you should call your doctor.  
 
  
PHASE I: IMMEDIATE POST-OP (0-3 WEEKS AFTER SURGERY)  
Rehabilitation 
Goals  
• Protect repair 
• Reduce swelling, minimize pain 
• Restore patellar mobility 
• Restore full extension 
• Flexion < 90 degrees  
• Minimize arthrogenic muscle inhibition, re-establish quad control, regain full active extension 
• Patient education  
• Keep your knee straight and elevated when sitting or lying down. Do not rest with a towel 
placed under the knee.  
• Do not actively bend your knee; support your surgical side when performing transfers (i.e. 
sitting to laying down) 
• Do not pivot on your surgical side. 
Weight Bearing  
 Walking  
• Brace locked, crutches  
• Partial weight bearing  
• When going up the stairs, make sure you are leading with the non-surgical side, when going down 
the stairs, make sure you are leading with the crutches and surgical side. 
 
 
Massachusetts General Brigham Sports Medicine  
 
Interventions 
Swelling Management  
• Ice, compression, elevation (check with MD re: cold therapy)  
• Retrograde massage 
• Ankle pumps 
 
Range of motion/Mobility  
• Patellar mobilizations: superior/inferior and medial/lateral  
• Seated assisted knee flexion extension and heel slides with towel  
- ***Avoid active knee flexion to prevent hamstring strain on the posteromedial joint  
• Low intensity, long duration extension stretches: prone hang, heel prop  
• Seated hamstring stretch  
 
Strengthening  
• Quad sets  
• NMES high intensity (2500 Hz, 75 bursts) supine knee extended 10 sec/50 sec, 10 contractions, 
2x/week during sessions—use of clinical stimulator during session, consider home units 
distributed immediate post op  
• Straight leg raise  
- **Do not perform straight leg raise if you have a knee extension lag  
• Hip abduction: side lying or standing  
• Multi-angle isometrics 90 and 60 deg knee extension  
 
Criteria to 
Progress  
• Knee extension ROM 0 deg  
• Knee flexion ROM 90 degrees  
• Quad contraction with superior patella glide and full active extension  
• Able to perform straight leg raise without lag  
  
PHASE II: INTERMEDIATE POST-OP (3-6 WEEKS AFTER SURGERY)  
Rehabilitation 
Goals  
• Continue to protect repair 
• Reduce pain, minimize swelling 
• Maintain full extension 
• Flexion < 90 degrees unless further direction from MD 
Weight Bearing  
Walking  
• Continue partial weight bearing unless directed otherwise by MD 
• Consult with referring MD regarding unlocking brace 
Additional 
Interventions 
*Continue with Phase I 
interventions  
Range of motion/Mobility  
• Stationary bicycle: gentle range of motion only (see Phase III for conditioning)  
 
Cardio  
• Upper body ergometer 
 
Strengthening  
• Calf raises  
• Lumbopelvic strengthening: Sidelying hip external rotation clamshell in neutral, plank, bridge 
with feet elevated 
 
Balance/proprioception  
• Double limb standing balance utilizing uneven surface (wobble board)  
• Joint position re-training  
Criteria to Progress  • No swelling (Modified Stroke Test)  
• Flexion ROM 120 degrees  
• Extension ROM equal to contra lateral side 
 
PHASE III: LATE POST-OP (6-9 WEEKS AFTER SURGERY)  
Rehabilitation 
Goals  
• Continue to protect repair 
• Maintain full extension 
 
 
Massachusetts General Brigham Sports Medicine  
 
• Normalize gait. 
• Flexion within 10 degrees of contra lateral side. 
• Safely progress strengthening. 
• Promote proper movement patterns. 
• Avoid post exercise pain/swelling. 
Weight Bearing  
• May discontinue use of brace/crutches after 6 weeks per MD and once adequate quad control is 
achieved and gait in normalized. 
Additional 
Interventions 
*Continue with Phase 
I-II Interventions as 
indicated 
Range of motion/Mobility  
• Supine active hamstring stretch  
• Gentle stretching all muscle groups: prone quad stretch, standing quad stretch, kneeling hip 
flexor stretch, standing gastroc stretch and soleus stretch  
• Rotational tibial mobilizations if limited ROM  
 
Cardio  
• Stationary bicycle, flutter kick swimming, pool jogging  
 
Strengthening  
• Partial squat exercise 0-60 degrees  
• Ball squats, wall slides, mini squats from 0-60 deg  
• Hamstring strengthening: prone hamstring curls, standing hamstring curls  
• Lumbopelvic strengthening: bridges on physioball, bridge on physioball with roll-in, bridge 
on physioball alternating, hip hike  
• Gym equipment: leg press machine, standing hip abductor and adductor machine, hip 
extension machine, roman chair, seated calf machine  
• Progress intensity (strength) and duration (endurance) of exercises  
 
Balance/proprioception  
• Single limb balance progress to uneven surface including perturbation training  
Criteria to Progress  • No swelling/pain after exercise  
• Normal gait  
• ROM equal to contra lateral side  
• Joint position sense symmetrical (<5 degree margin of error)  
  
PHASE IV: TRANSITIONAL (9-12 WEEKS AFTER SURGERY)  
Rehabilitation 
Goals  
• Maintain full ROM. 
• Safely progress strengthening. 
• Promote proper movement patterns. 
• Avoid post exercise pain/swelling. 
Additional 
Interventions 
*Continue with Phase 
I-III interventions as 
indicated 
Cardio  
• Elliptical, stair climber  
 
Strengthening  
- **The following exercises to focus on proper control with emphasis on good proximal 
stability  
• Squat to chair  
• Lateral lunges  
• Single leg progression: partial weight bearing single leg press, slide board 
lunges: retro and lateral, step ups and step ups with march, lateral step-ups, step downs, single 
leg squats, single leg wall slides  
• Knee Exercises for additional exercises and descriptions  
• Gym equipment: seated hamstring curl machine and hamstring curl machine  
• Romanian deadlift  
Criteria to Progress  • No episodes of instability  
• 10 repetitions single leg squat proper form through at least 60 deg knee flexion  
• KOOS-sports questionnaire >70%  
 
 
Massachusetts General Brigham Sports Medicine  
 
• Functional Assessment  
- Quadriceps index ≥80%; HHD mean preferred (isokinetic testing if available)  
- Hamstring, glut med, glut max index ≥80%; HHD mean preferred (isokinetic testing for HS 
if available)  
  
PHASE V: EARLY RETURN TO SPORT (3-5 MONTHS AFTER SURGERY)  
Rehabilitation 
Goals  
• Safely progress strengthening. 
• Safely initiate sport specific training program. 
• Promote proper movement patterns. 
• Avoid post exercise pain/swelling. 
Additional 
Interventions 
*Continue with 
Phase II-IV 
interventions as 
indicated 
• Interval running program  
- Return to Running Program  
• Progress to plyometric and agility program (with functional brace if prescribed).  
- Agility and Plyometric Program  
Criteria to Progress  • Clearance from MD and ALL milestone criteria below have been met 
• Completion of jog/run program without pain/swelling  
• Functional Assessment  
- Quad/HS/glut index ≥90%; HHD mean preferred (isokinetic testing if available)  
- Hamstring/Quad ratio ≥ 70% with isokinetic testing if available)  
- Hop Testing ≥90% compared to contra lateral side  
• KOOS-sports questionnaire >90%  
• International Knee Committee Subjective Knee Evaluation >93  
• Psych Readiness to Return to Sport (PRRS)  
  
PHASE VI: UNRESTRICTED RETURN TO SPORT (6+ MONTHS AFTER SURGERY)  
Rehabilitation 
Goals  
• Continue strengthening and proprioceptive exercises. 
• Symmetrical performance with sport specific drills. 
• Safely progress to full sport. 
Additional 
Interventions 
*Continue with Phase 
II-V interventions as 
indicated 
• Multi-plane sport specific plyometrics program  
• Multi-plane sport specific agility program  
• Include hard cutting and pivoting depending on the individuals’ goals  
• Non-contact practice→ Full practice→ Full play  
  
Criteria to 
Discharge  
• Quad/HS/glut index ≥90%; HHD mean preferred (isokinetic testing if available)  
• Hop Testing ≥90% compared to contra lateral side  
   Revised  4/2021 
  
Contact  
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol  
 
 
References: 
  
1. 
Adams D, Logerstedt D, et al. Current Concepts for Anterior Cruciate Ligament Reconstruction: A Criterion-Based Rehabilitation 
Progression. JOSPT 2012 42(7): 601-614.  
  
2. 
DeFroda SF, Bokshan SL, et al. Variability of online available physical therapy protocols from academic orthopedic surgery programs for arthroscopic 
meniscus repair. The Physician and Sports Medicine. 2018. 46 (3): 355-360.  
  
3. 
Glazer DD. Development and Preliminary Validation of the Injury-Psychological Readiness to Return to Sport (I-PRRS) Scale. Journal of Athletic 
Training. 2009;44(2):185-189.  
 
4. 
Harput, G., Guney-Deniz, H., Nyland, J., & Kocabey, Y. (2020). Postoperative rehabilitation and outcomes following arthroscopic isolated meniscus 
repairs: A systematic review. Physical Therapy in Sport, 45(2020), 76–85. 
  
5. 
Irrgang JJ, Anderson AF, Boland AL, et al. Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J 
Sports Med. 2001;29:600-613.  
  
 
 
. 
Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate 
Ligament Injuries in Female Athletes: 2-year follow-up. Am J Sports Med. 2005;33:1003-1010.   
 
7. 
Noyes, FR, Heckmann TP, et al. Meniscus Repair and Transplantation: A Comprehensive Update. JOSPT 2012 42(3): 274-290.  
  
8. 
VanderHave KL, Perkins C, et al. Weightbearing versus nonweightbearing after meniscus repair. Sports Health. 2015. 7 (5): 399-402.  
  
9. 
Vedi V, Williams A, et al. Meniscal movement: an in-vivo study using dynamic MRI. JBJS. 1999. 81: 37-41.  
  
10. Wilk KE, Macrina LC, et al. Recent Advances in the Rehabilitation of Anterior Cruciate Ligament Injuries. JOSPT 2012 42(3): 153-171.  
  
 
 
 
 
Massachusetts General Brigham Sports Medicine  
 
  
Return to Running Program  
  
This program is designed as a guide for clinicians and patients through a progressive return-to-run program. Patients 
should demonstrate > 80% on the Functional Assessment prior to initiating this program (after a knee ligament or 
meniscus repair). Specific recommendations should be based on the needs of the individual and should consider clinical 
decision making. If you have questions, contact the referring physician.   
  
PHASE I: WARM UP WALK 15 MINUTES, COOL DOWN WALK 10 MINUTES  
Day  
1  
2  
3  
4  
5  
6  
7  
Week 1  
W5/J1x5  
  
W5/J1x5  
  
W4/J2x5  
  
W4/J2x5  
Week 2  
  
W3/J3x5  
  
W3/J3x5  
  
W2/J4x5  
  
Week 3  
W2/J4x5  
  
W1/J5x5  
  
W1/J5x5  
  
Return to 
Run   
Key: W=walk, J=jog  
**Only progress if there is no pain or swelling during or after the run  
  
PHASE II: WARM UP WALK 15 MINUTES, COOL DOWN WALK 10 MINUTES  
Week  Sunday  
Monday  Tuesday  
Wednesday  
Thursday  Friday  
Saturday  
1  
20 min  
  
20 min  
  
20 min  
  
25 min  
2  
  
25 min  
  
25 min  
  
30 min  
  
3  
30 min  
  
30 min  
  
35 min  
  
35 min  
4  
  
35 min  
  
40 min  
  
40 min  
  
5  
40 min  
  
45 min  
  
45 min  
  
45 min  
6  
  
50 min  
  
50 min  
  
50 min  
  
7  
55 min  
  
55 min  
  
55 min  
  
60 min  
8  
  
60 min  
  
60 min  
  
  
  
Recommendations  
• Runs should occur on softer surfaces during Phase I  
• Non-impact activity on off days  
• Goal is to increase mileage and then increase pace; avoid increasing two variables at once  
• 10% rule:  no more than 10% increase in mileage per week  
 
 
 
 
Massachusetts General Brigham Sports Medicine  
 
Agility and Plyometric Program  
  
This program is designed as a guide for clinicians and patients through a progressive series of agility and plyometric 
exercises to promote successful return to sport and reduce injury risk. Patients should demonstrate > 80% on the 
Functional Assessment prior to initiating this program. Specific intervention should be based on the needs of the 
individual and should consider clinical decision making. If you have questions, contact the referring physician.   
  
PHASE I: ANTERIOR PROGRESSION  
Rehabilitation 
Goals  
• Safely recondition the knee  
• Provide a logical sequence of progressive drills for pre-sports conditioning  
Agility  
• Forward run  
• Backward run  
• Forward lean in to a run  
• Forward run with 3-step deceleration  
• Figure 8 run  
• Circle run  
• Ladder   
Plyometrics  
• Shuttle press: Double leg
alternating leg
single leg jumps  
• Double leg:   
- Jumps on to a box
 jump off of a box
 jumps on/off box  
- Forward jumps, forward jump to broad jump  
- Tuck jumps  
- Backward/forward hops over line/cone  
• Single leg (these exercises are challenging and should be considered for more 
advanced athletes):  
- Progressive single leg jump tasks  
- Bounding run  
- Scissor jumps  
- Backward/forward hops over line/cone  
Criteria to Progress  
• No increase in pain or swelling  
• Pain-free during loading activities  
• Demonstrates proper movement patterns  
  
PHASE II: LATERAL PROGRESSION  
Rehabilitation 
Goals  
• Safely recondition the knee  
• Provide a logical sequence of progressive drills for the Level 1 sport athlete  
Agility  
*Continue with Phase I 
interventions  
  
• Side shuffle  
• Carioca  
• Crossover steps  
• Shuttle run  
• Zig-zag run  
• Ladder  
Plyometrics  
*Continue with Phase I 
interventions  
• Double leg:   
- Lateral jumps over line/cone  
- Lateral tuck jumps over cone  
• Single leg(these exercises are challenging and should be considered for more 
advanced athletes):  
- Lateral jumps over line/cone  
- Lateral jumps with sport cord  
Criteria to Progress  
• No increase in pain or swelling  
• Pain-free during loading activities  
• Demonstrates proper movement patterns  
  
 
 
Massachusetts General Brigham Sports Medicine  
 
  
PHASE III: MULTI-PLANAR PROGRESSION  
Rehabilitation 
Goals  
• Challenge the Level 1 sport athlete in preparation for final clearance for return to 
sport  
Agility   
*Continue with Phase 
I-II interventions  
• Box drill  
• Star drill  
• Side shuffle with hurdles  
Plyometrics  
*Continue with Phase 
I-II interventions  
• Box jumps with quick change of direction  
• 90 and 180 degree jumps   
Criteria to Progress  
• Clearance from MD  
• Functional Assessment  
- Quad/HS/glut index ≥90% contra lateral side (isokinetic testing if 
available)  
- Hamstring/Quad ratio ≥70%  
- Hop Testing ≥90% contralateral side  
• KOOS-sports questionnaire >90%  
• International Knee Committee Subjective Knee Evaluation >93  
• Psych Readiness to Return to Sport (PRRS)  
  
 
 
 
 
Massachusetts General Brigham Sports Medicine  
 
 
