Arthroscopic Meniscectomy Rehabiliation Protocol

STAGE I: 0-2 WEEKS

GOALS

• Proper healing of surgical incisions.
• Edema control
• Quad Sets/SLR in all planes without assistance, emphasizing SLR without extension lag.
• ROM 0-90 in first week, then FULL ROM by end of 2nd week.
• Neoprene brace with patella cut out.
• Patient demonstrates understanding of home exercise program.

RESTRICTIONS

• Weight bearing as tolerated immediately following surgery using crutches until you can comfortably walk without a significant limp. Full weight bearing without crutches by beginning of 2nd week.

INTERVENTIONS

• Check for possible blood clot in calf.
• Monitor healing of surgical incisions.
• Instruct in home exercise program.
• Discuss goals of treatment with the patient.
• Passive and active assisted extension.
  a. prone knee hangs
  b. pillow under ankle
  c. supine or seated hamstring stretch
• Passive and active assisted flexion
  a. heel slides
  b. supine wall slides
  c. sitting assisted knee flexion
  d. quadriceps stretch prone or side lying
• Neuromuscular Re-Education
  a. Quad sets
  b. Seated SAQ 90-30 degrees
  c. SLR
• Patella mobilizations
• Strengthening
  a. Leg lifts into hip abduction, adduction, and extension
  b. Prone/standing hamstring curls
  c. Ankle pumps
  d. Bike with low resistance
  e. Treadmill once off crutches (walking)
• Gait Training as needed
• Cold pack with electrical stimulation following exercises for edema control if needed.

STAGE II: 2-3 WEEKS

GOALS

• Edema Control
• Strength – 4/5
• Gait: FWB without assistive device, no limp, full knee extension in stance
• Develop increased proprioception starting with stationary postures and progressing to dynamic movements.

RESTRICTIONS

• No running, jumping, twisting, or breaststroke
• Continue with flexibility exercises. Avoid extreme flexion (no crouching or deep squatting)

INTERVENTIONS
Continue as above with the following additions and/or modifications.

• Progress to weights with SLR program.
• Proprioception: BAPS (single leg sitting progressing to standing), progress to mini-trampoline with weight-shifting s/s, f/b, mini squats, heel raises, and single leg balance; step over cones
• Strengthening: double ¼ leg press with light weight/high reps, step ups f/b, s/s, T-band hip exercises in 4 directions, side stepping over cones, wall squats (standing) or mini squats, bridging, Stairmaster.
• Friction massage to scar.

STAGE III: 3-4 WEEKS

GOALS

• Develop eccentric neuromuscular control to allow acceptance of impact activities without increasing symptoms.
• Develop dynamic flexibility to allow proper alignment during activities of increasing speed.
• Begin jogging, plyometrics, agility training, and sport specific drills.

INTERVENTIONS

• Single leg press, single leg bridge, single leg heel raises, stool scoots
• Progress proprioceptive activities to dynamic surface.
• Walking figure 8’s, lateral shuffles, cariocas
• Treadmill f/b and s/s with emphasis on normal gait.
• Swimming/aquatic exercises
• Weight room activities: hip abduction/adduction, hamstring curls
• Eccentric neuromuscular control: squat and reach, step downs, forward lunges, s/s lunges, slipping, bounce jumps, jump stops
• Sport Cord: waling f/b, lunges f/b and s/s
• Proprioception: single leg balance with ball toss
• (10 weeks) Sliding board for lateral agility

STAGE IV: 5-6 WEEKS

*Address return to sport – continue physical therapy if further progression to sports is needed.