The meniscus is a C-shaped piece of cartilage that functions as a shock absorber and stabilizer between the thigh bone and the shin bone in the knee joint. When this tissue is torn, surgery is often performed, either to repair the tear or to remove the damaged portion, a procedure called a meniscectomy. Regardless of the surgical technique, the integrity of the knee joint is compromised, making a structured rehabilitation plan absolutely necessary. Following a dedicated exercise program is the only way to successfully restore full knee function and minimize the risk of a future re-injury.
Immediate Post-Operative Phase
The initial focus immediately after surgery, typically spanning the first one to two weeks, centers on controlling swelling, maintaining muscle function, and protecting the surgical site. The overall goal is to prevent the rapid muscle atrophy that occurs with immobilization and to promote circulation. Weight-bearing is typically restricted during this time, often allowing only touch-down weight bearing or none at all, depending on the type of surgery performed.
Simple, gentle movements are introduced almost immediately, such as ankle pumps, where the foot is flexed up and down repeatedly. This exercise is performed while lying down and works the calf muscles to encourage excess fluid to return to the body, which helps reduce post-operative swelling and decreases the risk of blood clots. To prevent the quadriceps muscle from weakening, quadriceps sets are performed by tightening the front thigh muscle and pressing the back of the knee flat against the surface, holding the contraction for several seconds.
Gentle range of motion exercises may also begin, such as passive heel slides, where the heel is slid toward the buttocks to bend the knee slightly, but only within the range permitted by the surgeon, often restricted to 90 degrees or less, especially after a meniscal repair. Hamstring sets, which involve pressing the heel into the floor to contract the hamstring muscle, are also introduced to maintain balanced muscle activation around the knee joint. These non-load bearing isometric exercises are the foundation for the next stage of recovery, where the intensity will gradually increase.
Early Strengthening and Stability
This phase usually begins around two to four weeks post-operation, once the pain and swelling have decreased significantly and the initial healing has progressed. The primary objectives now shift toward achieving full active range of motion and introducing controlled weight-bearing to build foundational strength in the entire leg. Progression in this stage is closely tied to the patient’s ability to manage pain and swelling without flare-ups.
Straight leg raises are commonly utilized and can be performed in multiple directions—to the front, side, and back—to strengthen the quadriceps, hip flexors, and hip abductors. This movement requires the patient to maintain a straight knee against gravity, demonstrating good quadriceps control before increasing the load. Once cleared for partial weight-bearing, standing miniature squats, or mini-squats, are introduced, often performed against a wall for support.
These squats involve bending the knees only slightly, typically to a depth of 15 to 30 degrees, placing controlled load on the joint without excessive compression. Wall slides are a similar exercise where the patient leans back against a wall and slides down a short distance, keeping the movement slow and controlled. Light resistance bands can be incorporated for exercises like standing hamstring curls to further strengthen the muscles that stabilize the knee joint.
Advanced Functional Movement
The advanced phase, generally starting around six to twelve weeks after surgery, focuses on rebuilding the dynamic strength, agility, and balance necessary for returning to activities of daily living and sport. These exercises demand full weight-bearing and functional control, mimicking the complex movements of the real world. This stage is particularly important for preventing chronic instability and long-term joint issues.
Single-leg balance activities are critical for improving proprioception, which is the body’s sense of its position in space. Standing on the operated leg, initially on a stable surface and later progressing to unstable surfaces like a foam pad or balance disc, challenges the knee’s stability and surrounding musculature. Functional exercises like step-ups and step-downs, performed onto a low platform, help restore the ability to negotiate stairs and uneven terrain with confidence.
Full-depth squats, where the knee bends to 90 degrees or more, are gradually added to the routine to restore maximum leg strength. Lateral steps and side-shuffling drills are also introduced to rebuild the knee’s ability to handle sideways movements and rotational stress, which are crucial for sports participation. Light jogging and sport-specific drills, such as gentle pivoting or cutting maneuvers, are only attempted once objective strength measures, such as 80% strength compared to the uninjured leg, have been met and clearance has been given by the medical team.
Recognizing Complications and Red Flags
While a structured exercise program is fundamental to recovery, it is important to recognize signs that may indicate a complication or a need to stop exercising and seek medical advice. Rehabilitation should always be guided by a physical therapist, and the exercises should never cause sharp or increasing pain. The presence of certain symptoms suggests that the knee is not tolerating the current activity level or that a more serious issue is developing.
A sudden, sharp increase in pain, especially if it does not subside quickly with rest and ice, is a significant red flag. Similarly, excessive or worsening swelling that does not improve after elevating the leg and applying ice may signal inflammation beyond the expected post-operative response. Other warning signs include a persistent fever above 100.4°F, which can indicate an infection, or visible signs of infection such as increased warmth, redness, or pus draining from the incision sites.
A feeling of the knee “giving way,” catching, or locking during movement, especially if it is a new symptom, can suggest a mechanical issue within the joint, like a failure of the repair or a loose body. The inability to bear weight after achieving previous milestones is also a serious sign that requires immediate medical consultation. These symptoms are signals that the planned progression must be halted to protect the healing joint.