Meniscus surgery addresses damage to the C-shaped cartilage in the knee joint. This cartilage acts as a shock absorber, distributing weight, and providing stability. Tears can cause pain, swelling, and instability, sometimes leading to a “locked” knee. Surgery aims to either repair the torn cartilage by stitching it back together or remove the damaged portion, a procedure called a meniscectomy. The surgical approach depends on the tear’s location, size, and pattern, as well as the patient’s age and activity level.
Immediate Post-Surgery Knee Movement
Immediately following meniscus surgery, patients can expect limitations in knee movement, particularly regarding bending. The primary goal during this initial phase is to protect the surgical repair and minimize stress on the healing tissue. Surgeons often prescribe a “protected range of motion” to prevent re-injury. For instance, after a meniscus repair, flexion might be limited to 90 degrees or less for the first few weeks, as bending beyond this point can put undue strain on the posterior horn of the meniscus where tears frequently occur.
Patients commonly use crutches and may wear a knee brace to limit weight-bearing on the operated leg. The brace often locks the knee in full extension, especially during walking and sleeping, to ensure stability and reduce stress on stitches. Brace use typically ranges from two to six weeks, depending on the surgery type and surgeon’s protocol. Despite these restrictions, gentle movements and muscle activation exercises are often encouraged within the first few days to prevent stiffness and promote early recovery.
Gradual Progression of Flexion During Recovery
Regaining full knee flexion after meniscus surgery is a gradual process. In the early rehabilitation phase (weeks 0-4), the focus is on achieving full passive knee extension and controlled flexion, often limited to around 90 degrees. This controlled movement helps diminish swelling and pain while restoring patellar mobility.
As recovery progresses (weeks 4-6), patients transition to more weight-bearing activities and a gradual increase in range of motion. The knee brace may be unlocked, allowing greater flexion, with a goal of reaching 120 degrees by weeks 4-5. Physical therapy plays a central role, introducing exercises like heel slides (sliding the heel towards the buttocks) and wall slides (squatting against a wall) to gradually increase knee flexion.
In the intermediate recovery phase (weeks 6-12), the emphasis shifts to strengthening the knee, improving balance, and working towards full active range of motion. Exercises become more dynamic, incorporating stationary biking and gentle closed-chain exercises like mini-squats and lunges. Following the prescribed program is important for achieving optimal flexion and extension, with many individuals returning to full activity around 4-5 months post-surgery, once cleared by their doctor.
Why Controlled Movement is Essential
Controlled and gradual knee movement after meniscus surgery is essential for healing and preventing complications. The primary reason for this measured approach is to protect the surgical repair, especially in meniscus repair procedures where torn edges are stitched. Excessive or uncontrolled bending too soon can stress the delicate healing tissue, potentially compromising sutures and leading to re-injury or repair failure.
Controlled movement also helps manage post-operative swelling and inflammation. Gentle, guided exercises promote blood circulation, reducing fluid buildup in the knee. Conversely, too little movement can lead to stiffness, muscle weakness, and scar tissue formation (arthrofibrosis), which can further restrict range of motion. Balancing sufficient movement to prevent stiffness with controlled movement to protect the repair ensures the knee recovers strength, stability, and full function while allowing the damaged cartilage to heal.
What to Do If Bending is Difficult
Patients may experience pain, stiffness, or limited range of motion when bending their knee after meniscus surgery. Swelling is a common cause of tightness, as the body sends fluids to the surgical site. Scar tissue around the surgical site can also contribute to stiffness, making it harder for the knee to move smoothly.
To manage these challenges, the RICE method (Rest, Ice, Compression, Elevation) is often recommended. Applying ice packs for 15-20 minutes several times daily can reduce swelling and numb pain. Elevating the leg above the heart, especially for the first few days, helps decrease swelling. Compression bandages or stockings can aid in reducing fluid buildup.
Pain management strategies include over-the-counter medications like acetaminophen or ibuprofen. For more severe pain, prescription painkillers may be provided. Continuing with prescribed physical therapy exercises, such as gentle range of motion movements, is crucial for breaking down scar tissue and improving flexibility.
Contact the surgeon or physical therapist if you experience a sudden increase in pain, excessive swelling, inability to progress with bending, signs of infection (e.g., increased warmth, redness, pus draining from incisions, fever), or symptoms of a blood clot (e.g., pain, redness, swelling in the calf, thigh, or groin).