Meniscus surgery addresses tears in the C-shaped cartilage that acts as a shock absorber in the knee joint. The two main surgical approaches are a meniscus repair, where the torn tissue is stitched back together, or a meniscectomy, which involves trimming away the damaged cartilage. Physical therapy is a necessary part of recovery, and the timing of its start is highly personalized, guided by the surgeon and therapist. The specific rehabilitation protocol depends entirely on the type of surgery performed, aiming to safely restore strength and mobility.
Factors Determining the Start of Physical Therapy
The decision to begin physical therapy immediately or to delay it centers on protecting the surgical site from undue stress. Patients who undergo a meniscectomy, where the torn portion is removed, can typically start formal physical therapy almost right away. Since the tissue was removed rather than repaired, the main concern is managing swelling and quickly regaining function, allowing for rapid initiation of exercises.
Conversely, a meniscus repair requires a much more cautious approach to allow the stitched tissue to heal properly. The repaired meniscus needs time to form a strong bond, so mobilization and weight-bearing must be restricted for several weeks. This often leads to a delayed start to aggressive physical therapy, sometimes for one to two weeks, with strict limitations on how far the knee can bend.
The Initial Post-Surgical Rehabilitation Phase
For those receiving a meniscectomy, the first phase of rehabilitation begins within the first few days of surgery. The focus is controlling pain and swelling through techniques like elevation and ice, while gently restoring the knee’s range of motion. Patients begin with basic muscle activation exercises, such as quadriceps setting and ankle pumps, to promote circulation.
In contrast, the initial phase following a meniscus repair is characterized by protection and limitation, often lasting four to six weeks. The knee is typically immobilized in a brace, locked in full extension, and weight-bearing is restricted to partial or touch-down status using crutches. Early exercises focus on achieving full knee extension and gentle, passive range of motion, often limited to bending the knee no more than 90 degrees to protect the repair.
Exercises in this early period for both procedures aim to minimize arthrogenic muscle inhibition, which is the body’s reflex to shut down muscle function due to joint pain and swelling. Patients practice heel slides for gentle bending and straight leg raises to activate the quadriceps muscle. Performing these basic exercises without pain or excessive swelling is the first step toward advancing the program.
Milestones for Advancing Physical Therapy
Progression through rehabilitation is based on achieving specific functional and biological milestones rather than simply the passage of time. A significant early milestone is achieving full, pain-free knee extension, which is necessary for a normal gait pattern. Once swelling and pain are well-controlled, the patient can begin weaning off crutches and the restrictive brace.
The next step involves advancing range of motion. For repair patients, the goal is to safely increase flexion beyond the initial 90-degree limit, typically around six to eight weeks post-surgery. The introduction of closed-chain strengthening exercises, such as mini-squats and step-ups, marks a major step forward and is initiated once the patient can bear full weight without pain and has good quadriceps control.
Later milestones involve incorporating balance and proprioception training, which helps the knee joint sense its position in space. The final stage is the return to high-impact and sport-specific activities, cleared only after the patient demonstrates symmetrical strength and passes functional testing, such as hopping tests. For meniscectomy, this can occur as early as four to six weeks, but a full return to cutting and pivoting sports after a repair may take six to nine months.
Indicators of a Delayed Recovery Timeline
Several symptoms indicate that the planned recovery timeline may need to be slowed down or reassessed by the medical team. Persistent, sharp pain that does not improve with rest or prescribed medication signals that the knee is not tolerating the current level of activity. Excessive or unresolving swelling, known as effusion, can signal ongoing internal irritation or inflammation that needs to be addressed.
The failure to meet expected range of motion goals, particularly a stiff knee that struggles to straighten completely, is also a cause for concern. Any sudden mechanical symptoms, such as the knee locking, catching, or giving way, should be immediately reported to the surgeon. These symptoms may suggest a complication, such as a re-tear of the meniscus or a buildup of scar tissue, requiring a change in the rehabilitation plan.