Meniscus Transplant / Large Meniscal Repair

Phase I – Maximum Protection (Weeks 0 to 4):

0 to 1 Week:

• Brace locked in full extension for 4 weeks
• Use crutches for PWB (50%) in brace for 4 weeks
• Ice and modalities to reduce inflammation and pain

Range of Motion

-0° of knee extension

-50° of knee flexion for weeks 0 to 3

-Advance as tolerated to 90° of knee flexion starting week 4

Exercises

-Patella mobility in all planes

-Passive/active knee range of motion with 50° flexion limit

-Quadriceps setting emphasize VMO function

-Multi-plane straight leg raising

-Gait training

Weeks 1 to 4:

• Continue with program as outlined in weeks 0 to 1

Range of Motion

-0° to 50° limitation for weeks 0 to 3; starting week 4 advance as tolerated to 90°

Exercises

-Initiate open kinetic chain multi-plane hip strengthening; progress to closed kinetic chain as swelling and pain permit

-Begin proprioceptive training, avoiding rotation

-Manual PNF hip and ankle strengthening

Phase II – Progressive Stretching and Early Strengthening (Weeks 4 to 6):

Weeks 4 to 6:

• Continue with modalities to control pain and inflammation
• Open brace 0° to 30° for 2 weeks and begin weight bearing as tolerated in brace, then open brace 0° to 90° for 2 weeks

Range of Motion

-Full knee extension/hyperextension

-Gradual progression to 90° flexion

Exercises

-Continue with phase I program

-Continue to emphasize patella mobility and quality VMO function

-Begin pool program working on ROM and light strengthening once incisions are healed

-Begin bilateral closed kinetic chain strengthening, gradually progressing to unilateral as swelling, pain, and neuromuscular function allow

-Begin stationary cycle- low resistance emphasizing endurance

-Gait training- normalize gait pattern

-Advance proprioception program

Phase III – Advanced Strengthening and Proprioceptive Phase (Weeks 6 to 10):

Weeks 6 to 8:

• Continue with exercises in phase I and II
• Wean out of brace over a 7 to 10 day period

Range of Motion

-Increase beyond 90° flexion, slowly advance as tolerated

Exercises

-Patellar mobility

-Terminal stretching in flexion and extension

-Begin stationary biking program

-Begin pool program with higher intensity strengthening

Weeks 8 to 10:

• Continue with program as outlined in weeks 6 to 8

Range of Motion

-Continue slow advance to full range of motion

Exercises

-Advance unilateral closed kinetic chain program

-Advance pool program

-Introduce treadmill walking and elliptical trainer

-Begin pool running program, no bounding or jumping

-Begin multi-directional functional cord program avoiding rotation (carioca)

-Increase intensity on stationary bike, elliptical trainer, and treadmill walking program, may begin interval programs

-Begin gym strengthening; squats, leg press, partial walk lunge, hamstring curls, ab/adduction, calf raises, and leg extensions (30° to 0° gradually increasing to full range of motion as patello-femoral arthrokinematics normalize

Phase IV – Advanced Strengthening and Plyometric Drills (Weeks 10 to 14):

Weeks 10 to 14:

• Continue to advance overall strength and conditioning program, emphasize unilateral work with gym program
• Begin straight plane running; emphasize distance and endurance
• Begin bilateral plyometrics

Phase V – Return to Sport Phase (Weeks 14 to 16):

Weeks 14 to 16:

• Begin sprinting program
• Begin multi-directional drills
• Advance plyometric drills from bilateral to unilateral
• Follow-up examination with the physician
• Sports test for return to play