Meniscus Transplantation
The Stone Clinic Post-Operative Physical Therapy Protocol
General Considerations:
-Partial weight-bearing status for 4 weeks post-op. 10-20% toe-touch for
1-2 weeks, progress as tolerated.
-Most patients will be in a hinged rehab brace locked in full extension for
4 weeks post-op unless otherwise indicated.
-Regular assessment of gait to avoid compensatory patterns.
-Regular manual mobilizations to surgical wounds and associated soft tissue
to decrease the incidence of fibrosis.
-No resisted leg extension machines (isotonic or isokinetic).
-No high impact or cutting / twisting activities for at least 4 months post-op.
-M.D. follow-up visits at Day 1, Day 8-10, 1 month, 4 months, 6 months, and
1 year post-op.
-During the first 4 weeks: TWICE PER DAY: Without brace and seated with feet
off the ground, gently bend knee back as tolerated BUT NO MORE THAN 90 DEGREES
for a good knee stretch without increase in pain. Relax knee and stretch
for 60 seconds.
Week 1:
-M.D. visit day 1 post-op to change dressing and review home program.
-Icing and elevation regularly. Aim for 5x per day, 15-20 minutes each time.
For ice machine: use as directed.
-Exercises:
1) straight leg raise exercises (lying, seated, and standing): quadriceps/adduction/abduction/gluteal
sets;
2) twice daily passive and active range of motion exercises;
3) theraband calf presses;
4) well-leg stationary cycling;
5) upper body training; and
6) core/trunk training.
-Soft tissue treatments to musculature for edema and pain control.
-Manual daily patella glides up/down/side to side by therapist and patient. 
Weeks 2 - 4:
-M.D. visit at 8 - 10 days for suture removal and check-up.
-GENTLE and BRIEF pool / deep water workouts after the first 8-10 days and
with the use of a brace. No more than 30 minutes per workout; no more than
3 workouts per week.
-Continue with pain control, gentle range of motion, and soft tissue treatments.
Weeks 4 - 6:
-M.D. visit at 4 weeks post-op, will progress to full weight bearing and
discontinue use of rehab brace.
-Increase stretching and manual treatments to improve knee range of motion.
Extension should be full, and flexion should be near 100 degrees.
-Incorporate functional exercises (i.e. partial squats, calf raises, mini-step-ups,
light leg pressing, proprioception).
-Stationary bike and progressing to road cycling as tolerated.
-Slow walking on treadmill for gait training (preferably a low-impact treadmill).
-Gait training to normalize movement patterns.
Weeks 6 - 8:
-Increase the intensity of functional exercises (i.e. cautiously increase
depth of closed-chain exercises., Shuttle/leg press). Do not overload closed-
or open-chain exercises.
- Continue to emphasize normal gait patterns.
-Range of motion: extension full, and flexion to 120 degrees.
Weeks 8 - 12:
-Add lateral training exercises (side-step ups, Theraband resisted side-stepping,
lateral stepping).
-Introduce more progressive single leg exercise.
-Patients should be pursuing a home program with emphasis on sport/activity-specific
training.
-Range of motion should be near normal.
Weeks 12-16:
-Low-impact activities until 16 weeks.
-Increasing intensity of strength and functional training for gradual return
to activities.