Meniscus and Cartilage Rehabilitation Protocol

The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assisted/mini-open rotator cuff repair. It is by no means intended to be a substitute for one’s clinical decision-making regarding the progression of a patient’s postoperative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with Dr. Roe.

Progression to the next phase based on clinical criteria and/or time frames as appropriate.

Phase I – Acute Ambulation: 

Goals: 

  • Full knee extension and quadriceps activation.
  • Patellar and fat pad mobility.
  • Restore balance and gait/walking.

Criteria for Phase Progression: 

  • Pain < 5/10 at worst and IKDC score > 30.
  • 0 knee extension or symmetry.
  • 110 of knee flexion.
  • Adequate single-leg balance (firm ground).
  • Good quad activation and endurance with straight leg raise test.

Phase II – Functional Symmetry: 

Goals: 

  • Progress Strength and symmetry with functional movements.
  • Normalize balance and proprioception.

Criteria for Phase Progression: 

  • Pain < 4/10 at worst and IKDC score > 40.
  • Near normal knee extension, at least to 0.
  • Adequate knee flexion per procedure appendix.
  • Symmetrical double leg squat.
  • Adequate single-leg balance (unstable platform).

Phase III – Strength: 

Goals: 

  • Emphasize single-leg squat mechanics and balance.
  • Promote strength on the involved lower extremity.
  • Improve strength of compound movements.

Criteria for Phase Progression:

  • Pain < 3 and IKDC > 60.
  • Maintain knee extension to at least 0.
  • Increase quad/hamstring strength - isometric strength > 60% symmetry.
  • Good single leg balance and control by single-leg squat < 4 cm diff.
  • Restore single leg muscle endurance by Vail single-leg squat test > one minute.

Jogging Program: 

1.    Full knee extension and no pain > 3/10
2.    > 1 min of single-leg squats

    Walk Time Jog Time Total Time
Phase 1 (3 days) 1 min 2 min 12 min
Phase 2 (3 days) 1 min 4 min 15 min
Phase 3 (3 days) 1 min 6 min  21 min
Phase 4 (3 days) 1 min 8 min 24 min
Phase 5 (3 days) 1 min 10 min 20+ min
Phase 6   progress as tolerated without walking breaks

Phase IV – Power and Agility: 

Goals: 

  • Continue gaining strength.
  • Introduce plyometric and agility movements.

Criteria for Phase Progression: 

  • Full ROM passive and active.
  • Symmetric knee strength by HS/Quad ratio > 55% and 85% symmetry.
  • Neuromuscular control with jumping by Landing Error Scoring System (LESS).
  • Demonstrate single-leg power by Single Leg Hop for Distance > 80% symmetry.

Phase V – Return to Sport: 

Goals: 

  • Introduce sport-specific stimuli and unpredictable movements.
  • Facilitate graded return to full competition.

Criteria for Phase Progression: 

  • Restore confidence and reduce fear of movement by ACL-RSI.
  • Full knee ROM passive and active.
  • Symmetric knee strength by HS/Quad ratio > 55% and 90% symmetry.
  • Neuromuscular control with jumping by Landing Error Scoring System (LESS).
  • Symmetry on Hot Tests by Single Leg Hop for Distance > 80% symmetry.
  • Symmetrical agility by figure of 8 Test, 5-10-5 Test > 95% symmetry.
  • Complete injury prevention program with Sports Metrics.

Meniscus/Cartilage Protocol

Range of Motion, Weightbearing and Functional Restrictions

Passive ROM Limitations for Meniscus and Chondral Procedures
MENSCAL/CHONDRAL PROCEDURE PROM LIMITS (EXTENSION - FLEXION)*
TIMEFRAME GOAL(S)
Body Repair (Small) Weeks 0-2 Allow 0-90
After Week 2 Allow Full ROM
Body Repair (Large) Weeks 0-2 Allow 0-90
After Week 2 Allow Full ROM
Root Repair Weeks 0-2 Allow 0-60
Weeks 2-4 Allow 0-120
After Week 6 Allow Full ROM
Meniscus Transplant Weeks 0-2 Allow 0-60
Weeks 2-4 Allow 0-120
After Week 6 Allow Full ROM
Trochlear MicroFx Allow Full ROM Immediately
Chondral MicroFx/Carticel/OATS Weeks 0-2 Allow 0-60
Weeks 2-4 Allow 0-120
After Week 6 Allow Full ROM
*All Motion and Timelines are for Non-Weight Bearing Activities
Weight Bearing and ROM Limitations for Meniscus and Chondral Procedures
MENSCAL/CHONDRAL PROCEDURE PROM LIMITS (EXTENSION - FLEXION)*
TIMEFRAME GOAL(S)
Body Repair (Small) Allow Immediate FWB* in Extension
Allow Loaded Flexion > 90 at 4 Weeks
Body Repair (Large) Allow Immediate FWB* in Extension
Allow Loaded Flexion > 90 at 6 Weeks
Root Repair Weeks 0-4 TTWB
Allow Immediate FWB in Extension at 4 Weeks
Allow Loaded Flexion > 90 at 8 Weeks
Meniscus Transplant Weeks 0-4 TTWB
Allow Immediate FWB in Extension at 6 Weeks
Allow Loaded Flexion > 90 at 10 Weeks
Trochlear MicroFx Allow Immediate FWB*in Extension
Allow Loaded Flexion > 90 at 4 Weeks
Chondral MicroFx/Carticel/OATS

Weeks 0-4 TTWB
Allow FWB in Extension at 4 Weeks
Allow WB in Flexion > 90 at 8 Weeks

*FWB - Full Weight Bearing
*TTWB - Toe-touch Weight Bearing
Functional Progression of Meniscus and Chondral Procedures
MENSCAL/CHONDRAL PROCEDURE MINIMAL TIMELINE FOR PROGRESSION
FULL AMBULATION WITHOUT ASSISTIVE DEVICE
Body Repair (Small) 2 Weeks
Body Repair (Large) 4 Weeks
Root Repair 6 Weeks
Meniscus Transplant 6 Weeks
Trochlear MicroFx

2 Weeks

Chondral MicroFx / Carticel / OATS 6 Weeks
INITIATE JOGGING
Body Repair (Small) 3 Months
Body Repair (Large) 4 Months
Root Repair 4 Months
Meniscus Transplant

4 Months

Trochlear MicroFx 3 Months
Chondral MicroFx / Carticel / OATS 5 Months
INITIATE AGILITY
Body Repair (Small) 4 Months
Body Repair (Large) 5 Months
Root Repair

5 Months

Meniscus Transplant 6 Months
Trochlear MicroFx 4 Months
Condral MicroFx / Carticel / OATS 6 Months
FULL RETURN TO SPORT
Body Repair (Small) 6 Months
Body Repair (Large)

7 Months

Root Repair 8 Months
Meniscus Transplant

9 Months

Trochlear MicroFx 6 Months
Condral MicroFx / Carticel / OATS 9 Months