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

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