Meniscal Root Repair PT Protocol

Protect the repair — therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 6 sections

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If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

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Overview

Meniscal root attachments are critical to knee function; untreated root tears lead to rapid cartilage degeneration, so it is crucial to protect the knee after a root repair. Both young athletes and middle-aged patients with mild degenerative change require 6 weeks of non-weight bearing and slow progression. The hamstrings attach to the posterior horn of the meniscus, so no active hamstring activity (e.g., standing knee flexion) for at least 6 weeks.

Phase 1 · Weeks 0–6 (Strict Protection)

  • Weight bearing: strict non-weight bearing for 6 weeks.
  • Hinged knee brace for 6 weeks — locked in full extension for ambulation and sleeping (remove for hygiene and PT); may unlock 0–30° while awake. Protects against active hamstring contraction.
  • ROM: AAROM → AROM for extension, PROM for flexion. Weeks 0–4: no flexion past 90°. Weeks 4–6: progress past 90° as tolerated.
  • Exercises (formal PT at 2–3 weeks): quad sets, passive heel slides, 4-way SLR in brace, co-contractions, isometric abduction/adduction, patellar mobilizations, prone/supine hangs for full extension. At 4 weeks: protected supine wall slides (flexion <90°).

Phase 2 · Weeks 7–11 (Progressive Loading)

  • Avoid squatting or flexion past 90° in a deep weight-bearing position.
  • Weight bearing as tolerated; wean off crutches at 6–8 weeks once gait is normal. Brace optional once full extension with no extension lag (still useful to limit deep squatting in less compliant patients).
  • Full active ROM. Closed-chain: lunges 0–60°, leg press 0–90°, Total Gym 0–90°; proprioception (weight shifting, balance, plyoball toss).
  • Stationary bike (high seat, low resistance) once flexion ≥110°. Begin light hamstring work at 8 weeks (bodyweight stiff-leg deadlift). Non-impact endurance at 8 weeks (elliptical, Nordic track, deep-water running). Swimming OK — no frog kick.

Phase 3 · Weeks 12–16 (Individualized)

  • More individualized from here. Some evidence supports permanent squatting restrictions, especially in older patients with less robust tissue. Even in young athletes, avoid loaded squatting and sprinting for at least 4 months.
  • Full weight bearing with normal gait and quad tone; full painless ROM; avoid posterior knee pain at end-range flexion.
  • Progress quad/hamstring and single-leg strength (4-way band, steamboats, balance board); low-amplitude agility (side shuffle, skipping, carioca); plyometrics and sport-specific drills. Light jogging in athletes — no sprinting.

Phase 4 · Months 4–6 (Return to Activity)

  • Gradual return to full activity while monitoring for pain, swelling, or post-activity soreness.
  • Recommend a return-to-sport test (e.g., hop test) before resuming sport; consider an unloader brace in select cases.
  • Maintenance strength/endurance, agility-ladder drills, landing mechanics, cutting/pivoting, and core stabilization.

References

  • The Formal EU-US Meniscus Rehabilitation 2024 Consensus (ESSKA–AOSSM–AASPT), Part I. JOSPT Open, 2025.
  • Postoperative Weight-Bearing and Range-of-Motion Protocols After Meniscal Root Repair: A Systematic Review. PMC, 2024.
Questions about this sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.