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.