| Time required for rehabilitation and return to sport varies with severity and location of meniscus injury. Duration ranges from approximately 2 to 12 weeks. |
| Goals | Protection | Exercises | Sets and repetitions | Frequency | Criteria for progression |
| Acute phase (0 to 2 weeks)¶ |
- Reduce pain.
- Improve hip and knee mobility as necessary (minimize loss of knee flexion and knee extension).
- Prevent muscle atrophy, especially quadriceps.
| - Avoid positions and activities that place excessive pressure on knee until pain and swelling resolve. Problematic positions include squatting, pivoting, repetitive bending (eg, climbing stairs, rising from seated position, operating clutch and pedals), jogging, and swimming using the frog or whip kick.
- Modify weightbearing:
- If pain is severe, patient remains non-weightbearing and uses crutches.
- Partial weightbearing if pain greater than 5/10 or significant swelling.
- Increase weightbearing as pain and swelling decrease. May bear full weight once weightbearing is pain free.
- During acute phase, perform an exercise only if pain level is 2/10 or less.
| - After exercise, apply ice with compressive wrap to knee.
| Apply for 20 minutes or longer. | | - Performs ADLs and walks 150 m (500 feet) without crutches and with knee pain no more than 0 to 1/10.
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| Perform exercises on injured and non-injured leg. |
- Perform gradual knee flexion and extension (in pool if possible).
- If pool unavailable, may use stationary bicycle with zero resistance and maximal knee motion of 45 degrees flexion and near-full extension.
| | 1 to 2 times per day. |
- Straight leg raises.
| 3 sets × 10 reps; 10-second hold per rep at 7/10Δ effort; 2-minute rest between sets. | 1 to 2 times per day. |
- Isometric quadriceps contractions with 30 to 60 degrees knee flexion (use pillow under knee).
| 3 sets × 5 reps; 45- to 60-second hold per rep at 7/10Δ effort; 2-minute rest between sets. | 1 to 2 times per day. |
- If too painful to hold contraction with knee fully extended, perform following 2 exercises:
- Quadricep isometric contraction with approximately 30 to 60 degrees knee flexion (use pillow under knee).
- Hamstring isometric contraction; lie prone with approximately 30 to 60 degrees knee flexion.
| For each exercise, 3 sets × 5 reps; 45- to 60-second hold per rep at 7/10Δ effort; 2-minute rest between sets. | |
- May use upper-extremity ergometer or swim to maintain fitness.
- If swimming, only flutter kick (knee flexion-extension) permitted; breast stroke-style kicks prohibited.
- May use upper-body resistance machines.
- Avoid any exercise or movement that causes knee pain.
| Duration of cardiovascular conditioning depends upon baseline fitness. Can begin with 10 to 15 minutes and increase by 3 to 5 minutes daily with goal of 30 to 45 minutes. | May perform conditioning work daily. Upper-body strength workouts should not be performed on consecutive days. |
| Subacute phase (1 to 4 weeks total)¶ – Early stage |
- Increase pain-free knee flexion to 90 degrees.
- Increase strength.
- Improve cardiovascular fitness.
| - Gradually increase knee flexion during exercises to 90 degrees.
| Perform exercises 1 through 4 with injured leg only for grade 1 injury; perform bilaterally for grade 2 injury.◊ | - Walks 300 m (1000 feet) with pain no greater than 1/10.
- Achieves knee flexion beyond 90 degrees without pain.
|
- Seated heel slides from knee extended to knee flexed (may use isokinetic variation of this exercise if available).
| 2 sets × 10 reps; knee flexion should not exceed 90 degrees. | Early subacute phase exercises are performed 1 to 2 times per day; 2 times preferred. |
- Short-arc quadriceps extension (may use isokinetic variations of this exercise if available).
| 3 sets × 10 reps; knee flexion should not exceed 45 degrees. |
- Side-lying hip abduction.
| 3 sets × 10 reps; no added resistance. |
- Clam shell.
|
- Continue range-of-motion exercises:
- Hamstring stretch.
- Knee flexion stretch.
- May continue upper-extremity ergometer or swimming for conditioning.
| 2 sets: gentle hold for 45 seconds per set for each stretch. |
- Begin stationary bicycle ergometer; begin with seat high to prevent excessive knee flexion; gradually lower seat until knee reaches 90 degrees of flexion; pedal resistance should be minimal; pain should not exceed 2/10.
| Start with 10 to 15 minutes of cycling; increase by 3 to 5 minutes per day with a goal of 30 minutes. |
| Subacute phase – Progressive stage |
- Increase pain-free knee flexion to 90 degrees.
- Increase strength.
- Improve cardiovascular fitness.
| - Gradually increase knee flexion during exercises to 90 degrees.
| - Quarter squats (knee flexion ≤45 degrees); dumbbell or goblet squats may be used.
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ | Progressive subacute phase exercises are performed once per day. | - Able to perform all exercises with pain no greater than 3/10.
|
- Knee extension on weight machine; knee moves from 90 degrees flexion to full extension.
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ |
- Hamstring (knee flexion) weight machine; knee moves from full extension to 90 degrees flexion.
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ |
- Standing exercises with resistance bands:
| 3 sets × 10 reps for each exercise. Perform with injured leg only for grade 1 injury; perform bilaterally for grade 2 injury.◊ |
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- Hip extension to 45 degrees.
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| Functional phase |
- Improve knee strength.
- Improve balance.
- Improve cardiovascular fitness.
| | - Core stability and balance exercises:
| Functional phase exercises are performed once per day. | - Able to perform all exercises with pain no greater than 3/10 and no knee effusion.
|
| | Hold position for 30 seconds × 3 sets; build to 60-second hold. |
| | Hold position for about 5 seconds per repetition; perform 3 sets × 10 reps per side. |
- Single-leg standing balance.
| Start by performing it in shoes, then without shoes, and finally with a towel roll underfoot. |
| | 3 sets × 10 repetitions holding the lift (or bridge) for 5 seconds before returning to the starting position. |
- Single-leg half-squats on affected leg.
| 3 sets × 5 reps. |
- Side step-ups on affected leg.
| 3 sets × 5 reps; use approximately 10 cm step. |
- Two-leg squats (keep knee flexion ≤75 degrees).
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ |
- Walking lunge.
| 3 sets × 10 reps/leg; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ |
- Stair walk.
| Begin by walking up and down 5 stairs. Increase the number of steps by 2 each day, provided pain is no greater than 3/10. Goal is 20 stairs. Complete 1 set daily. |
- Continue mobility, conditioning, and upper-body strength exercises.
| Reasonable conditioning goal is 30 to 60 minutes on stationary bicycle using light resistance. |
| Sport-specific phase |
- Prepare for return to full sport.
| - Completes all exercises with pain no greater than 3/10.
- Report any significant mechanical or other symptoms (eg, knee locking, joint effusion) to clinician.
| Exercises vary by type of sport. | - Approximately equal strength of hamstring and quadriceps in each lower extremity.
- Approximately symmetric strength of lower extremities.
- Able to perform full-speed, sport-specific movements without difficulty or pain.
- Able to complete dynamic exercise program or sport-specific equivalent.
- Sample dynamic exercise program:
- Jog 1 km.
- 5 × 50-m sprint at half speed.
- 5 × 50-m sprint at three-quarter speed.
- 5 × 50-m sprint at full speed.
- 5 × 25-m direction-change (cutting or "zig-zag") sprints at half speed.
- 5 × 25-m direction-change sprints at full speed.
- Agility drills.
- Passes hop test.
- Perform a single hop for maximal distance on one leg, landing on same leg. Measure distance from starting line to the point where heel landed.
- Perform 2 practice hops and 2 recorded hops. Test both involved and uninvolved legs.
- Distance hopped on affected leg should be within 90% of that of unaffected leg.
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- Generally includes ballistic movements (eg, skipping, jumping) and sport-specific movements (eg, cutting); gradually increase movement intensity.
| | Sport-specific training is performed once per day. |
- Squat (progress to 90 degrees knee flexion).
| 3 sets × 10 reps; weight should be increased gradually as soon as all repetitions can be completed without difficulty or pain greater than 3/10.Δ | 2 to 3 times per week on nonconsecutive days. |
