Isolated meniscal repair
Protocol modulated on tear pattern (PAASS framework): freer loading and ROM in peripheral longitudinal tears, more protected in radial, complex and root tears.
Return to sport: 4-6 months, criteria-driven
This protocol is part of the post-operative pathway and must be adapted to the surgeon’s instructions and to the individual clinical response.
These documents are protocol templates for information and education only: they do not replace the rehabilitation prescription for the individual case. Timing, loading and progressions must always be adapted to the patient, the lesion pattern, the surgical technique used and the clinical course, in collaboration between orthopaedic surgeon, physiotherapist and, where appropriate, physiatrist. Progression is driven by objective criteria, not by the calendar alone.
At a glance
- Loading — stable peripheral tears
- Early weight bearing as tolerated, essentially free ROM if pain-free.
- Loading — radial / root / complex tears
- Partial weight bearing 4-6 weeks, brace with 0-90° ROM for the first 2-4 weeks.
- Loaded deep flexion
- Avoided for 8-12 weeks in all patterns.
- Pivoting and rotation
- Avoided until around 3 months.
- Running
- From week 8-12 if there is no pain or effusion and quadriceps strength is ≥80%.
- Return to sport
- 4-6 months, based on criteria rather than the calendar alone.
- Weeks 0-2Flexion 0-90°, weight bearing as directed
- Weeks 4-6Full weight bearing, progressive flexion release
- Week 12Deep squatting allowed
- Months 4-5Running and progressive impact
- Months 5-6Return to sport with tests passed
Repairing rather than removing the meniscus protects cartilage in the long term, but requires respect for biological healing times: the repair is vulnerable above all to the combination of load, deep flexion and rotation.
Step by step
Each phase lists the goals, what to do and the exercises for that exact moment: do not anticipate them. Dosage is indicative and must be adapted by your physiotherapist.
Before surgery — Short preoperative preparation
Short, conditional phase: a few days or some weeks, depending on symptoms and surgical timing; often around 1-2 weeks for elective surgery. There is no mandatory minimum.
When it applies
- •Only for elective surgery, with an unlocked knee and controllable symptoms.
- •There is no strong specific evidence that a preoperative phase improves the outcome of meniscal repair: the aim is to reach surgery with a less irritable knee and a prepared patient.
Goals before surgery
- •Reduction of effusion.
- •Recovery of extension.
- •Quadriceps activation.
- •Education on crutches, brace and the early post-operative restrictions (flexion and weight bearing).
Activities
- •Pain and effusion control with ice, elevation and activity management.
- •Practical trial of the crutches and brace to be used after surgery.
Preoperative exercises
Quadriceps isometric contraction (quad set)
- •Lying down, knee straight in a neutral position on the surface; if proprioceptive feedback helps, place a small rolled towel under the knee.
- •Contract the quadriceps pushing the back of the knee toward the surface, hold, then release slowly.
- •Aim for a visible, global quadriceps contraction, without breath holding.
Dosage: Indicative: 10 contractions of 5 seconds, 2-3 times a day. To be adapted with the physiotherapist.
Extension recovery with the heel supported
- •Lying down, rest only the heel on a low support leaving the knee unsupported.
- •Let the knee drop under gravity with the thigh relaxed; a gentle quadriceps contraction can be added.
- •Do not force and do not push abruptly on the knee: extension returns with time and relaxation.
Dosage: Indicative: 3-5 minutes, several times a day if well tolerated.
Crutch and weight-bearing training
- •Try the crutches before surgery, with correct height and the weight-bearing status set by the surgeon.
- •Practise on level ground, stairs and the entrance to your home, with someone assisting.
- •Also practise sitting, standing and moving in the bathroom while respecting the planned loading restrictions.
Dosage: At least one training session before admission; repeat until the technique is safe.
Readiness criteria for surgery
- ☐Extension regained or clearly improving.
- ☐Effusion reduced compared with the acute phase.
- ☐Voluntary quadriceps contraction present.
- ☐Patient and family informed about the flexion and loading restrictions expected after repair.
When surgery must not be delayed
- •Locked knee: surgery must not be delayed to complete preparation.
- •Tear requiring early treatment to preserve meniscal reparability.
What to prepare at home and school
- •Organise movement at home: clear pathways, remove rugs, keep useful items within reach.
- •Prepare ice, a support for the heel, comfortable clothing and crutches already adjusted.
- •Inform school or the sports club: plan the absence, temporary exemption and gradual return.
- •Agree the first post-operative physiotherapy session in advance.
Indicative dosages, to be adapted by the physiotherapist. This phase neither replaces nor delays the surgical indication.
Phase 1 — Protection and control
Indicative timing: Weeks 0-2
The time window is indicative: progression depends on the criteria listed below, not on the calendar.
Goals
- •Pain and swelling control
- •Full extension
- •Early muscle activation
What to do
- •Cryotherapy, compression, elevation
- •Quadriceps isometrics, straight leg raise, patellar mobilisations
- •Weight bearing according to the tear pattern prescribed by the surgeon
- •Ankle mobility and hip work
Restrictions and precautions
- •No deep flexion, no loaded rotation
- •For radial or root repairs: respect brace and partial weight bearing
Exercises for this phase
1. Quadriceps isometric contraction (quad set)From day 1
- •Lie on your back with the leg straight and a rolled towel under the ankle.
- •Push the knee down by tightening the thigh, as if flattening the bed.
- •The heel lifts slightly: that means you are reaching full extension.
Dosage: 10 contractions of 5 seconds, 4-6 times a day
2. Straight-leg raiseFrom day 1-2
- •Lying on your back, first tighten the thigh until the knee locks straight.
- •Lift the straight leg about 30 cm, hold 3 seconds and lower slowly.
- •If the knee bends while lifting, the quadriceps is not ready yet: go back to quad sets.
Dosage: 3 sets of 10, twice a day
Ready for the next phase when
- ☐Full passive extension
- ☐Controlled pain and decreasing effusion
- ☐Effective quad set without extension lag
Phase 2 — Full ROM and progressive loading
Indicative timing: Weeks 2-6
The time window is indicative: progression depends on the criteria listed below, not on the calendar.
Goals
- •Full ROM (unloaded where weight bearing is still limited)
- •Normal gait without aids when allowed
- •Protected-range closed kinetic chain strengthening
What to do
- •Load progression as prescribed, gait re-education
- •Mini squat 0-60°, protected-range leg press, low step up
- •Low-resistance cycling, walking in water
- •Gluteal, core and posterior chain strengthening
Restrictions and precautions
- •No loaded squat beyond 90°
- •No pivoting, no twisting on a planted foot
Exercises for this phase
3. Global quadriceps recoveryWeeks 1-6
- •Sitting with a pillow under the slightly bent knee.
- •Extend the knee by pushing the heel forward, keeping the thigh on the pillow.
- •Aim for a full, even contraction of the whole thigh: isolating a single portion of the muscle is not useful.
Dosage: 3 sets of 12, once or twice a day
4. Glute bridgeFrom week 2
- •Lie on your back, knees bent, feet flat on the floor.
- •Lift the pelvis by squeezing the glutes until shoulders, hip and knee are aligned.
- •Lower slowly without arching the back.
Dosage: 3 sets of 12-15, on alternate days
5. Mini-squat 0-45°From the full weight-bearing phase
- •Standing, feet hip-width apart, weight evenly distributed.
- •Bend the knees to about 45°, keeping the knees aligned over the feet.
- •Rise by pushing through the heels, without letting the knee collapse inwards.
Dosage: 3 sets of 12, 3-4 times a week
Ready for the next phase when
- ☐Full ROM without joint-line pain
- ☐Symmetrical gait without aids
- ☐No effusion after sessions
Note for the physiotherapist
Use joint-line pain and the 24-hour effusion response as load regulators: they are more informative than a time-based protocol.
Phase 3 — Strengthening and return to running
Indicative timing: Weeks 6-12
The time window is indicative: progression depends on the criteria listed below, not on the calendar.
Goals
- •Quadriceps strength ≥80% of the contralateral side
- •Stable single-leg control
- •Return to straight-line running
What to do
- •Strength progression: squat, lunges through progressive range, step down, leg curl
- •Single-leg proprioception on unstable surfaces
- •Progressive straight-line running once criteria are met
Restrictions and precautions
- •Loaded deep flexion introduced gradually only after week 8-12
- •No change of direction
Exercises for this phase
6. Single-leg balanceFrom the full weight-bearing phase
- •Stand on one leg, knee slightly bent, looking ahead.
- •Progress: eyes open → eyes closed → soft surface → catching a ball.
- •The pelvis must stay level: if it drops on one side, the gluteus medius is weak.
Dosage: 3 x 30 seconds per side, daily
7. Low-impact conditioningAll intermediate phases
- •Stationary bike with high saddle and minimal resistance, swimming (avoiding breaststroke early), elliptical.
- •These maintain general fitness without compressing the repaired area.
- •The rule is always the same: no swelling the next day.
Dosage: 20-30 minutes, 3-5 times a week
Ready for the next phase when
- ☐No pain or effusion
- ☐Full ROM
- ☐Quadriceps strength LSI ≥80%
- ☐Controlled single leg squat without dynamic valgus
Phase 4 — Plyometrics, agility and return to sport
Indicative timing: Months 3-6
The time window is indicative: progression depends on the criteria listed below, not on the calendar.
Goals
- •Safe plyometrics and agility
- •Sport-specific skills
- •Full functional symmetry
What to do
- •Bilateral then single-leg plyometrics, progressive agility and cutting
- •Sport-specific training, then partial team training
- •Heavy strengthening and conditioning
Exercises for this phase
8. Progressive plyometricsImpact phase
- •Start with two-foot hops on the spot, landing softly with bent knees.
- •Progress to front-back and lateral hops, then single-leg.
- •Landings must be silent: noise means insufficient shock absorption.
Dosage: 2-3 sets of 10-20 contacts, 2-3 times a week
Ready for the next phase when
- ☐Plyometrics and cutting performed with controlled landings and no pain
- ☐No mechanical symptoms or effusion after the most demanding sessions
- ☐Sport-specific training tolerated progressively
- ☐The instrumented criteria for clearance are listed in the return-to-sport section
If symptoms appear after a progression
If persistent pain, effusion or swelling, or loss of movement appears after moving to a new phase or increasing load, temporarily reduce load and volume and have the situation reassessed by the surgeon or physiotherapist before progressing again. This document is informative for families and physiotherapists and does not replace individual clinical assessment.
Return to sport / full activity
4-6 months, depending on tear pattern and criteria achieved.
- ☐Hop tests with LSI ≥90%
- ☐Quadriceps and hamstring strength LSI ≥90%
- ☐No mechanical symptoms (locking, catching) and no joint-line pain
- ☐High IKDC score
- ☐Sport-specific functional tests passed without compensation
Red flags: stop and contact us
- •Joint-line pain that persists or recurs later after surgery
- •Joint locking or inability to fully extend
- •Recurrent effusion after loading: suspected repair failure
- •Painful catching or a feeling of instability
- •Fever, redness or discharge from the surgical wound
- •Calf pain with asymmetric swelling (suspected deep vein thrombosis)
Written and reviewed by Dott. Daniele Priano, Paediatric Orthopaedics. Last review: August 2026.
Timings are indicative: progression depends on clinical and functional criteria and on the surgeon’s indications.
Frequent questions
Why can I not fully bend the knee?
Beyond 90° of flexion the femoral condyle rolls back and compresses the posterior horn, where most sutures are placed. Limiting flexion early protects the sutures while the meniscus heals.
Is repair better than removing the torn part?
When the tear is repairable, repair is preferable: preserving the meniscus protects the cartilage and reduces the risk of early osteoarthritis, especially in young patients. The price is a longer, more restricted rehabilitation.
Is swelling in the evening normal?
Mild evening swelling in the first weeks is common. It becomes a warning sign when it increases day by day, appears after every session, or does not settle within 24-48 hours with ice and elevation: in that case the weekly load is excessive and should be reduced by one level.
Can I do physiotherapy only once a week?
The physiotherapy session is for setting up, correcting and progressing the programme. The result, however, depends on the exercises performed at home every day: a short daily home programme is worth more than an isolated weekly session.
In-depth content (full introduction, technique comparison, FAQ, references) at ortopediaevolutiva.com/en/rehabilitation/isolated-meniscal-repair
Isolated meniscal repair — Dott. Daniele Priano, Pediatric Orthopaedics · Information document: it does not replace an in-person assessment.
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Email: daniele.priano@ortopediaevolutiva.com