Pathway after meniscal repair without ligament reconstruction, tailored to tear type.
At least 4 months for some vertical repairs; often 6-9 months for complex, radial or meniscal root repairs.
For physiotherapists: adapt exercises, dosage and progression to the injury or procedure, protection, permitted loading and movement; check clinical criteria, not elapsed time alone.
Scope and before starting
This pathway covers isolated meniscal repair, not meniscectomy or repair combined with ACL reconstruction. Tear type and stability affect early loading and flexion: operative instructions must state the limits. Feeling better does not cancel repair-protection time.
Written plan
Record tear type and location, stability and technique; specify permitted weight bearing, knee bending and straightening (range of motion, ROM), and brace use. Clarify missing limits before progressing.
Tear type
A stable vertical tear may allow early loading with limited movement; repair of a complete radial tear or the meniscal attachment (root) often needs about 6 weeks without weight bearing and protected flexion. Follow the individual plan.
Impact
For at least 4 months avoid deep loaded knee bends, jumps and knee rotation. This precaution comes from expert consensus; repair type and follow-up may require longer protection.
The repair still needs protection when pain improves. If permitted loading or movements are missing from your handout, ask for these to be completed before starting.
Crutches, brace and motion follow the tear type recorded at surgery.
Running and sport follow checks of motion, strength and knee response.
Treatment phases and illustrated exercises
Exercises are shown in their assigned starting phase, with their instructions and precautions. The physiotherapist selects them for the individual plan; the complete protocol is not a prescription to perform them all.
Respect the minimum times and protection required for the procedure. Time alone does not authorise progression: the treating team checks the clinical criteria.
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.
Goals
Reduction of effusion.
Recovery of extension.
Quadriceps activation.
Education on crutches, brace and the early post-operative restrictions (flexion and weight bearing).
Preparation plan
Pain and effusion control with ice, elevation and activity management.
Practical trial of the crutches and brace to be used after surgery.
Precautions
Locked knee: surgery must not be delayed to complete preparation.
Tear requiring early treatment to preserve meniscal reparability.
Criteria checked by the treating team
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 preparation is useful
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.
Home and school preparation
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.
Quadriceps isometric contraction (quad set)
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.
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.
Dose and progression: Indicative: 10 contractions of 5 seconds, 2-3 times a day. To be adapted with the physiotherapist.
Extension recovery with the heel supported
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.
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.
Dose and progression: Indicative: 3-5 minutes, several times a day if well tolerated.
Crutch and weight-bearing training
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.
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.
Dose and progression: At least one training session before admission; repeat until the technique is safe.
Phase 1 · Protection and instructions
Early weeks; restrictions may last about 6 weeks
Goals
Reduce effusion and preserve permitted extension.
Use prescribed aids and brace safely.
Physiotherapy plan
Quadriceps isometrics and motion within written range; straight-leg raise only if permitted and without lag.
Practise transfers and gait while respecting prescribed loading.
Precautions
No weight on the operated leg if non-weight bearing is prescribed; no unauthorised twisting or loaded flexion.
Criteria the treating team checks before progression
Decreasing pain and effusion.
Correct aid use and clarified next-step limits.
Illustrated exercise options
Quadriceps isometric contraction (quad set)
Only when the exercise is cleared in the indicated phase, within prescribed loading and motion.
Lie on your back with the leg supported and the knee within the authorised extension range.
Tighten the front of the thigh without lifting the leg or forcing the knee. Use a small support under the knee only if demonstrated by your physiotherapist.
Hold briefly and relax. Lifting the heel is neither a target nor proof of full extension.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Controlled straight-leg raise
When motion and muscle activation are permitted and you can keep the knee straight without it sagging; practise first with the physiotherapist.
Lie on your back, position the other leg within its permitted range and keep the exercising leg as instructed; if both sides are treated, respect each side’s limits.
Tighten the thigh and slightly lift the leg while keeping the knee straight; lower it slowly.
If the knee bends during the lift, return to a supported quadriceps contraction. No ankle weights; do not remove a brace without permission.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Phase 2 · Protected motion
During repair-protection period
Goals
Regain motion without stressing repair.
Maintain muscle activation.
Physiotherapy plan
Assisted motion only within permitted range.
Hip and trunk strength work compatible with loading; mini-squats only if cleared.
Precautions
No jumps, knee rotation or deep loaded bends for at least 4 months; also respect repair-specific loading and motion limits.
Criteria the treating team checks before progression
Controlled effusion and good quadriceps activation.
Explicit clearance for the next increase in ROM and loading.
Phase 3 · Gait and strength
After initial protection, often from month 2 to month 4
Goals
Walk without aids and regain strength.
Physiotherapy plan
Increase loading and correct gait as prescribed.
Dynamic strength with partial squats and steps within allowed motion and loading; single-leg balance after safe gait, cycling if cleared.
Precautions
Elapsed weeks alone do not permit running or jumping.
Criteria the treating team checks before progression
Restored motion and gait without reactive effusion.
Adequate strength and single-leg control, with impact clearance.
Illustrated exercise options
Double-leg bridge
When knee flexion, foot contact and pushing through both feet are allowed. This is not a non-weight-bearing exercise.
Lie on your back with knees bent within the permitted range and feet supported.
Slowly lift the pelvis using the buttock muscles, without arching the back or aiming for extra height.
Lower with control. No single-leg bridge, pelvic weights or forefoot-only support without further instruction.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Wall-supported mini-squat
Only after clearance for full weight bearing and strengthening; use the range selected by the physiotherapist.
With your back against the wall as shown, place the feet slightly forward and keep within prescribed loading.
Slide down a short distance within the range set by the physiotherapist, with knees pointing in the same direction as the feet.
Return slowly. Do not copy the illustrated depth if it exceeds your prescribed limit.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Firm-ground balance
After clearance for full weight bearing and single-leg support; practise first with the physiotherapist.
On firm ground with eyes open, slightly lift the other foot while keeping the pelvis level.
Keep one hand on a stable support as illustrated; an adult must be able to assist the child.
Put the free foot down before losing control. Do not add cushions, closed eyes or perturbations.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Easy stationary cycling
Only if the treating clinician permits cycling, pedal loading and the movement range. Cycling is not equivalent to complete offloading.
Use a stationary bike suited to your height; the physiotherapist adjusts the seat and supports for the permitted movement.
Pedal seated and slowly with minimal resistance; do not force a complete revolution if motion is still insufficient.
Do not stand on the pedals, sprint or increase duration and resistance together. Monitor pain, movement quality and swelling during the session and the next day. If they worsen, stop the activity that causes them and inform the team; absence of swelling alone does not authorise increasing the load.
Dose and progression: Use the sets, repetitions or duration, rests and frequency written in your individual handout. Stop before movement control deteriorates; do not choose the dose from the illustration.
Phase 4 · Impact and sport
After criteria; at least 4 months for some vertical repairs, often 6-9 for complex tears
Goals
Tolerate running, impact and progressive sport movement.
Physiotherapy plan
Before running: restored ROM and gait, no effusion or mechanical symptoms; measure quadriceps strength (dynamometry if available) and check a controlled step-down, considering both limbs. Then straight-line running, cleared jumps and finally guided cutting.
Complete individual then full training before competition.
Precautions
Reduce and reassess for persistent pain, locking or effusion.
Criteria the treating team checks at the end of the pathway
No mechanical symptoms or post-activity effusion.
Strength, function and full training assessed by team.
Illustrated exercise options
Straight-line walk–run progression
Only after running clearance under this protocol and assessment of motion, strength and control. Also respect the protection period for the injury or operation.
On level, even ground, alternate walking with short bouts of easy straight-line jogging according to the physiotherapist’s programme.
Keep an even gait without limping. Begin without sprinting, hills, jumping or direction changes.
Increase one demand at a time. If joint pain, limping or swelling occurs during the work or the next day, stop the progression and report it to the physiotherapist.
Dose and progression: Run/walk intervals, duration and recovery set by the physiotherapist for the procedure, age and response to loading; the phase does not provide an automatic dose.
Small two-foot forward hops
No earlier than 4 months after meniscal repair and only after review and jump clearance; complex repairs may need longer. First check on-the-spot landings with the physiotherapist, then this forward progression.
With the physiotherapist, make one small two-foot forward hop on a firm, even surface, as illustrated.
Land on both feet with control and pause before repeating. The physiotherapist selects distance and number of hops; no sideways or single-leg hops without further instruction.
Stop for pain or loss of control and report pain or swelling afterwards.
Dose and progression: Initial attempts and dose selected by the physiotherapist; increase only after checking the subsequent response.
Planned braking and direction changes
No twisting for at least 4 months after repair; complex repairs may need longer. After tolerating straight-line running and receiving specific clearance for braking and direction changes. First practise with the physiotherapist; this is not an initial running exercise.
With the physiotherapist, begin with controlled slowing and wide turns at low speed in agreed directions.
Control the trunk, knee and foot. Increase speed and turning angle separately; sharp, reactive or contact movements require further assessment.
Stop for pain, giving way or limping; also report swelling or pain after the session and the next day.
Dose and progression: Intervals, rests and recovery days selected for age, sport and previous level. No independent maximal tests; tolerate full training before competition.
Return to sport / full activity
Depends on repair: at least 4 months for some vertical repairs, often 6-9 months for radial, root or complex repairs; time alone is insufficient.
Restored motion without locking, persistent pain or effusion.
Adequate strength and dynamic control on patient-appropriate tasks.
Sport progression and full training tolerated.
Evidence is heterogeneous; no single hop test or score universally validates the repair. The surgeon confirms pattern-specific restrictions.
Warning signs: stop and contact the treating team
Fever or a red/draining wound: contact the team promptly.
Locking or new loss of extension: stop and seek reassessment.
Persistent joint-line pain or recurrent effusion: reduce loading and inform the clinician.
New calf pain with swelling: seek urgent medical assessment the same day.
Sudden breathing difficulty or chest pain: seek emergency medical help immediately.
Guidelines and literature
Sources inform the pathway; they do not validate every dose for an individual child.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
Select the exact phase assigned by the treating team, then choose each prescribed activity. No exercise is selected automatically. The team sets loading, movement, aids, dose and frequency; missing instructions must be completed before use, including by hand.
Browse illustrated exercise options
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.
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.
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.
Only when the exercise is cleared in the indicated phase, within prescribed loading and motion.
When motion and muscle activation are permitted and you can keep the knee straight without it sagging; practise first with the physiotherapist.
When knee flexion, foot contact and pushing through both feet are allowed. This is not a non-weight-bearing exercise.
Only after clearance for full weight bearing and strengthening; use the range selected by the physiotherapist.
After clearance for full weight bearing and single-leg support; practise first with the physiotherapist.
Only if the treating clinician permits cycling, pedal loading and the movement range. Cycling is not equivalent to complete offloading.
Only after running clearance under this protocol and assessment of motion, strength and control. Also respect the protection period for the injury or operation.
No earlier than 4 months after meniscal repair and only after review and jump clearance; complex repairs may need longer. First check on-the-spot landings with the physiotherapist, then this forward progression.
No twisting for at least 4 months after repair; complex repairs may need longer. After tolerating straight-line running and receiving specific clearance for braking and direction changes. First practise with the physiotherapist; this is not an initial running exercise.
Choose the current phase to prepare a printable sheet.
Phase safety summary ·
COMPLETE BEFORE EXERCISING — The treating team must complete the blank instructions, including handwritten entries, before this sheet is used.
Follow the assigned phase and instructions confirmed by the treating team; filling in fields does not authorise exercise.
No exercises assigned. This is a safety summary, not a complete exercise prescription.
Individual instructions for this phase
Loading (how much weight on the leg): ________________________________
Brace and crutches: ________________________________
Procedure and starting conditions
Written plan: Record tear type and location, stability and technique; specify permitted weight bearing, knee bending and straightening (range of motion, ROM), and brace use. Clarify missing limits before progressing.
Tear type: A stable vertical tear may allow early loading with limited movement; repair of a complete radial tear or the meniscal attachment (root) often needs about 6 weeks without weight bearing and protected flexion. Follow the individual plan.
Impact: For at least 4 months avoid deep loaded knee bends, jumps and knee rotation. This precaution comes from expert consensus; repair type and follow-up may require longer protection.
Advice before starting
The repair still needs protection when pain improves. If permitted loading or movements are missing from your handout, ask for these to be completed before starting.
Crutches, brace and motion follow the tear type recorded at surgery.
Running and sport follow checks of motion, strength and knee response.
Warning signs: stop and contact the treating team
Fever or a red/draining wound: contact the team promptly.
Locking or new loss of extension: stop and seek reassessment.
Persistent joint-line pain or recurrent effusion: reduce loading and inform the clinician.
New calf pain with swelling: seek urgent medical assessment the same day.
Sudden breathing difficulty or chest pain: seek emergency medical help immediately.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
A framework to personalise with the orthopaedic clinician and physiotherapist, not a replacement for an individual prescription. Respect protection and clinical criteria, not dates alone.
