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
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.
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.
The 2024-2025 international consensus on meniscus rehabilitation recommends against a single protocol, modulating loading and ROM according to the PAASS framework: tear pattern, patient age, acuity, knee stability and tear size. Peripheral vertical longitudinal tears tolerate early loading; radial, complex or root tears require longer protection.
Reported failure rates range roughly between 15% and 25%, higher for complex and radial repairs: cautious progression in the first 8-12 weeks is part of the surgical result.
Key parameters
- 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.
Milestones at a glance
- 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
Phases of the pathway
Phase 1 — Protection and control
Weeks 0-2
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
Criteria to progress
- ☐Full passive extension
- ☐Controlled pain and decreasing effusion
- ☐Effective quad set without extension lag
Phase 2 — Full ROM and progressive loading
Weeks 2-6
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
Criteria to progress
- ☐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
Weeks 6-12
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
Criteria to progress
- ☐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
Months 3-6
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
Criteria to progress
- ☐Hop tests with LSI ≥90%
- ☐Quadriceps and hamstring strength LSI ≥90%
- ☐No mechanical symptoms
- ☐Sport-specific tests passed without compensation
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)
Guidelines and literature
- EU-US Meniscus Rehabilitation Consensus (ESSKA-AOSSM-AASPT), PAASS framework. IJSPT 2025.
- Barbier O et al. Rehabilitation and return to sports after isolated meniscal repairs: a new evidence-based protocol. J Exp Orthop 2022.
- Current rehabilitation principles following meniscus repair. Curr Rev Musculoskelet Med 2025.
- JOSPT Clinical Practice Guideline: Meniscal and Articular Cartilage Lesions.
Key exercises, step by step
Each exercise belongs to a specific phase: do not anticipate them. Dosage is indicative and must be adapted by your physiotherapist.
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 raise
From 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
3. Vastus medialis activation
Weeks 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.
- •Focus on the teardrop muscle above the inner side of the knee.
Dosage: 3 sets of 12, once or twice a day
4. Glute bridge
From 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
6. Single-leg balance
From 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 conditioning
All 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
8. Progressive plyometrics
Impact 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
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.
Isolated meniscal repair — Dott. Daniele Priano, Pediatric Orthopaedics · ortopediaevolutiva.com/en/rehabilitation/isolated-meniscal-repair · Information document: it does not replace an in-person assessment.
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Email: daniele.priano@ortopediaevolutiva.com