Although, I always make every effort to preserve meniscal (shock absorber) tissue, most times in a symptomatic tear meniscal (cartilage) tissue will be removed. The post-operative course has no restrictions with regard to progression of function as long as:

1) There is no other significant pathology in the knee.
2) You do not have pain during any therapeutic exercise or increased pain the next day. In those situations, you must inform the therapist so that the program can be modified.
3) There is no decrease of range of motion or increase swelling with your therapy program.

Until you have full range of motion (FROM) and no swelling do not think that more walking, standing or stair climbing will ultimately enhance the function of your knee. That is a myth. The above activities early on have a potential for overloading your knee and causing more pain and swelling.

For the first few weeks after surgery limit the above activities until you have achieved full range of motion and no swelling in the knee. Focus on your therapy program which initially will encourage range of motion and strengthening in a controlled, supervised manner. As you progress, I will encourage return to full activity as tolerated.

Stretching should be provided by one-on-one supervision in the therapy center and done on a daily basis at home. The therapist should instruct you on a home program before you attempt to perform these exercises at home.

Strengthening should only be performed in a very slow manner. Initially, one should start with a multi-angle isometric program (tightening the muscles) and progress to a PRE (progressive resistive exercise program i.e. lifting weights). When lifting weights, lift the weight over a 10 second time period and lower the weight over 5 seconds. If pain develops during any part of the range of motion, inform the therapist. The therapist will have 3 options.

1) To lower the weight and continue the exercise through a full range of motion.
2) To avoid the range of motion which is painful
3) To stop the exercise totally.

The exercises should initially be performed for one set and 12-15 repetitions. Patients may progress as tolerated. Ideally, one should perform one set of 6-8 repetitions. Upon the last repetition the patient will have total muscle fatigue but absolutely no pain in the joint i.e. in an open knee extension exercise the patient will attempt to raise his leg but it just won’t go. There is no pain but the muscle is totally fatigued. Exercises should be performed for all muscle groups of both lower extremities.

ADVERSE SIGNS AND SYMPTOMS

1. Increased knee pain >24 hours
2. Increased knee swelling that is not reduced with ice and elevation
3. Increased redness, localized skin temperature and/or drainage or bleeding from surgical site.

PHASE 1- ACUTE PHASE- LIMITED ROM AND SWELLING

WEIGHT BEARING	ROM	BRACE	EXERCISE
Progress weight bearing as tolerated	Obtain full ROM early	None	1. stretching 2.  multi-angle 3.  isometrics progress to pre’s 4.  patellar mobility

PHASE 2 - RETURN TO FULL FUNCTION

CRITERIA TO ENTER PHASE 2
1) FROM
2) No pain or effusion
3) Satisfactory clinical exam

EXERCISE
1) Continue all stretching and strenthening exercises
2) Increase functional aerobic activity level specific to the patient’s functional goals i.e. do not aggressively utilize the elliptical if the patient’s goals are to increase their everyday walking
3) Progress to sport-specific skill training as required
4) Avoid plyometrics that are not sport-specific