Phase I: Protection and Restricted Motion (0–6 Weeks)

Immobilisation:

• Hinged knee brace locked in extension for ambulation

• Range limited to 0–90°

• Touch weight bearing with crutches for 6 weeks

Precautions:

• Avoid knee flexion beyond 90°

• Avoid pivoting, twisting, or rotational loading

• Avoid deep squatting or lunging

• Avoid loaded knee flexion

• Avoid resisted hamstring activation

Therapy:

• Passive and assisted range of motion 0–90°

• Emphasis on full extension (heel props, prone hangs)

• Quadriceps activation (quads sets, straight leg raises)

• Patellar mobilisation

• Swelling management (ice, compression)

Criteria to Progress:

• Full knee extension

• Flexion to at least 90°

• Minimal effusion

• Straight leg raise without lag

Phase II: Progressive Motion and Protected Loading (6–12 Weeks)

Immobilisation:

• Discontinue brace when adequate quadriceps control is achieved

• Gradual progression to full weight bearing from 6 weeks

Precautions:

• Avoid deep flexion under load (>90° early)

• Avoid pivoting or twisting under load

• Avoid high-impact activity

• Avoid loading beyond body weight until approximately 12 weeks

Therapy:

• Gradual progression to full range of motion

• Closed chain strengthening in a controlled range

• Step-ups and sit-to-stand

• Stationary cycling

• Balance and proprioceptive training

Criteria to Progress:

• Full range of motion

• Minimal or no swelling

• Normal gait pattern

• Good neuromuscular control

Phase III: Advanced Strengthening (12–16 Weeks)

Precautions:

• Avoid high-impact pivoting activities

• Avoid deep loaded flexion if symptomatic

Therapy:

• Progressive strengthening including single-leg exercises

• Lunges and controlled squat progression

• Advanced proprioception and balance training

• Commence light jogging if appropriate

• Continue cardiovascular conditioning

Criteria to Progress:

• No pain or swelling with activity

• Symmetrical range of motion

• Strength at least 80–90% of contralateral limb

• Good single-leg control

Phase IV: Return to Function and Sport (4–6 Months)

Precautions:

• Ensure adequate strength and control prior to return to pivoting sport

Therapy:

• Running progression to sprinting

• Plyometric training and landing mechanics

• Agility and change-of-direction drills

• Sport-specific training

• Criteria for Return to Sport

• Full range of motion

• Strength at least 90–100% of contralateral limb

• Satisfactory functional testing

General Recommendations

Work:

• Desk-based work may resume after 2–4 weeks.

• Manual labour is typically deferred until 3–6 months depending on job demands and recovery progression.

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

• In general, for left knee surgeries in vehicles with automatic transmission, return to driving may be sooner.

Sports and Leisure:

• Low-impact activities may resume from 8-12 weeks.

• Running may commence at approximately 3–4 months if strength and control permit.

• Pivoting, jumping, and contact sports are typically delayed until 4–6 months or longer with surgeon clearance.

Thromboprophylaxis

Routine postoperative pharmacological thromboprophylaxis is not generally required following arthroscopic meniscal surgery. In selected cases – particularly where weight bearing is restricted (e.g. meniscal root repair) or patient-specific risk factors are present – A/Prof Ernstbrunner and his medical team may consider thromboprophylaxis based on individual risk assessment.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.