Post-Operative Management of Anterior Horn Meniscal Repair

Introduction to Rehabilitation Protocols

The British Journal of Sports Medicine recommends implementing immediate structured rehabilitation with protected weight-bearing for 5 weeks, followed by progressive functional restoration over 9-12 months, as meniscal repair demonstrates superior long-term outcomes compared to meniscectomy 1, 2

The British Journal of Sports Medicine suggests progressing to full weight-bearing only after achieving specific criteria, which is critical for anterior horn repairs to allow adequate tissue healing before mechanical loading 3
Achieve full knee extension range of motion immediately, according to the British Journal of Sports Medicine 4
Progress knee flexion gradually, restricting to 90-45° during weeks 0-4, then advance to 90-30° by week 5, 90-20° by week 6, 90-10° by week 7, and full ROM by week 8, as recommended by the British Journal of Sports Medicine 3
Maintain no effusion or trace effusion only, as suggested by the British Journal of Sports Medicine 4
Begin quadriceps activation exercises immediately, but avoid adding extra weight for the first 12 weeks to prevent graft elongation, according to the British Journal of Sports Medicine 3

The British Journal of Sports Medicine recommends that patients demonstrate a limb symmetry index (LSI) >80% for quadriceps strength before advancing 4
Patients must also demonstrate LSI >80% eccentric impulse during countermovement jump, as suggested by the British Journal of Sports Medicine 4
Pain-free aqua jogging and Alter-G running are required, according to the British Journal of Sports Medicine 4
Pain-free repeated single-leg hopping is also necessary, as recommended by the British Journal of Sports Medicine 4
Initiate closed kinetic chain exercises with progressive resistance, as suggested by the British Journal of Sports Medicine 3
Add neuromuscular (motor control) training to strength training, which cannot replace each other and must be combined, according to the British Journal of Sports Medicine 4
Neuromuscular training optimizes self-reported outcomes and reduces risk of secondary injury, as recommended by the British Journal of Sports Medicine 3

Combine strength training with motor control exercises throughout this phase, as altered neuromuscular function after meniscal repair increases risk of subsequent injury, according to the British Journal of Sports Medicine 3
Address psychological factors including self-efficacy, locus of control, and fear of reinjury using objective instruments, as suggested by the British Journal of Sports Medicine 3
Progress to sport-specific training only after meeting objective criteria, as recommended by the British Journal of Sports Medicine 4

The British Journal of Sports Medicine recommends that patients achieve no pain or swelling before returning to sport 4
Full knee ROM with stable knee examination is required, according to the British Journal of Sports Medicine 4
Normalized subjective knee function (IKDC, ACL-RSI, Tampa Scale) is necessary, as suggested by the British Journal of Sports Medicine 4
Isokinetic quadriceps and hamstring peak torque showing 100% symmetry at 60°/s for pivoting sports is required, according to the British Journal of Sports Medicine 4
Countermovement jump and drop jump >90% symmetry is necessary, as recommended by the British Journal of Sports Medicine 4
Reactive strength index >1.3 for double leg and >0.5 for single leg (field sports) is required, according to the British Journal of Sports Medicine 4
Running mechanics with >90% symmetry of vertical ground reaction forces is necessary, as suggested by the British Journal of Sports Medicine 4

Progressing based on time alone rather than functional criteria leads to suboptimal outcomes, according to the British Journal of Sports Medicine 3
Neglecting neuromuscular training in favor of strength training alone increases reinjury risk, as recommended by the British Journal of Sports Medicine 3, 4
Clearing patients for return to sport before achieving 100% strength symmetry for pivoting sports is not recommended, according to the British Journal of Sports Medicine 4

If ACL reconstruction was performed concurrently, extend the total rehabilitation period to 9-12 months minimum before return to high-intensity sport, as suggested by the British Journal of Sports Medicine 3, 4