Development and preliminary validation of a new protocol for postoperative rehabilitation of partial meniscectomy

Alhadi Jahan, Margarita Dmitrievna, Miya Ismayilova


Background: Meniscal injuries are common among athletic populations and are one of the most common indications of knee joint surgeries. Meniscectomies are a common practice among orthopaedic surgeons in meniscal injury surgical treatment. Currently, no consensus exists for a standardized postoperative rehabilitation protocol after partial meniscectomy. Purpose: This article describes the development and validation of a new rehabilitation protocol for the management of meniscus injury after partial meniscectomy. Methods: A rehabilitation protocol for the postoperative meniscectomy was developed based on literature reviews. Evaluation from clinical experts were done by a 2-hour discussion with a group of seven clinicians to validate the protocol. Finally, an experimental design was used to test the effectiveness of the proposed protocol on a sample of 38 patients who had partial meniscectomies. Results: The final protocol included easy step-by-step directions for physiotherapists. The experts’ validation process resulted in modifications related to clarity, feasibility, technical descriptions, and usability. Our experimental study showed significant improvement of knee joint functions compared to a conventional physiotherapy group. Conclusions: Our final protocol includes detailed instructions which a physiotherapist should be able to follow up rehabilitate patients who have undergone partial meniscectomy from the third day post-surgery until 8 weeks post-surgery. The protocol is clear, easy to follow, and applicable in rehabilitation settings.


Meniscectomy, Rehabilitation, Knee joint, Athletes, Meniscus injury, Protocol


Ageberg, E., Thomeé, R., Neeter, C., Silbernagel, K. G., & Roos, E. M. (2008). Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: A two to five-year followup. Arthritis Care & Research, 59(12), 1773–1779.

Akatsu, Y., Yamaguchi, S., Mukoyama, S., Morikawa, T., Yamaguchi, T., Tsuchiya, K., … Sasho, T. (2015). Accuracy of high-resolution ultrasound in the detection of meniscal tears and determination of the visible area of menisci. The Journal of Bone and Joint Surgery. American Volume, 97(10), 799–806.

Albright, J., Allman, R., Bonfiglio, R. P., Conill, A., Dobkin, B., Guccione, A. A., … McGowan, J. (2001). Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions: Overview and Methodology. Physical Therapy, 81(10), 1629–1640.

American College of Sports Medicine. (2009). American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Medicine and Science in Sports and Exercise, 41(3), 687–708.

Astur, D. C., Xerez, M., Rozas, J., Debieux, P. V., Franciozi, C. E., & Cohen, M. (2016). Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma. Revista Brasileira de Ortopedia (English Edition), 51(6), 652–656.

Brindle, T., Nyland, J., & Johnson, D. L. (2001). The Meniscus: Review of Basic Principles With Application to Surgery and Rehabilitation. Journal of Athletic Training, 36(2), 160–169.

Brosseau, L., Tousignant, M., Budd, J., Chartier, N., Duciaume, L., Plamondon, S., … Balmer, S. (1997). Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects. Physiotherapy Research International, 2(3), 150–166.

Bruns, J., Volkmer, M., & Luessenhop, S. (1993). Pressure distribution at the knee joint. Archives of Orthopaedic and Trauma Surgery, 113(1), 12–19.

Cavanaugh, John T., & Killian, S. E. (2012). Rehabilitation following meniscal repair. Current Reviews in Musculoskeletal Medicine, 5(1), 46–58.

Cavanaugh, J.T. (1991). Rehabilitation following meniscal surgery. In R. P. Engle (Ed.), Knee Ligament Rehabilitation (pp. 59–69). New York, USA: Churchill Livingston.

Cullen, K. A., Hall, M. J., & Golosinskiy, A. (2009). National health statistics reports: Ambulatory surguery in the united states (No. 11) (p. 28). U.S.A.: U.S. Department of health and human services.

Cuthbert, S. C., & Goodheart, G. J. (2007). On the reliability and validity of manual muscle testing: a literature review. Chiropractic & Osteopathy, 15, 4.

Czamara, A., Tomaszewski, W., Bober, T., & Lubarski, B. (2011). The effect of physiotherapy on knee joint extensor and flexor muscle strength after anterior cruciate ligament reconstruction using hamstring tendon. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 17(1), CR33-CR41.

DeHaven, K. E., Cosgarea, A. J., & Sebastianelli, W. J. (2003). Arthrofibrosis of the knee following ligament surgery. Instructional Course Lectures, 52, 369–381.

Doerti, M. (1993). Clinical diagnosis of joint diseases. Minsk: Tivali.

Durand, A., Richards, C. L., Malouin, F., & Bravo, G. (1993). Motor recovery after arthroscopic partial meniscectomy. Analyses of gait and the ascent and descent of stairs. The Journal of Bone and Joint Surgery. American Volume, 75(2), 202–214.

Englund, M., Guermazi, A., & Lohmander, S. L. (2009). The role of the meniscus in knee osteoarthritis: a cause or consequence? Radiologic Clinics of North America, 47(4), 703–712.

Farooq, M. N., Bandpei, M. A. M., Ali, M., & Khan, G. A. (2016). Reliability of the universal goniometer for assessing active cervical range of motion in asymptomatic healthy persons. Pakistan Journal of Medical Sciences, 32(2), 457–461.

Fisher, A. C. (1990). Adherence to sports injury rehabilitation programmes. Sports Medicine (Auckland, N.Z.), 9(3), 151–158.

Fox, A. J. S., Bedi, A., & Rodeo, S. A. (2012). The Basic Science of Human Knee Menisci. Sports Health, 4(4), 340–351.

Frizziero, A., Ferrari, R., Giannotti, E., Ferroni, C., Poli, P., & Masiero, S. (2013). The meniscus tear: state of the art of rehabilitation protocols related to surgical procedures. Muscles, Ligaments and Tendons Journal, 2(4), 295–301.

Gajdosik, R. L., & Bohannon, R. W. (1987). Clinical measurement of range of motion. Review of goniometry emphasizing reliability and validity. Physical Therapy, 67(12), 1867–1872.

Glatthorn, J. F., Berendts, A. M., Bizzini, M., Munzinger, U., & Maffiuletti, N. A. (2010). Neuromuscular Function after Arthroscopic Partial Meniscectomy. Clinical Orthopaedics and Related Research, 468(5), 1336–1343.

Gogia, P. P., Braatz, J. H., Rose, S. J., & Norton, B. J. (1987). Reliability and Validity of Goniometric Measurements at the Knee. Physical Therapy, 67(2), 192–195.

Goodwin, P. C., Morrissey, M. C., Omar, R. Z., Brown, M., Southall, K., & McAuliffe, T. B. (2003). Effectiveness of supervised physical therapy in the early period after arthroscopic partial meniscectomy. Physical Therapy, 83(6), 520–535.

Goodwin, Peter C., & Morrissey, M. C. (2003). Physical therapy after arthroscopic partial meniscectomy: is it effective? Exercise and Sport Sciences Reviews, 31(2), 85–90.

Grelsamer, R. P. (2000). Patellar malalignment. The Journal of Bone and Joint Surgery. American Volume, 82–A(11), 1639–1650.

Hendrickson, T. (2002). Massage for Orthopedic Conditions (1 edition). Philadelphia, Pa: Wolters Kluwer.

Hendrickson, T. (2009). Massage and Manual Therapy for Orthopedic Conditions (2 edition). Philadelphia: Wolters Kluwer.

Holla, J. F. M., Steultjens, M. P. M., van der Leeden, M., Roorda, L. D., Bierma-Zeinstra, S. M. A., den Broeder, A. A., & Dekker, J. (2011). Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the CHECK cohort. Osteoarthritis and Cartilage, 19(4), 411–419.

Howick, J., Chalmers, I., Glasziou, P., Greenhalgh, T., Heneghan, C., Liberati, A., … Hodgkinson, M. (2011). OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence. Retrieved December 24, 2017, from

Kearney, G., Cioppa-Mosca, J., Peterson, M. G. E., & MacKenzie, C. R. (2007). Physical Therapy and Complementary and Alternative Medicine: An Educational Tool for Enhancing Integration. HSS Journal, 3(2), 198–201.

Kelln, B., Ingersoll, C., Saliba, S., Miller, M., & Hertel, J. (2009). Effect of early active range of motion rehabilitation on outcome measures after partial meniscectomy. Knee Surgery, Sports Traumatology, Arthroscopy, 17(6), 607–616.

Kurosawa, H., Fukubayashi, T., & Nakajima, H. (1980). Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clinical Orthopaedics and Related Research, (149), 283–290.

Labs, K.-H., Tschoepl, M., Gamba, G., Aschwanden, M., & Jaeger, K. A. (2000). The reliability of leg circumference assessment: a comparison of spring tape measurements and optoelectronic volumetry. Vascular Medicine, 5(2), 69–74.

Levy, A. R., Polman, R. C. J., Clough, P. J., & McNaughton, L. R. (2006). Adherence to Sport Injury Rehabilitation Programmes: A Conceptual Review. Research in Sports Medicine, 14(2), 149–162.

Levy, I. M., Torzilli, P. A., & Warren, R. F. (1982). The effect of medial meniscectomy on anterior-posterior motion of the knee. The Journal of Bone and Joint Surgery. American Volume, 64(6), 883–888.

Logerstedt, D. S., Snyder-Mackler, L., Ritter, R. C., & Axe, M. J. (2010). Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions. The Journal of Orthopaedic and Sports Physical Therapy, 40(6), A1–A35.

Ludwig, F. R. L. (2000). Clinical Massage Therapy: Understanding Assessing and Treating Over 70 Conditions. Toronto: Talus Incorporated.

Magyar, O. M., Illyés, A., Knoll, Z., & Kiss, R. M. (2008). Effect of medial meniscectomy on gait parameters. Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA, 16(4), 427–433.

Makris, E. A., Hadidi, P., & Athanasiou, K. A. (2011). The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials, 32(30), 7411–7431.

Martin, L. R., Williams, S. L., Haskard, K. B., & DiMatteo, M. R. (2005). The challenge of patient adherence. Therapeutics and Clinical Risk Management, 1(3), 189–199.

Matthews, P., & St-Pierre, D. M. (1996). Recovery of muscle strength following arthroscopic meniscectomy. The Journal of Orthopaedic and Sports Physical Therapy, 23(1), 18–26.

McClintock, J. H., Kirkley, A., & Fowler, P. J. (1995). Prospective randomized controlled trial of standard physiotherapy versus aquatic therapy for early rehabilitation of the ACL reconstructed knee. Journal Of Bone And Joint Surgery-British Volume, 77(3), 313–314.

Mendell, J. R., & Florence, J. (1990). Manual muscle testing. Muscle & Nerve, 13 Suppl, S16-20.

Moffet, H., Richards, C. L., Malouin, F., & Bravo, G. (1993). Impact of knee extensor strength deficits on stair ascent performance in patients after medial meniscectomy. Scandinavian Journal of Rehabilitation Medicine, 25(2), 63–71.

Mohtadi, N. G., Webster-Bogaert, S., & Fowler, P. J. (1991). Limitation of motion following anterior cruciate ligament reconstruction. A case-control study. The American Journal of Sports Medicine, 19(6), 620-624; discussion 624-625.

Niu, N. N., Losina, E., Martin, S. D., Wright, J., Solomon, D. H., & Katz, J. N. (2011). Development and preliminary validation of a meniscal symptom index. Arthritis Care & Research, 63(2), 208–215.

Nussbaumer, S., Leunig, M., Glatthorn, J. F., Stauffacher, S., Gerber, H., & Maffiuletti, N. A. (2010). Validity and test-retest reliability of manual goniometers for measuring passive hip range of motion in femoroacetabular impingement patients. BMC Musculoskeletal Disorders, 11, 194.

O'donnell, K., Freedman, K. B., & Tjoumakaris, F. P. (2017). Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review. The American Journal of Sports Medicine, 45(7), 1687–1697.

Papalia, R., Vasta, S., Tecame, A., D'Adamio, S., Maffulli, N., & Denaro, V. (2013). Home-based vs supervised rehabilitation programs following knee surgery: a systematic review. British Medical Bulletin, 108(1), 55–72.

Parvizi, J., Tarity, T. D., Steinbeck, M. J., Politi, R. G., Joshi, A., Purtill, J. J., & Sharkey, P. F. (2006). Management of stiffness following total knee arthroplasty. The Journal of Bone and Joint Surgery. American Volume, 88 Suppl 4, 175–181.

Rider, L. G., Koziol, D., Giannini, E. H., Jain, M. S., Smith, M. R., Whitney-Mahoney, K., … Hicks, J. E. (2010). Validation of manual muscle testing and a subset of eight muscles for adult and juvenile idiopathic inflammatory myopathies. Arthritis Care & Research, 62(4), 465–472.

Rockborn, P., Hamberg, P., & Gillquist, J. (2000). Arthroscopic meniscectomy: treatment costs and postoperative function in a historical perspective. Acta Orthopaedica Scandinavica, 71(5), 455–460.

Rohman, E., & Tompkins, M. (2015). Changes in the Uninvolved Limb during Rehabilitation Following ACL Reconstruction, and Recommendations for a Practical and Evidence-Based Functional Testing Battery. Journal of Yoga & Physical Therapy, 5(3), 1–2.

Rudman, D., & Hannah, S. (1998). An instrument evaluation framework: Description and application to assessments of hand function. Journal of Hand Therapy, 11(4), 266–277.

Sapega, A. A. (1990). Muscle performance evaluation in orthopaedic practice. JBJS, 72(10), 1562.

Shoji, H., Solomonow, M., Yoshino, S., D'Ambrosia, R., & Dabezies, E. (1990). Factors Affecting Postoperative Flexion in Total Knee Arthroplasty. Orthopedics; Thorofare, 13(6), 643–649.

Taylor, A. H., & May, S. (1996). Threat and coping appraisal as determinants of compliance with sports injury rehabilitation: An application of protection motivation theory. Journal of Sports Sciences, 14(6), 471–482.

Torry, M. R., Decker, M. J., Viola, R. W., O'Connor, D. D., & Steadman, J. R. (2000). Intra-articular knee joint effusion induces quadriceps avoidance gait patterns. Clinical Biomechanics (Bristol, Avon), 15(3), 147–159.

Tovin, B. J., Wolf, S. L., Greenfield, B. H., Crouse, J., & Woodfin, B. A. (1994). Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Physical Therapy, 74(8), 710–719.

Vervest, A. M. J. S., Maurer, C. a. J., Schambergen, T. G. R., Bie, R. A. de, & Bulstra, S. K. (1999). Effectiveness of physiotherapy after meniscectomy. Knee Surgery, Sports Traumatology, Arthroscopy, 7(6), 360–364.

Wheatley, W. B., Krome, J., & Martin, D. F. (1996). Rehabilitation programmes following arthroscopic meniscectomy in athletes. Sports Medicine (Auckland, N.Z.), 21(6), 447–456.

Wirth, C. J., & Peters, G. (1997). Meniscus injuries of the knee joint: pathophysiology and treatment principles. In T. Baillière (Ed.), Baillière's Clinical Orthopedics (p. 232). London.

Zalta, J. (2008). Massage Therapy Protocol for Post–Anterior Cruciate Ligament Reconstruction Patellofemoral Pain Syndrome: A Case Report. International Journal of Therapeutic Massage & Bodywork, 1(2), 11–21.


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