This protocol is intended to be a general outline only. The physician reserves the right toeither advance or delay this protocol as deemed necessary. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery.

Guidelines for Pre-Op Physical Therapy
Patients may be required to attend one pre-op PT visit to receive gait training, issue crutches, review post-op exercises, and discuss post-op expectations.
Patient should be instructed in edema control and post-op exercises (quad set, SLR, ankle pumps, etc.) and the importance of achieving full knee ext ASAP post-op.

Guidelines for Post-Op Physical Therapy
Therapy beings on Day One post op in the outpatient clinic.
Patient is typically seen 2x/week for 12-20 weeks post-operatively, tapering depending on patient status and ADL demands.

Meniscal Repair Precautions
No closed-chain knee flexion for first eight weeks.
No resisted hamstring exercises (open or closed chain) for first three weeks.
PROM restricted to 90 degrees for first 4-6 weeks (based on surgeon instruction)
After above PROM restrictions are lifted, flexion ROM performed in supine or prone to tolerance is allowed.

Guidelines for Ambulation and Hinged Knee Brace
Bilateral axillary crutches to be used immediately post-op (patient should bring them to the surgical center) to maintain NWB status.
Hinged knee brace will be issued at surgical center. Brace to be worn and locked in 0 degrees extension with all ADL’s for first 4 weeks (includes sleeping). Brace may removed for bathing and exercises.
Maintain NWB with crutches and brace locked in extension for 4 weeks
After 4 weeks, begin WBAT with brace locked in extension for an additional 2 weeks unless otherwise instructed post-op. After that, allow gait without brace or with hinge unlocked depending on tolerance.

Guidelines for Wound Care
Surgical wounds should be covered with steri-strips, then with gauze and occlusive dressing. Change as needed and do not allow to become wet.
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