Table 2

Previously published rehabilitation protocols

Paper	No of patients (meniscal repairs)	WB restrictions	ROM restrictions	Other restrictions	Outcome	Level of evidence
Morgan and Casscells⁵⁴	67 (70)	Immediate WBAT in extension 4 weeks	Full extension for 4 weeks	Pivoting not until 4 months	Excellent results in 69 (98%) repairs, 1 patient had second tear and 2 patients had surgical complications.	(Retrospective) case series; level IV evidence
Morgan et al³¹	353 repairs, 74 had second-look arthroscopy	Immediate WBAT in full extension 4 weeks	Active 0°−60° after 1 week	No pivoting for 6 months	Asymptomatic healing occurred in 84% of patients at second-look arthroscopy.	Non-randomised cohort/follow-up study; level III evidence
Barber³⁸	95 (98) 56 (58) in standard protocol 39 (40) in accelerated protocol	Standard protocol: NWB for 12 weeks Accelerated protocol: Immediate WBAT	Standard protocol: immobilisation at flexion for 6 weeks Accelerated protocol: immediate unlimited ROM	Standard protocol: No pivoting for 6 months Accelerated protocol: Pivoting sports as soon as the patient desired	Standard protocol: 11/20 failure at second-look arthroscopy. Accelerated protocol: 4/10 failure at second-look arthroscopy.	Non-randomised cohort/follow-up study; level III evidence
Horibe et al⁵⁵	122 (132)	WBAT after 5–6 weeks	Immobilisation for 1–2 weeks	Vigorous not for 4–6 months	97 menisci (73%) had complete healing; 21 of which had new tear at second-look arthroscopy.	Non-randomised cohort/follow-up study; level III evidence
Fritz et al²⁹	1	Immediate WBAT with two crutches	Brace locked in extension for 6 weeks, 6–8 weeks unlocked for gait training ROM limited to 0°−90°	Return to full activity approximately in 1 year	Full ROM and no effusion with 4+/5 quadriceps strength on clinical examination, no progression of degenerative changes on X-ray.	Case report; level V evidence
Mariani et al⁴⁰	22	Immediate WBAT	Immobilisation with brace locked at 0° during ambulation for 1 month, passive 0°−90° ROM from day 2 to 2 weeks	Progressive resistance exercise from 4 weeks, running and biking after 2 months; full return to sport after 6 months	17 (77%) patients showed ‘good clinical’ results. 3 (14%) showed signs of meniscal re-tear on MRI one of which had second surgery	Non-randomised cohort/follow-up study; level III evidence
Shelbourne et al⁴¹	61 17 in conventional protocol 39 in accelerated protocol	Conventional protocol: NWB until 6 weeks. Accelerated protocol: immediate WBAT	Conventional protocol: limited ROM until 6 weeks Accelerated protocol: immediate ROMAT	Conventional protocol: restricted activities Accelerated protocol: Bike and swim as tolerated 2–4 weeks, strength work	No significant difference between two protocols in Lysholm score, Noyes questionnaire score or self-evaluation score.	Non-randomised cohort/follow-up study; level III evidence
Barber and Click⁵⁰	63 (65)	Immediate WBAT	Immediate unrestricted ROM, no braces were used	After adequate motion (0° to 120°), good strength and no effusion are achieved, return to all activities—including pivoting sports—is allowed	Second-look arthroscopy in 17 (26%) showed repair failure in 7 patients.	Non-randomised cohort/follow-up study; level III evidence
Mintzer et al*¹⁷	26 (29)	5 patients: NWB in a knee immobiliser for 4 weeks 21 patients: Allowed WBAT in a knee immobiliser for 4 weeks	Immobilisation for 4 weeks	NR	24 patients returned to their previous level of sports activity. The remaining two patients cited reasons other than surgery for limiting their sports activity	Non-randomised cohort/follow-up study; level III evidence
Bloome et al†¹⁸	2	Case 1: Partial WB in cast for 4 weeks. Case 2: Partial WB using crutches 2 weeks, WBAT 2–6 weeks	Case 1: Long-leg splint/cast for 4 weeks at full extension, then removable posterior splint for 2 weeks to use when ambulating Case 2: Long-leg cylinder cast until 6 weeks, then immobiliser for walking	NR	Case 1: Full return to activities at 7-month follow-up. Case 2: Normal gait at 3 months and full activities at 6 months.	Case report; level V evidence
Noyes and Barber-Westin⁴⁶	29 (30)	Partial WB for 4 or 6 weeks	ROM progressed to 135° over 6 weeks Restriction of squatting or deep flexion beyond 125° for 4 months	No vigorous activities for 6 months	26 (87%) were asymptomatic at follow-up. Three repairs failed to heal, requiring partial meniscectomy, and one knee with tibiofemoral symptoms related to the repair was treated conservatively.	Non-randomised cohort/follow-up study; level III evidence
O’Shea and Shelbourne⁴⁷	52 (55)	WBAT postoperative day 3	Immediate ROMAT	NR	At second-look arthroscopy showed 30 menisci (55%) appeared healed, 19 menisci (34%) appeared partially healed, and 6 menisci (11%) showed no healing.	Non-randomised cohort/follow-up study; level III evidence
Kocabey et al⁴²	52 (55)	Immediate WBAT	ROM 0°−125°	Return 3–5 months depending on tear type	Excellent results is all with combined ACL–meniscus repair³² and in 96% (22 cases) with isolated meniscus repair.	Retrospective case series; level IV evidence
Bryant et al⁴⁸	100	Protected WB for 3 weeks, then WBAT	Locked in extension for 3 weeks, then full ROM	No squatting, pivoting and twisting for a minimum of 6 months	Of 88 patients at follow-up, 22 (25%) patients had failed meniscal repairs.	Randomised controlled clinical trial; level I evidence
Haklar et al⁴⁵	5	NWB 6–8 weeks	No squat beyond 120°	No running until 4 months, then return to normal activities	MRI showed that all five patients had fully healed meniscus.	Non-randomised cohort/follow-up study; level III evidence
Logan et al⁴⁹	42 (45)	Protected WB for 6 weeks	90° flexion by 6 weeks	NR	34 (81%) patients returned to their main sport. There were 11 (24%) failures in meniscal repair.	Case series; level IV evidence
Lind et al³⁵	60 32 in free protocol 28 restricted protocol	Free protocol: 2 weeks TDWB. Restricted protocol: TDWB for 6 weeks	Free protocol: ROM 0°−90°, no brace, then return to normal activities Restricted protocol: 6 weeks hinged brace, gradual increase ROM to 90°	Free protocol: Running at 8 weeks contact sports at 4 months Restricted protocol: 12 weeks, contact sports 6 months	Second-look arthroscopy showed failure of healing in 9 (28%) patients in free and 10 (36%) patients in the restricted rehabilitation groups. No difference in failure rate and no difference in functional outcome at 1–2 years.	Randomised controlled clinical trial; level I evidence

*Athletes 17 years old or younger.
†Very young children.
NR, not reported; NWB, non-weight-bearing; ROM, range of motion; ROMAT, range of motion as tolerated; TDWB, touch-down weight-bearing; WB, weight-bearing; WBAT, weight-bearing as tolerated.