The UW Health website has a very informative document entitled "Rehabilitation Guidelines for Knee Arthroscopy" that shows and explains:

• the structure of the knee
• the different types of cartilage in the knee
• how the meniscus distributes the pressure on the bones above and below the knee (femur and tibia)
• the different types of meniscus tears
• the different treatment options for meniscus tears
• the rehabilitation process and guidelines for meniscus tears

UW Health is an academic health system associated with the University of Wisconsin-Madison that includes University of Wisconsin Hospital and Clinics, the University of Wisconsin Medical Foundation, and the University of Wisconsin School of Medicine and Public Health.

My Injury

At the age of 50 I was out for a three-mile run. Somewhere in the third mile I suddenly felt pain in my left knee when my foot hit the ground – enough pain that I had to stop and walk the rest of the way home.

For the next couple of months I had to "nurse" my knee for a while, icing it, and laying off my usual exercises at the gym. Gradually, I was able to get back to my usual gym routine, but I noticed that any kind of twisting or impact was uncomfortable, and the knee felt less solid and stable than my right knee. I had to give up all impact sports (basketball, racquetball, running, etc.).

For the next ten years I wore a knee brace whenever I participated in any activity that put a lot of strain on my knees like heavy lifting or hiking up a mountain (I recommend the Ace knee brace sold at Walgreens for $25-$30. It has stays along the sides for support, as well as two wide adjustable velcro straps). The brace, along with an ongoing routine of leg-strengthening exercises at the gym and a constant awareness that I had to be careful with my left knee allowed me to do everything I wanted to do – except impact sports. Occasionally my knee would flare up and ache for short periods of time. I would apply ice and the discomfort would go away, usually by the next day.

During those ten years I had no health insurance, so going to see a doctor for a diagnosis, which I knew would require x-rays and an MRI, was out of the question – it would be too expensive. When I finally did get health insurance and had my knee evaluated by an orthopedic surgeon, it turned out I had a tear in the medial meniscus. The surgeon first suggested physical therapy to see if that would increase the stability of my knee. After 5-6 weeks of PT I felt no appreciable difference in my knee, so I opted for arthroscopic surgery.

Make sure to discuss with your doctor how any existing arthritis might affect the outcome of your surgery. When tissue is removed from the knee area (or trimmed away as in a partial menisectomy) it changes the dynamics and weight distribution in the knee joint to some degree, which means it's possible that any existing arthritis in the knee joint might be more noticeable after surgery. This could impact your decision on whether to go ahead with surgery or not.

My Surgery

My surgery was performed outpatient and required anesthesia. I arrived at the surgery center around noon and was out the door around 4pm, a total of four hours, on crutches.

My knee and the areas 6-inches above and below my knee were shaved prior to surgery.

I was told to not eat anything eight hours prior to surgery (some people get sick from the anesthesia).

I had to wear compression stockings on both legs for two weeks after surgery to help prevent blood clotting.

I was advised to take aspirin, twice a day for a month after surgery to help thin my blood and reduce the possibility of blood clotting.

A gauze dressing was applied around my knee, along with a pad over the kneecap.

The First Two Weeks after Surgery

After my surgery the rehab objective was to:

• Reduce swelling
• Restore range of motion
• Strengthen

The first order of business was to reduce the swelling in my knee, which was substantial. For the first week I kept me knee elevated most of the day and applied ice every couple of hours, along with elevation all night when I slept.

The first two nights my knee began to ache later in the day, so much so that I had to take a pain pill (and another one during the night). Other than that, no other pain medication was necessary.

I was told to flex and extend my toes/foot many times throughout the day.

It was about a week before I felt I could put any weight at all on my left knee.

I was on crutches for almost two weeks – the last few days of which were on just one crutch.

My knee was tight. The whole joint and surrounding area felt locked up, with not much flex, extension, or range of motion. In particular, I had tightness and noticeable swelling right above the kneecap on the lateral (outside) quadriceps muscle.

Post-surgery Follow-up with my Surgeon

Thirteen days after surgery, I saw my surgeon. We went over the notes and the still photos taken during the surgery and I asked questions so I knew what had been done and what my prognosis was. I was told I had grade III arthritis in my "tibial plateau", and grade II/III in my "intercondylar groove".

My surgeon told me about a therapy using hyaluronic acid which is injected directly into the knee joint and replaces the natural fluid in the joint. He said this option was available if, after a long round of PT, I still felt discomfort in my knee due to arthritis. The idea of having to get injections was really not where I wanted to go, but at least I knew that option was available.

Physical Therapy – Weeks 1-2

I started PT two weeks after surgery.

Initially, my left quadriceps muscle seemed to have "shut down", and it did not want to flex. The NMES (neuro-muscular electrical stimulation) helped to "jump-start" that.

At the start of PT, I had about 90-degrees of flexion in my knee.

My initial, 3-day per week, routine of PT exercises was designed to restore range of motion in the knee joint, break up scar tissue, and begin strengthening my glutes and leg muscles. For a comprehensive list of all the exercises I was shown, see the section "PT Exercises" below.

My knee extension returned fairly quickly, but it took about two weeks before I noticed an appreciable difference in the flexion of my knee – it seemed very resistant to bending. My knee would also tighten up when it was partially flexed for a long period of time (for example when sitting at a computer).

In the second week, I was finally able to sit on a recumbent stationary bike and push the pedals all the way around. Over the next 4-5 days I was able to increase the resistance and exercise for 10-20 minutes, paying close attention to the pressure I was applying to each foot/leg and trying to balance it out between right and left.

Squatting and kneeling were definitely out of the question.

Physical Therapy – Weeks 3-4

During week 3 I experienced slow, but continuing improvement in my knee flexion. Still, the knee tightened throughout the day, although by the end of week 4 less than before. I was still unable to kneel or fully squat down.

During week 4 I finally felt my knee was making significant progress in terms of flexibility and bending. I was able to do 30 minutes on a recumbent bike, working up to level 4.

Second Post-surgery Follow-up with my Surgeon

I was examined and told that unless there were complications, no further visits were required.

I was told that leg extensions, a treadmill going forward (backwards is OK), stairs (including stair-master, step mill, etc.) are not recommended. Instead, I was told to do leg presses and lunges.

I was also told to not rush my recovery, and that doing so could end up causing problems.

Physical Therapy – Weeks 5-6

I experienced more progress with flexibility and bending, but I still had a ways to go compared to my right knee.

I started kneeling on a pillow, letting my weight sink down but controlling the depth of the sinking with my hands out to the sides. Then, I slowly rocked side to side letting my knee get used to having some weight on it.

I also started squatting down several times throughout the day, using a chair in front of me for support and balance, making sure to push my butt back on descent and feeling all of the weight in my heels, not my toes.

By the end of week 6 my knee flexion was about 140-degrees – a 50-degree improvement since starting PT.

I was able to squat down fully, but still felt some tightness in my left knee.

I still had a small "lump" in my quad (lateral side, just above the knee).

I was still not able to fully stretch my left quad, and noticed my left thigh was thrown forward and not perpendicular like my right. To correct this, my therapist suggested doing my left quad stretch using a corner of a wall, with my right foot forward and my left leg back, with the top of my left thigh up against the wall, forced (gently) back because of my body position and the wall.

Physical Therapy – Weeks 7-8

At the end of week 7 I had used up all of my insurance-covered PT sessions, so my therapist and I discussed a plan for continuing self-PT.

I was able to start hiking again, on relatively flat ground, up to ¾ of a mile.

I started swimming again, just 4-5 laps at first, then increasing the laps based on how the knee felt.

I also began biking outdoors, doing short 5-8 mile trips on fairly level ground at first.

Physical Therapy – Week 9 and Beyond

At 9 weeks I was finally able to achieve full knee flexion doing heel slides seated on the floor, as well as my heel touching my butt on a quad stretch. I also did a hike of about three miles with a low to medium grade incline.

At 10 weeks I started my usual routine at the gym (leg presses, leg curls, calf raises, plus all of the other PT exercises, along with 30 minutes of cardio on a recumbent bike and 5-10 minutes on the rowing machine). I found the recumbent bike particularly useful, as I was able to change the seat position while pedaling, which allowed me to work the knee joint in varying degrees of flexion and extension.

At 12 weeks I was able to do a hike of three miles with a medium grade incline to the top of a local peak, along with the return 3-mile descent with no discomfort.

At 13 weeks I was able to do 15-20 miles on a bicycle outdoors, but I noticed discomfort just above the kneecap in the left quad for the first part of the ride, which eventually went away. I also notice some barely noticeable "clicking" in the knee when extending, and somewhat more tightness than before.

During weeks 14 through 16, the discomfort and additional tightness which started at week 13 continued. Eventually, I was able to contact my PT, and she said that maybe my kneecap was not tracking properly. She suggested more frequent stretching, as well as using a foam roller to loosen up my IT band (on the side of the thigh). I immediately starting stretching my quads, hamstrings, and calves, as well as using the foam roller 2-3 times per day.

During weeks 17 through 20, I continued the stretching and foam roller regimen and saw significant improvement, however I still had that same discomfort in the left quad from time to time. During week 20 I challenged myself to a more strenuous hike - Squaw/Piestewa Peak in the Phoenix, Arizona area. It's 1.2 miles to the top with a 1,200 foot elevation gain, with a steady grade and lots of irregular terrain on the trail, which is great for conditioning. For extra support, I chose to wear my knee brace, and I was able to complete the entire hike/climb with virtually no discomfort. What was most encouraging was how my knee felt the next several days - no discomfort at all, and very little remaining tightness. I noticed when squatting down that my left knee was still just a little tighter than my right, but less so than before the hike.

At week 26, six months after surgery, my knee feels about 95% healed, which I attribute to more fairly strenuous hikes (still wearing a brace), more outdoor bicycling, daily stretching, and continued weight-training at the gym. The tightness when squatting is nearly gone. It still feels that something is not fully healed however, which I notice when I climb up stairs - it feels less stable than my other knee.

PT Exercises

• LEG EXTENSION (to strengthen the quadriceps and fully extend the leg) – sitting on the floor with back up against a wall, affected leg straight out, other leg bent with foot flat on the floor, using a rope/towel/strap, flex the quadriceps and lift with the rope/towel/strap just slightly keeping the leg straight (try to push the knee down to the floor), 5 second holds, 2 sets of 10
• HEEL SLIDE (to increase flexion and break up scar tissue) – same position as for previous exercise, use the rope/towel/strap to slowly pull the affected leg from a straight (knee flat against the floor) position up toward your body trying to bring your knee to your chest, 5 second holds, 2 sets of 10 (works best using a towel under the heels or wearing socks on a smooth hard surface)
• HEEL SLIDE (a variation of the previous exercise) – lying on your back near a wall with your legs facing the wall, affected leg extends up the wall with foot flat against the wall (or as close as possible to flat), other leg supports as needed, let the affected leg slowly descend until you feel a stretch and hold, use the unaffected leg to control the amount of stretch and to push/lift the leg back up the wall and repeat, 5 second holds, 2 sets of 10 (might need a towel under the heels so foot slides more easily down the wall)
• HEEL LIFT (to strengthen the leg/thigh adductors) – same position as previous exercise, lift the affected leg and flex the quads keeping the leg straight and lift up 18", 5 second holds, 2 sets of 10 (if necessary, use a towel to help lift the heel)
• LEG SQUEEZE (works the leg/thigh adductors) – using a medium-sized ball or a rolled up towel between the thighs, squeeze the thighs together and hold for 5 seconds, repeat 20 times
• CLAMS (works the glutes) – lying on your unaffected side with head, hips, and feet aligned, knees together, using a thera-band around both legs just above the knees, lift/pivot the upper leg at the knee (like a clam opening) about 6 inches and hold 5 seconds, 2 sets of 10
• BRIDGES (works the glutes) – lying on your back, affected leg bent with foot flat, unaffected leg flat, contract the glutes and push your pelvis up, hold 5 seconds, 2 sets of 10 (can also be done with both legs at the same time to work glutes on both sides)
• BRIDGES (a variation of the previous exercise for both sides) – using a medium-sized exercise ball, with head and shoulders on the ball, perform the same motion pushing the pelvis up, hold 5 seconds, 2 sets of 10
• SQUATS (to strengthen the quads) – using a 2-pound ball, with feet shoulder-width or slightly further apart, feet pointing straight ahead, squat down and bring the ball up to chest level, make sure to lead with your butt and push up from the heels (not the toes), 2 sets of 10 (increase the ball weight as strength increases)
• BALL SQUATS (to strengthen the quads) – using a medium-sized exercise ball, stand with your back to the wall, the ball between your back and the wall, feet at shoulder width or slightly more, feet pointing straight ahead, squat down leading with your butt, push up from the heels (not the toes), if necessary use a thin foam pad underneath the toes to help keep the weight and pressure on the heels, 2 sets of 10
• HAMSTRING CURLS (to strengthen the hamstrings) – facing a wall or a wall corner, using a small pad or towel (if necessary) on the thigh, lift the leg at the knee as far as comfortable, 2 sets of 10 (can also be done with an exercise ball lying on your back)
• HURDLES (to practice walking and lifting the legs) – set up hurdles a comfortable distance apart so you can step over them one step at a time, make sure your stepping motion on the affected leg is the same as the unaffected leg
• BALANCE – near a table or wall for support, balance on just the affected leg for 10 seconds, increase to 15-20 seconds
• RECUMBENT STATIONARY BIKE – great for a warm up and for helping restore general movement in the knee
• TREADMILL – walking backwards, focus on reaching back with the leg to engage the glutes and allowing the front foot to release with toes up
• STEP-UPS – using increasingly taller steps, stepping up onto the step then back, heel-toe stepping up, hips/glutes back just a bit to step-down so you release from the heels and not the toes
• BAND WALKS (works the glutes) – using a thera-band around both legs just above the knees, feet shoulder-width apart, butt back like you're doing a squat, step about 6 inches directly to the side keeping the other leg stationary, then bring the stationary leg back into position and repeat, when completed repeat on the other side
• LUNGES – from a standing position, "lunge" forward a comfortable distance (not too far), dip the knee down to the floor, knee back up and step back to starting position
• TERMINAL KNEE EXTENSIONS (works the quads) – using a weight machine, loop the end of the cable around the affected leg at the lower calf, start on toes of affected leg, drop toes down so foot is flat causing the cable to pull out from the weight stack so you feel the resistance
• SHUTTLE JUMP (to help the knee get used to low-impact)