It is common for physicians to recommend that patients avoid exercises that require deep squatting, cutting, or pivoting after both a knee meniscectomy and meniscal repair. Examples of exercises to avoid include weighted squats, leg presses, or lunges with greater than 90 degrees of flexion, full ROM on the leg-extension machine, and plyometric or agility drills that include cutting or pivoting. These exercises may impart high shear forces to the healing tissues, which can result in re-injury. In fact, deep squatting and excessive flexion of the knee may be discouraged for the first six months following a meniscal repair.
These recommendations are a double-edged sword, as multi-joint movements such as squatting and lunging are very functional and important in activities of daily life. One option to consider is to perform these movements with a very reduced range of motion. That is, activities such as partial-depth squats, leg presses, and lunges can be performed initially from 0 to 45 degrees of knee flexion and progressed to 90 degrees once you are cleared by your physician to do so. Of course, any exercise you engage in post-surgery should be approved by your physician or rehabilitation specialist, since he or she has the best understanding of your specific case and health history.
Exercises other than squats, lunges, and leg presses can also be beneficial for people with knee osteoarthritis and meniscal removal or repair. These include activities such as the straight-leg raise (for the front of the thigh), side-lying leg lifts (for the outer thigh), and side-lying adduction (for the inner thigh). These exercises target the hip and knee musculature in a non-weight-bearing manner, which is often better tolerated than standing, weight-bearing activities. Consequently, the hip and thigh muscles are strengthened, which can help to support an arthritic knee and take some of the pressure off of the joint.
Another important consideration with any lower extremity injury is to keep in mind that deficits in general balance may be present due to disuse and factors related to tissue healing. Therefore, balance activities can be helpful in developing the functional strength of the muscles supporting the knee. Start by placing one or both hands on a wall or countertop for support while attempting to balance on one leg at a time. Try to build up to 10, 20, 30, and even 60 seconds of balancing on one foot. When you’ve mastered standing on one foot for one minute, progress the balance challenge in the same manner by working up to 60 seconds of balancing on one foot with the hands free.
The exercises described above should help you strengthen your legs in a safe and effective manner, while avoiding deep squats and lunges. For more help in progressing your strength program beyond these initial options, consider enlisting the services of an ACE-certified fitness professional who has experience in post-rehabilitation techniques.