The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part I-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction)

Nicolas Pujol¹, Airelle O Giordano², Stephanie E Wong³, Philippe Beaufils⁴, Juan Carlos Monllau⁵, Elanna K Arhos⁶, Roland Becker^{7

8

9}, Francesco Della Villa¹⁰, J Brett Goodloe¹¹, James J Irrgang¹², Jitka Klugarova^{13

14}, Emma L Klosterman¹⁵, Aleksandra Królikowska¹⁶, Aaron J Krych¹⁷, Robert F LaPrade¹⁸, Robert Manske¹⁹, Nicky van Melick²⁰, Jill K Monson²¹, Marko Ostojic²², Mark V Paterno^{23

24}, Tomasz Piontek²⁵, Simone Perelli²⁶, Alexandre Rambaud²⁷, James Robinson²⁸, Laura C Schmitt²⁹, Eric Hamrin Senorski³⁰, Thorkell Snaebjornsson^{31

32}, Adam J Tagliero¹⁷, C Benjamin Ma³, Robert Prill^{7

8

9}

Affiliations

¹ Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France.
² Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
³ Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.
⁴ ESSKA Office, Centre Médical, Fondation Norbert Metz, Luxembourg, Luxembourg.
⁵ Department of Orthopedics and Traumatology, Hospital del Mar, Barcelona, Spain.
⁶ Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA.
⁷ Department of Orthopedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, Brandenburg, Germany.
⁸ Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany.
⁹ Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
¹⁰ Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
¹¹ Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
¹² Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA.
¹³ Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
¹⁴ Center of Evidence-based Education and Arts Therapies: A JBI Affiliated Group, Faculty of Education, Palacký University Olomouc, Prague, Czech Republic.
¹⁵ Michigan Medicine Department of Orthopaedic Surgery, Ann Arbor, Michigan, USA.
¹⁶ Physiotherapy Research Laboratory, University Centre of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland.
¹⁷ Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota, USA.
¹⁸ Twin Cities Orthopedics, Edina, Minnesota, USA.
¹⁹ Wichita State University, Ascension Via Christi, Wichita, Kansas, USA.
²⁰ Sports & Orthopedics Research Center, Anna TopSupport, Eindhoven, the Netherlands.
²¹ Twin Cities Orthopedics, Eagan, Minnesota, USA.
²² Osteon Orthopedics and Sports Medicine Clinic, Mostar, Bosnia and Herzegovina.
²³ Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁴ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁵ Rehasport Clinic and Sport Medicine Lab, Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznań, Poland.
²⁶ Knee and Arthroscopy Unit, Institut Català de Traumatologia i Medicina del'Esport (ICATME) - Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁷ Institute of Physiotherapy of Saint-Etienne - Saint-Michel Campus, Saint-Etienne, France.
²⁸ MS Knee Specialists, Bristol, UK.
²⁹ Division of Physical Therapy, School of Health and Rehabilitation Sciences and OSU Sports Medicine Research Institute, Ohio State University, Columbus, Ohio, USA.
³⁰ Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³¹ Landspitali, University Hospital of Iceland, Reykjavik, Iceland.
³² Medical Faculty, University of Iceland, Reykjavik, Iceland.

PMID: 40353298
PMCID: PMC12310086
DOI: 10.1002/ksa.12674

Practice Guideline

The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part I-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction)

Nicolas Pujol et al. Knee Surg Sports Traumatol Arthrosc. 2025 Aug.

. 2025 Aug;33(8):3002-3013.

doi: 10.1002/ksa.12674. Epub 2025 May 12.

Authors

Affiliations

¹ Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles, Le Chesnay-Rocquencourt, France.
² Department of Physical Therapy, University of Delaware, Newark, Delaware, USA.
³ Department of Orthopaedic Surgery, University of California, San Francisco, California, USA.
⁴ ESSKA Office, Centre Médical, Fondation Norbert Metz, Luxembourg, Luxembourg.
⁵ Department of Orthopedics and Traumatology, Hospital del Mar, Barcelona, Spain.
⁶ Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA.
⁷ Department of Orthopedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, Brandenburg, Germany.
⁸ Faculty of Health Science Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany.
⁹ Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.
¹⁰ Education & Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.
¹¹ Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
¹² Department of Physical Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, Pennsylvania, USA.
¹³ Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic.
¹⁴ Center of Evidence-based Education and Arts Therapies: A JBI Affiliated Group, Faculty of Education, Palacký University Olomouc, Prague, Czech Republic.
¹⁵ Michigan Medicine Department of Orthopaedic Surgery, Ann Arbor, Michigan, USA.
¹⁶ Physiotherapy Research Laboratory, University Centre of Physiotherapy and Rehabilitation, Faculty of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland.
¹⁷ Mayo Clinic Department of Orthopedic Surgery, Rochester, Minnesota, USA.
¹⁸ Twin Cities Orthopedics, Edina, Minnesota, USA.
¹⁹ Wichita State University, Ascension Via Christi, Wichita, Kansas, USA.
²⁰ Sports & Orthopedics Research Center, Anna TopSupport, Eindhoven, the Netherlands.
²¹ Twin Cities Orthopedics, Eagan, Minnesota, USA.
²² Osteon Orthopedics and Sports Medicine Clinic, Mostar, Bosnia and Herzegovina.
²³ Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
²⁴ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁵ Rehasport Clinic and Sport Medicine Lab, Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznań, Poland.
²⁶ Knee and Arthroscopy Unit, Institut Català de Traumatologia i Medicina del'Esport (ICATME) - Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁷ Institute of Physiotherapy of Saint-Etienne - Saint-Michel Campus, Saint-Etienne, France.
²⁸ MS Knee Specialists, Bristol, UK.
²⁹ Division of Physical Therapy, School of Health and Rehabilitation Sciences and OSU Sports Medicine Research Institute, Ohio State University, Columbus, Ohio, USA.
³⁰ Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³¹ Landspitali, University Hospital of Iceland, Reykjavik, Iceland.
³² Medical Faculty, University of Iceland, Reykjavik, Iceland.

PMID: 40353298
PMCID: PMC12310086
DOI: 10.1002/ksa.12674

Abstract

Purpose: The aim of part one of this EU-US consensus was to combine literature research and expertise to provide recommendations for the usage of rehabilitation (including physical therapy) of patients undergoing surgical treatment for degenerative meniscus lesions or acute meniscus tears (including meniscectomy, repair, or reconstruction). Prevention programmes, non-operative treatment of acute tears and degenerative lesions, return to sports and patient-reported outcome measures will be presented in a part II article.

Methods: This consensus followed the European Society for Sports Traumatology and Arthroscopy (ESSKA)'s 'formal consensus' methodology. For this combined ESSKA, American Orthopedic Society for Sports Medicine and American Academy of Sports Physical Therapy initiative, 67 experts (26 in the steering group and 41 in the rating group) from 14 countries (US and 13 European countries), including orthopaedic surgeons, sports medicine doctors and physiotherapists were involved. Steering group members established guiding questions, searched the literature and proposed statements. Rating group members assessed the statements according to a Likert scale and provided grades of recommendations, reaching a final agreement about rehabilitation of the knee after meniscus surgery. Final documents were then assessed by a peer review group to address the geographical adaptability.

Results: The overall level of evidence in the literature was low. Of the 19 questions (leading to 29 statements), 1 received a Grade A of recommendation, 2 a Grade B, 9 a Grade C and 17 a Grade D. Nevertheless, the mean median rating of all questions was 8.2/9 (9 being the highest rating on a scale of 1-9). The global mean rating was 8.4 ± 0.2, indicating a high agreement. Rehabilitation depends on the type of lesion, the treatment performed and is the same after medial or lateral meniscus surgery. Rehabilitation after meniscectomy should follow a criterion-based rehabilitation protocol, based on milestones rather than a time-based protocol. After meniscus repair and reconstruction, rehabilitation should be progressed according to both time and criterion-based milestones.

Conclusion: Rehabilitation after meniscus surgery is a debated topic that may influence surgical outcomes if not optimally performed. This international formal consensus established clear, updated and structured recommendations for both surgeons and physiotherapists treating patients after meniscus surgery.

Level of evidence: Level I, consensus.

Keywords: consensus; knee; meniscus; physical therapy; rehabilitation; repair.

© 2025 The Author(s). Co‐published by European Society of Sports Traumatology, Knee Surgery and Arthroscopy, American Orthopaedic Society for Sports Medicine, North American Sports Medicine Institute and Movement Science Media.

PubMed Disclaimer

Conflict of interest statement

Nicolas Pujol: Occasional consultant for education for Smith&Nephew, Stryker, ZimmerBiomet. Philippe Beaufils: ESSKA Consensus Projects advisor. Stephanie Wong: Editor‐in‐Chief of Current Reviews in Musculoskeletal Medicine. Robert Prill: Associate Editor KSSTA, Chair ESSKA Rehabilitation Committee. Airelle O. Giordano: Education Chair, AASPT. Robert F. LaPrade: Consultant: Smith and Nephew, Ossur; Royalties; Smith and Nephew, Ossur, Elsevier; Research support: AOSSM, AANA, Ossur, Smith and Nephew, Arthrex; Editorial Boards: AJSM, KSSTA, JEO, Journal of Knee Surgery; JISPT, OTSM; AOSSM: Nominating Committee; ISAKOS: Travelling Fellowship Committee, Program Committee. Aaron J. Krych: Consulting and Royalties Arthrex, Inc. Editorial Boards: AJSM, KSSTA. AANA Board. James J. Irrgang: Currently serves as President of the Board of Directors of Movement Media Sciences/Journal of Orthopaedic & Sports Physical Therapy. Alexandre Rambaud: Member of ESSKA Rehabilitation Committee; Deputy Editor: European Rehabilitation Journal, Journal de Traumatologie du Sport, Editor‐in‐Chief of Kinésithérapie, la Revue. Laura C. Schmitt: Editorial Board: MSSE; Research Support from Arthritis Foundation and NFL Players Association. Jill K. Monson: Member AASPT Research Committee, Consultant Smith & Nephew. Mark V. Paterno: Co‐Chair AASPT Research Committee, Research Support from AOSSM/AIrCast Research Foundation. Simone Perelli: Paid consultancy for Smith&Nephew. Aleksandra Królikowska: Member of ESSKA Rehabilitation Committee. Nicky van Melick: Member of ESSKA Rehabilitation Committee. Jitka Klugarová: Deputy director of the Czech CEBHC: JBI Centre of Excellence, Czech GRADE Network, member of methodological group within JBI and GRADE working group. The remaining authors declare no conflicts of interest.

Figures

See this image and copyright information in PMC

References

1. Alessio‐Mazzola M, Lovisolo S, Capello AG, Zanirato A, Chiarlone F, Formica M, et al. Management of ramp lesions of the knee: a systematic review of the literature. Musculoskelet Surg. 2020;104(2):125–133. - PubMed
1. Beaufils P, Becker R, Kopf S, Englund M, Verdonk R, Ollivier M, et al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):335–346. - PMC - PubMed
1. Beaufils P, Dejour D, Filardo G, Monllau JC, Menetrey J, Seil R, et al. ESSKA consensus initiative: why, when and how? J Exp Orthop. 2023;10(1):101. - PMC - PubMed
1. Beaufils P, Saffarini M, Karlsson J, Hirschmann MT, Prill R, Becker R, et al. High scientific value of consensus is based on appropriate and rigorous methodology: the ESSKA formal consensus methodology. Knee Surg Sports Traumatol Arthrosc. 2024;33:16–20. - PubMed
1. Cong T, Reddy RP, Hall AJ, Ernazarov A, Gladstone J. Current practices for rehabilitation after meniscus repair: a survey of members of the American Orthopaedic Society for Sports Medicine. Orthop J Sports Med. 2024;12(2):23259671231226134. - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part I-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction)

Affiliations

The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part I-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials