Next Article in Journal
Hair Transplantation in Primary Cicatricial Alopecias: A Review and Update
Previous Article in Journal
Peri-Operative Nursing of Patients with Malignant Hyperthermia: A Narrative Literature Review
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Surgeries
Volume 6
Issue 4
10.3390/surgeries6040079
surgeries-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Postoperative Rehabilitation and Functional Recovery After Knee Meniscectomy: An Ambispective Cohort Study

by
Juan Luis Martínez-Fernández
1 and
Rubén Cuesta-Barriuso
2,3,*
1
Faculty of Physiotherapy, Podiatry and Occupational Therapy, Catholic University San Antonio-UCAM, 30107 Murcia, Spain
2
Department of Surgery and Medical-Surgical Specialties, University of Oviedo, 33006 Oviedo, Spain
3
InHeFis Research Group, Instituto Asturiano de Investigación Sanitaria (ISPA), 33011 Oviedo, Spain
*
Author to whom correspondence should be addressed.
Surgeries 2025, 6(4), 79; https://doi.org/10.3390/surgeries6040079
Submission received: 31 July 2025 / Revised: 12 September 2025 / Accepted: 19 September 2025 / Published: 25 September 2025
Browse Figures
Versions Notes

Abstract

Background/Objectives: Meniscectomy is commonly performed to treat meniscal injury. Recovery of patients and restoration of functional capacity may be influenced by several factors, among which postoperative rehabilitation could play a significant role. The objective was to compare clinical and functional status in patients undergoing meniscectomy according to receipt of postoperative rehabilitation. Methods: An ambispective cohort study was conducted in 89 patients who underwent meniscectomy. The primary outcome was functional capacity, assessed using the Timed Up and Go (TUG) test. The primary exposure was receipt of postoperative rehabilitation. Secondary outcomes included knee range of motion (goniometry), pain intensity (visual analogue scale, VAS), and kinesiophobia (Tampa Scale of Kinesiophobia). Results: Functional capacity differed significantly between patients who received postoperative rehabilitation and those who did not (U = 490; p = 0.03), with lower (better) TUG times in the rehabilitation group. A significant difference was also observed between patients who did and did not engage in preoperative regular physical exercise (U = 680.0; p = 0.01), with better postoperative functional performance in those who had not exercised preoperatively. A sex difference was identified, with females demonstrating superior functional performances compared with males (U = 1187.0; p = 0.01). Older age was positively associated with functional impairment (β = 0.02; p = 0.02). Conclusions: Postoperative rehabilitation was associated with superior objective functional performance after meniscectomy, alongside improvements in pain, range of motion, and kinesiophobia. Female sex and younger age predicted better function; preoperative inactivity was associated with superior postoperative performance, while postoperative exercise showed no clear association. Findings should be interpreted cautiously in view of potential residual confounding and the small non-rehabilitation subgroup, and warrant validation in larger, preferably randomised, cohorts.

1. Introduction

Meniscal injuries are common and are associated with an increased risk of knee osteoarthritis. Occupations involving high biomechanical loads may precipitate such injuries, either acutely or progressively [1]. These lesions are typically classified by aetiology as degenerative or traumatic. Degenerative meniscal tears arise from age-related change or repetitive joint use and are more prevalent in middle-aged and older adults [2]. Traumatic tears are generally caused by compressive and shear forces within the joint. They occur in isolation or—more commonly—in conjunction with ligamentous and chondral injuries [3], often during twisting or pivoting movements when the ipsilateral foot is fixed to the ground.
The incidence of meniscal tears is approximately 60 per 100,000 population, a figure that has risen with increased public participation in sport and wider access to diagnostic imaging [4]. The prevalence of degenerative meniscal injury increases with age [5]; in middle-aged and elderly populations, MRI-detected tears may be present in up to 35% of knees, even when asymptomatic [2].
When conservative management fails and symptoms persist with functional impairment, surgery—most commonly meniscectomy—is the treatment of choice. This procedure, used for both degenerative and traumatic tears, is typically performed arthroscopically as a day case [6]. Arthroscopic partial meniscectomy, which removes unstable meniscal tissue, remains one of the most frequently performed orthopaedic procedures for this indication [7].
Meniscectomy aims to alleviate pain in patients with persistent symptoms or mechanical phenomena after unsuccessful conservative care [6]. Postoperatively, substantial pain reduction is generally observed within 6–12 months, particularly when mechanical symptoms are addressed. However, in the presence of degenerative change or pre-existing osteoarthritis, pain often re-emerges over time owing to progressive joint deterioration [8].
The removal of damaged meniscal tissue is generally performed with the expectation of improving joint mobility and restoring functional capacity, thereby contributing to meaningful gains in patients’ overall quality of life [9]. In the immediate postoperative period and during the first stages of recovery, many individuals indeed experience a reduction in pain and mechanical symptoms, which facilitates a return to daily activities. Nevertheless, accumulating evidence indicates that these short-term benefits may not be sustained for all patients. A considerable proportion of individuals subsequently report a decrease in participation in sports and recreational activities, together with a gradual shift towards a more sedentary lifestyle [10]. This decline in activity levels has been attributed to several interrelated factors, including progressive reductions in muscle strength and muscle mass, impaired neuromuscular control, and the loss of the meniscus’s intrinsic shock-absorbing capacity after partial resection. The alteration of this key biomechanical role of the meniscus contributes to increased load transmission to the articular cartilage and subchondral bone, which in turn may promote discomfort, reduce confidence in knee stability, and ultimately limit physical activity [10].
Meniscectomy is also associated with an increased risk of knee osteoarthritis. Partial or total meniscal removal compromises load distribution, alters knee biomechanics, and increases contact pressures on the articular cartilage, potentially contributing to chondrolysis and reduced joint space [11]. Contemporary clinical practice prioritises meniscal preservation whenever feasible, reserving partial meniscectomy for selected cases in which mechanical symptoms or tissue quality preclude repair.
Younger patients generally display a superior biological capacity for tissue regeneration and neuromuscular adaptation, which allows them to respond more effectively to structured rehabilitation protocols. This enhanced recovery potential facilitates faster improvements in functional outcomes and a more reliable return to pre-injury levels of activity. In contrast, older individuals tend to exhibit a diminished regenerative response following meniscectomy, a factor that is often compounded by age-related sarcopenia, reduced neuromuscular plasticity, and the presence of degenerative joint changes. These elements collectively increase the likelihood of persistent symptoms, slower recovery trajectories, and a higher risk of developing or accelerating osteoarthritic alterations in the knee joint after surgery [12]. With regard to sex-related differences, several studies have consistently demonstrated that men, on average, present with higher baseline levels of muscle strength and greater muscle mass prior to undergoing meniscectomy [13]. These attributes may contribute to an enhanced mechanical environment for the knee and allow for more rapid functional recovery, which can translate into an earlier resumption of occupational duties, social participation, and engagement in recreational or competitive sporting activities compared with their female counterparts [13].
Postoperative rehabilitation can accelerate functional recovery, alleviate pain, and prevent complications [14]. Early, individualised programmes centred on progressive therapeutic exercise yield meaningful improvements in range of motion, pain control, and joint stability [15]. Neuromuscular control exercises, proprioceptive and balance training, and task-specific functional activities have proven effective in restoring physical performance and facilitating return to work or sport [14]. Moreover, rehabilitation may address psychosocial factors such as kinesiophobia, improving confidence in the operated knee and contributing to more complete and sustained recovery [16].
The aim of this study was to evaluate the clinical and functional status of patients undergoing meniscal surgery and to identify the optimal predictive model for postoperative functional performance according to receipt of postoperative rehabilitation.

2. Materials and Methods

2.1. Study Design

This study was an ambispective, multicentre cohort study and was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [17].

2.2. Ethical Considerations

Confidentiality and anonymity of all collected data were ensured in accordance with the ethical principles of the Declaration of Helsinki. All participants were fully informed about the study and provided written informed consent prior to enrolment. The study protocol was approved by the Ethics Committee of the Catholic University of San Antonio of Murcia (code: CE112415; date: 29 November 2024). The study was registered at ClinicalTrials.gov (NCT06920394; date: 1 April 2025).

2.3. Participants

The inclusion criteria were (i) individuals aged between 20 and 65 years; (ii) of either sex; (iii) with a history of unilateral knee meniscectomy performed within the past five years; and (iv) who signed the informed consent form. All patients included in the study presented with traumatic meniscal tears, confirmed by clinical examination and magnetic resonance imaging at the hospital centre where the surgical intervention was performed.
The exclusion criteria included (i) individuals requiring assistive devices for ambulation; (ii) individuals dependent in activities of daily living (ADLs); and (iii) individuals with cognitive impairments that could affect understanding of the assessments and procedures.
Data collection was conducted between April and May 2025 at two clinical centres, Fisiomaturana and Fisialty, both located in the city of Murcia, Spain. All surgical procedures were performed at two reference hospital centres by surgeons with extensive clinical and surgical experience in meniscectomy. Although protocol variations between centres cannot be ruled out, all included patients presented with traumatic meniscal tears, which contributes to the homogeneity of the study cohort. Patients in the rehabilitation group received a standardised programme comprising five sessions per week, each lasting 45 min. Each session incorporated manual therapy techniques (including joint mobilisations and soft-tissue treatment) together with individualised therapeutic exercises designed to improve mobility, strength, and motor control.

2.4. Outcome Measures

The primary outcome was functional performance, treated as a continuous variable. The primary exposure was receipt of postoperative rehabilitation following meniscectomy, analysed as a dichotomous categorical variable (yes/no) and used as the grouping variable for between-group comparisons. The measurement instruments were as follows:
Functional performance: assessed with the Timed Up and Go (TUG) test [18], which involves standing from a chair, walking three metres around a marker, and returning to the seated position. The outcome is time (seconds); shorter times indicate better functional performance.
Knee range of motion (ROM): measured by goniometry following the protocol of Hancock et al. [19]. The stationary arm was aligned between the centre of the greater trochanter and the lateral femoral epicondyle; the moving arm was aligned with the tibial axis, between the lateral femoral epicondyle and the centre of the lateral malleolus. Participants performed maximal active knee flexion and extension. The unit of measurement was degrees; higher values indicate greater ROM.
Joint pain intensity: measured using a visual analogue scale (VAS) from 0 (no pain) to 10 (worst pain imaginable) [20].
Kinesiophobia: assessed with the 11-item Tampa Scale for Kinesiophobia (TSK-11), with each item scored 1 (“strongly disagree”) to 4 (“strongly agree”); total scores range from 11 to 44, with higher scores indicating greater fear of movement [21].
In addition, anthropometric measures and sociodemographic characteristics were collected as covariates: age (years, continuous); sex (male/female, dichotomous); weight (kg) and height (cm) to derive body mass index (BMI, kg/m2); occupational type (active/sedentary, dichotomous); and engagement in physical exercise before and after surgery (yes/no, dichotomous). Time since surgery was defined as the interval (days) between the index meniscectomy and the study assessment. A single assessment time point was used, and all data were analysed in anonymised form.

2.5. Sample Size

The required sample size was computed using G*Power (version 3.1.9.2; Heinrich Heine University, Düsseldorf, Germany). Assuming a moderate effect size (f2 = 0.15) to assess functional performance in adults undergoing knee meniscectomy, an α of 0.05, a power of 90% (1−β = 0.90), and 14 predictors, the minimum sample size was 89 participants with a prior history of knee meniscectomy.

2.6. Statistical Analysis

Quantitative variables were summarised as mean (standard deviation), and categorical variables as absolute frequencies and percentages. Normality of quantitative variables was assessed using the Kolmogorov–Smirnov test. Between-group comparisons (postoperative rehabilitation vs. no rehabilitation) employed the independent-samples t-test when normality was satisfied, or the non-parametric Mann–Whitney U test otherwise; categorical variables were compared using the chi-squared test.
A multiple linear regression model was fitted to identify independent predictors of functional performance. Time since surgery was entered as a continuous covariate (days) in the regression model. Multicollinearity was assessed using the variance inflation factor (VIF). Model fit was evaluated with the adjusted coefficient of determination (R2adj) and the overall F-test.
All analyses were performed using IBM SPSS Statistics, version 26.0 (IBM Corp., Armonk, NY, USA). A two-sided p-value < 0.05 was considered statistically significant.

3. Results

3.1. Participants

A total of 123 patients were assessed for eligibility. Thirty-four were excluded (age < 20 years, n = 8; requiring assistive devices, n = 6; dependent in activities of daily living, n = 5; cognitive impairment affecting questionnaire comprehension, n = 4; declined participation, n = 11). The final study cohort comprised 89 patients, of whom 68 underwent postoperative rehabilitation and 21 did not. All patients were included in the final analyses. The study flow diagram is shown in Figure 1.
Eighty-nine patients were included in the study. The mean age was 42.08 years (SD = 9.95), with an average body mass index (BMI) of 26.32 kg/m2 (SD = 4.02). Most patients (76.4%) had received postoperative rehabilitation following meniscectomy, and most participants were male (64%). Regarding occupational type, the proportion of patients with sedentary versus active jobs was very similar (51.7% and 48.3%, respectively). Treatment adherence, assessed as the percentage of attended physiotherapy sessions, was high among the treated patients, with a mean of 90.91% (SD: 6.26). Postoperative follow-up corresponded to the medium-to-long-term recovery period (i.e., time since surgery), with a mean of 672 days (SD 383.6) in the rehabilitation group and 1046 days (SD 471.7) in the non-rehabilitation group. No patients were lost to follow-up, and complete outcome data were available for the entire cohort.
Secondary outcomes at assessment favoured the rehabilitation group in clinical domains: lower joint pain intensity (2.18 ± 1.79 vs. 3.38 ± 1.98; p = 0.02), greater knee flexion (132.93 ± 5.86° vs. 128.57 ± 6.43°; p = 0.01), greater total knee range of motion (131.28 ± 7.44° vs. 125.76 ± 9.65°; p = 0.01), and lower kinesiophobia (23.29 ± 5.64 vs. 27.48 ± 5.05; p < 0.001). No relevant differences were observed for categorical variables. Sociodemographic characteristics are summarised in Table 1; sex-based differences in functional performance are reported in Section 3.4, and independent effects of sex and age are presented in the multivariable model in Section 3.5. Table 1 presents the main descriptive statistics for the participants, according to whether they received this intervention following meniscectomy.
Given that the prespecified primary outcome was functional performance assessed by the Timed Up and Go (TUG) test, between-group comparisons for this endpoint are presented first, followed by secondary outcomes, subgroup analyses, and multivariable predictors.

3.2. Functional Performance Based on Receipt of Postoperative Rehabilitation

A significant difference was observed between patients who received postoperative rehabilitation and those who did not (U = 490; p = 0.03), with lower (better) TUG times in the rehabilitation group. Table 2 presents the results of the functional performance analysis stratified by receipt of postoperative rehabilitation. Similarly, Figure 2 illustrates a boxplot comparing functional performance between these two groups.

3.3. Functional Performance in Relation to Pre- and Postoperative Physical Exercise

Patients who had not engaged in preoperative exercise exhibited better postoperative TUG performance (U = 680.0; p = 0.01; rank-biserial r = 0.31, favouring no preoperative exercise). No significant difference was observed for postoperative exercise (U = 750.5; p = 0.08; r = 0.21).

3.4. Functional Performance According to Sex

Female patients demonstrated significantly better functional performance than males (U = 1187.0; p = 0.01), consistent with the mean-rank comparison.

3.5. Predictors of Functional Performance

A multiple linear regression model including postoperative rehabilitation, sex, age, time since surgery, and pre- and postoperative exercise was significant (F [6,82] = 4.89; p < 0.001), explaining 20.9% of the adjusted variance in functional performance (R2adj = 0.21). Female sex (β = 0.75; p = 0.01) and younger age (β = 0.02; p = 0.02) were associated with better functional performance; the remaining variables showed no significant associations (p > 0.05). Occupational type did not show an independent association with functional performance in the adjusted model. Full model details are provided in Table 3 and Table 4.

4. Discussion

The aim of this study was to compare clinical and functional status in patients undergoing meniscectomy according to receipt of postoperative rehabilitation. We also examined sociodemographic and clinical determinants to develop a predictive model of functional performance. The principal finding was that objective functional performance was superior in the rehabilitation group. This occurred despite the already favourable clinical profile of reduced pain, greater range of motion, and lower kinesiophobia observed with rehabilitation, and contrasts with our a priori expectation of a null difference. The between-group effect size for the primary endpoint was small to moderate (r ≈ 0.23), indicating a measurable advantage.
Dias et al. [22] reported that postoperative rehabilitation combined with home-based exercises appears to improve patient-reported knee function and range of motion after arthroscopic meniscectomy. However, the randomised controlled trials included in their meta-analysis were judged to be at moderate-to-high risk of bias, which necessitates cautious interpretation of these results. Similarly, Nutarelli et al. [23] observed no clear superiority of supervised programmes over home-based rehabilitation in terms of physical, functional, occupational, or patient-reported outcomes. Nonetheless, they concluded that home-based postoperative rehabilitation may constitute an effective therapeutic approach after isolated arthroscopic meniscectomy. More recently, the international consensus published by Pujol et al. [24] emphasised that, although the overall quality of the available evidence remains low, there is strong expert agreement supporting the use of criterion-based, milestone-driven rehabilitation protocols rather than rigid, time-based schemes, with adjustments made according to the type of lesion and the surgical procedure undertaken.
Several factors should be considered when comparing our results with previous evidence. First, differences in outcome measures: we used the Timed Up and Go test as the primary endpoint—an objective, performance-based test—whereas many prior studies relied on patient-reported questionnaires, which are more sensitive to subjective perceptions of improvement than to actual motor performance. Second, sample characteristics: our cohort comprised exclusively traumatic meniscal tears, unlike many reports that included degenerative or mixed populations, in which the role and magnitude of rehabilitation effects may differ. Third, unmeasured confounders—including preoperative function, lesion severity, and psychosocial or hormonal influences—may have shaped recovery trajectories. Finally, real-world variability in rehabilitation practice (content, intensity, and timing) contrasts with the structured, standardised interventions typically delivered in clinical trials and may also account for differences in effect estimates.
Taken together, our findings support a beneficial role of postoperative rehabilitation in a homogeneous cohort with traumatic meniscal tears—typically younger and clinically active—by demonstrating measurable advantages in an objective performance-based outcome (TUG) alongside improvements in pain, mobility, and kinesiophobia. While the magnitude of the functional effect appears small-to-moderate, these results, together with prior evidence, favour criterion-based, milestone-driven protocols tailored to lesion type and surgical procedure.
Women in our cohort demonstrated superior functional performance following meniscectomy. The role of sex as a determinant of recovery after this surgical procedure has been debated for several decades, and previous investigations addressing sex-related differences have yielded inconsistent and sometimes contradictory findings. Certain studies have reported that men are more likely to achieve superior functional outcomes after meniscectomy, a result often attributed to their generally higher baseline muscle strength and greater muscle mass, which may provide a mechanical advantage for postoperative recovery [13]. In contrast, other studies have found no statistically significant differences between men and women once potential confounding variables—such as lesion severity, tear location, or concomitant degenerative changes—are accounted for, thereby suggesting that sex per se may not constitute an independent determinant of postoperative function [25]. Beyond these physiological considerations, behavioural and psychosocial factors may also influence recovery. In particular, women have been consistently observed to demonstrate greater adherence to prescribed rehabilitation exercises, reflecting a higher level of consistency, discipline, and long-term commitment to therapeutic protocols [26]. This greater adherence is likely to promote more sustained improvements in neuromuscular control and muscular endurance, which in turn may contribute to enhanced functional performance over time. Taken together, these findings highlight that sex-related differences in outcomes after meniscectomy may be the result of a multifactorial interaction between biological predispositions and behavioural determinants, rather than a simple dichotomy based solely on sex.
Younger patients achieved superior functional results. Multiple studies indicate that age is a key determinant of outcome after meniscectomy, with a clear trend towards superior recovery in younger individuals. This advantage is attributed primarily to a lower prevalence of advanced cartilage lesions and more favourable joint alignment in younger patients [27], alongside generally better baseline physical condition, greater muscle strength, and superior proprioception [28]. In addition, acute traumatic injuries—typically associated with a better prognosis—predominate in younger cohorts, whereas degenerative tears are more common in older adults. Consequently, clinically meaningful improvements are more frequently observed in patients under 50 years of age [29]. Interestingly, time since surgery did not emerge as a significant predictor of functional performance in our adjusted model. This result contrasts with previous studies that have reported progressive deterioration in knee function and performance within 2–5 years after meniscectomy [30,31]. Several explanations may account for this apparent discrepancy. First, our cohort comprised exclusively traumatic meniscal tears, which generally involve younger patients with less degenerative burden compared with the mixed or degenerative populations studied previously. Second, time since surgery was treated as a continuous covariate, which may have limited sensitivity to detect non-linear effects across different follow-up intervals. Finally, the relatively small non-rehabilitation subgroup (n = 21) may have reduced statistical power. For these reasons, our findings should be interpreted with caution and confirmed in larger, prospective longitudinal cohorts.
Overall, these findings suggest that the process of functional recovery following meniscectomy cannot be attributed exclusively to the implementation of postoperative rehabilitation programmes. Although structured rehabilitation is undoubtedly a cornerstone of recovery, the outcomes achieved by patients are also shaped by a complex interplay of additional determinants. Among these, biological sex and chronological age emerge as particularly relevant, given their established influence on muscle strength, regenerative capacity, and susceptibility to degenerative joint changes. Likewise, the degree of adherence to prescribed rehabilitation exercises, together with the level of habitual physical activity prior to surgery, substantially conditions the trajectory of recovery. Patients who maintain higher levels of preoperative activity, for instance, may possess superior baseline strength and neuromuscular control, thereby facilitating faster gains postoperatively, while those with lower levels of adherence to physiotherapy are at risk of suboptimal recovery. Understanding how these diverse factors interact, rather than considering them in isolation, is essential to design rehabilitation strategies that are not only more effective but also tailored to the specific characteristics, needs, and expectations of each patient. Such an individualised approach could maximise functional outcomes and ultimately improve quality of life after meniscectomy.

Study Limitations

This ambispective, observational design precludes causal inference and is susceptible to residual confounding, including confounding by indication. Several potentially influential variables were not available for adjustment, notably baseline functional performance, meniscal tear severity/morphology, and details of postoperative rehabilitation protocols (exercise type, dose/intensity, and timing). Hormonal and psychosocial factors (e.g., pain tolerance, fear-avoidance, and self-efficacy) were also not assessed systematically. To mitigate these constraints as much as possible, strict inclusion criteria were applied (traumatic meniscal tears only) to reduce clinical heterogeneity; all procedures were conducted in reference centres by experienced knee arthroscopists to minimise surgical variability; the primary functional endpoint (Timed Up and Go) was analysed using a non-parametric approach (Mann–Whitney); and a multivariable model was fitted adjusting for relevant sociodemographic and clinical covariates (rehabilitation, sex, age, time since surgery, and pre- and postoperative exercise), with low collinearity. Nevertheless, residual confounding cannot be excluded.
Although the total cohort was adequate for the primary analyses, the comparatively small non-rehabilitation subgroup limits the precision of estimates and increases the risk of type II error for clinically meaningful contrasts; hence, generalisability should be interpreted with caution. Post hoc matching or truncation of follow-up to ≤2 years was considered; however, given the ambispective design and the comparatively small non-rehabilitation subgroup, such a restriction would have substantially reduced statistical power and potentially introduced selection bias. We therefore modelled time since surgery as a continuous covariate, while acknowledging that time-related residual confounding cannot be fully excluded.
Assessments were performed at a single medium-to-long-term time point, and time since surgery differed between groups—being longer in the non-rehabilitation group than in the rehabilitation group. Although this variable was included as a covariate in the multivariable model, time-related residual confounding remains possible, and longitudinal trajectories could not be examined.
Two reference hospital centres contributed patients. While all procedures were undertaken by experienced arthroscopists, we could not verify that identical operative protocols were used across centres, and unmeasured centre effects cannot be ruled out.
Finally, some outcomes (e.g., pain intensity) were self-reported and thus subject to perception bias, which may affect objectivity, whereas the primary functional performance (Timed Up and Go) was performance-based. The restriction of the cohort to traumatic meniscal tears enhances internal comparability but may limit external validity to degenerative populations.

5. Conclusions

Objective functional performance was higher in patients who received postoperative rehabilitation after meniscectomy than in those who did not. Furthermore, rehabilitation was associated with favourable clinical effects, including reduced pain intensity, improved range of motion, and lower kinesiophobia.
Sex and age were the strongest positive predictors of functional recovery: females outperformed males, and younger patients achieved superior outcomes, likely reflecting more favourable baseline joint status and a lower degenerative burden.
Preoperative physical inactivity was associated with better postoperative functional performance, whereas postoperative exercise showed no clear association with functional performances in this cohort.
Overall, recovery after meniscectomy appears to be shaped by a combination of demographic, clinical, and lifestyle factors rather than by postoperative rehabilitation alone. While rehabilitation may not consistently enhance objective functional performance, it confers meaningful clinical benefits that support its role in comprehensive care.
These findings should be interpreted cautiously in light of potential residual confounding and the small non-rehabilitation subgroup, and require validation in larger, ideally randomised, cohorts.

Author Contributions

Conceptualisation, J.L.M.-F. and R.C.-B.; methodology, J.L.M.-F. and R.C.-B.; software, R.C.-B.; validation, J.L.M.-F. and R.C.-B.; formal analysis, R.C.-B.; investigation, J.L.M.-F.; resources, J.L.M.-F.; data curation, J.L.M.-F.; writing—original draft preparation, J.L.M.-F.; writing—review and editing, J.L.M.-F. and R.C.-B.; visualisation, J.L.M.-F. and R.C.-B.; supervision, R.C.-B.; project administration, J.L.M.-F. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Research Ethics Committee of the San Antonio Catholic University of Murcia (protocol code CE112415; approved on 29 November 2024).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data Availability Statement: Data supporting the findings of this study are openly available in the Institutional Repository of the University of Oviedo (RUO) at http://dx.doi.org/10.17811/ruo_datasets.80605.

Acknowledgments

The authors express their gratitude to the participating centres for their involvement in this study, by facilitating the recruitment and evaluation of the patients included in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Bahns, C.; Bolm-Audorff, U.; Seidler, A.; Romero Starke, K.; Ochsmann, E. Occupational risk factors for meniscal lesions: A systematic review and meta-analysis. BMC Musculoskelet. Disord. 2021, 22, 1042. [Google Scholar] [CrossRef] [PubMed]
  2. Englund, M.; Guermazi, A.; Gale, D.; Hunter, D.J.; Aliabadi, P.; Clancy, M.; Felson, D.T. Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons. N. Engl. J. Med. 2008, 359, 1108–1115. [Google Scholar] [CrossRef]
  3. Popper, H.R.; Fliegel, B.E.; Elliott, D.M.; Su, A.W. Surgical Management of Traumatic Meniscus Injuries. Pathophysiology 2023, 30, 618–629. [Google Scholar] [CrossRef] [PubMed]
  4. Bhan, K. Meniscal Tears: Current Understanding, Diagnosis, and Management. Cureus 2020, 12, e8590. [Google Scholar] [CrossRef] [PubMed]
  5. Rotini, M.; Papalia, G.; Setaro, N.; Luciani, P.; Marinelli, M.; Specchia, N.; Gigante, A. Arthroscopic surgery or exercise therapy for degenerative meniscal lesions: A systematic review of systematic reviews. Musculoskelet. Surg. 2023, 107, 127–141. [Google Scholar] [CrossRef]
  6. Burgess, C.J.; De Cicco, F.L. Meniscectomy; StatPearls Publishing: Treasure Island, FL, USA, 2023. [Google Scholar]
  7. Li, J.; Zhu, W.; Gao, X.; Li, X. Comparison of Arthroscopic Partial Meniscectomy to Physical Therapy following Degenerative Meniscus Tears: A Systematic Review and Meta-analysis. BioMed Res. Int. 2020, 2020, 1709415. [Google Scholar] [CrossRef]
  8. Abram, S.G.F.; Hopewell, S.; Monk, A.P.; Bayliss, L.E.; Beard, D.J.; Price, A.J. Arthroscopic partial meniscectomy for meniscal tears of the knee: A systematic review and meta-analysis. Br. J. Sports Med. 2020, 54, 652–663. [Google Scholar] [CrossRef]
  9. Rohella, D.; Swathy, A.P.J.; Ajmeera, R.; Das, P.; Tiwari, R.V.; Tiwari, H.D. Comparison of Quality of Life in Patients Operated for Knee Surgery via Conventional Method and Arthroscopy: An Original Research. J. Pharm. Bioallied Sci. 2023, 15, S293–S298. [Google Scholar] [CrossRef]
  10. Roos, E.M.; Roos, H.P.; Ryd, L.; Lohmander, L.S. Substantial disability 3 months after arthroscopic partial meniscectomy: A prospective study of patient-relevant outcomes. Arthroscopy 2000, 16, 619–626. [Google Scholar] [CrossRef]
  11. Bedrin, M.D.; Kartalias, K.; Yow, B.G.; Dickens, J.F. Degenerative Joint Disease After Meniscectomy. Sports Med. Arthrosc. Rev. 2021, 29, e44–e50. [Google Scholar] [CrossRef]
  12. Roos, E.M.; Östenberg, A.; Roos, H.; Ekdahl, C.; Lohmander, L.S. Long-term outcome of meniscectomy: Symptoms, function, and performance tests in patients with or without radiographic osteoarthritis compared to matched controls. Osteoarthr. Cartil. 2001, 9, 316–324. [Google Scholar] [CrossRef] [PubMed]
  13. Mai, C.; Mai, P.; Hinz, M.; Saenger, R.; Seil, R.; Tischer, T.; Roessler, P.P. Females show worse functional performance and quality of life compared to males 2 years after meniscus surgery: Data analysis from the German Arthroscopy Registry. Knee Surg. Sports Traumatol. Arthrosc. 2024, 32, 2644–2654. [Google Scholar] [CrossRef] [PubMed]
  14. Vivekanantha, P.; Diao, D.; Cohen, D.; Murphy, B.; De Sa, D. Strength-based rehabilitation on clinical outcomes in patients post-partial meniscectomy: A systematic review and meta-analysis. Am. J. Phys. Med. Rehabil. 2023, 102, 764–772. [Google Scholar] [CrossRef] [PubMed]
  15. Ericsson, Y.B.; Dahlberg, L.E.; Roos, E.M. Effects of functional exercise training on performance and muscle strength after meniscectomy: A randomized trial. Scand. Med. Sci. Sports 2009, 19, 156–165. [Google Scholar] [CrossRef]
  16. Hsu, C.J.; George, S.Z.; Chmielewski, T.L. Fear-Avoidance and self-efficacy psychosocial factors are altered after partial meniscectomy an associated with rehabilitation outcomes. Int. J. Sports Phys. Ther. 2020, 15, 557–570. [Google Scholar] [CrossRef]
  17. von Elm, E.; Altman, D.G.; Egger, M.; Pocock, S.J.; Gøtzsche, P.C.; Vandenbroucke, J.P.; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007, 335, 806–808. [Google Scholar] [CrossRef]
  18. Podsiadlo, D.; Richardson, S. The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons. J. Am. Geriatr. Soc. 1991, 39, 142–148. [Google Scholar] [CrossRef]
  19. Hancock, G.E.; Hepworth, T.; Wembridge, K. Accuracy and reliability of knee goniometry methods. J. Exp. Ortop. 2018, 5, 46. [Google Scholar]
  20. Karcioglu, O.; Topacoglu, H.; Dikme, O.; Dikme, O. A systematic review of the pain scales in adults: Which to use? Am. J. Emerg. Med. 2018, 36, 707–714. [Google Scholar] [CrossRef]
  21. Weermeijer, J.D.; Meulders, A. Clinimetrics: Tampa Scale for Kinesiophobia. J. Physiother. 2018, 64, 126. [Google Scholar] [CrossRef]
  22. Dias, J.M.; Mazuquin, B.F.; Mostagi, F.Q.R.C.; Lima, T.B.; Silva, M.A.C.; Resende, B.N.; da Silva, R.M.B.; Lavado, E.L.; Cardoso, J.R. The effectiveness of postoperative physical therapy treatment in patients who have undergone arthroscopic partial meniscectomy: Systematic review with meta-analysis. J. Orthop. Sports Phys. Ther. 2013, 43, 560–576. [Google Scholar] [CrossRef] [PubMed]
  23. Nutarelli, S.; Delahunt, E.; Cuzzolin, M.; Delcogliano, M.; Candrian, C.; Filardo, G. Home-Based vs Supervised Inpatient and/or Outpatient Rehabilitation Following Knee Meniscectomy: A Systematic Review and Meta-analysis. JAMA Netw. Open 2021, 4, e2111582. [Google Scholar] [CrossRef] [PubMed]
  24. Pujol, N.; Giordano, A.O.; Wong, S.E.; Beaufils, P.; Monllau, J.C.; Arhos, E.K.; Becker, R.; Della Villa, F.; Goodloe, J.B.; Irrgang, J.J.; et al. The formal EU-US Meniscus Rehabilitation 2024 Consensus: An ESSKA-AOSSM-AASPT initiative. Part I-Rehabilitation management after meniscus surgery (meniscectomy, repair and reconstruction). Knee Surg. Sports Traumatol. Arthrosc. 2025, 33, 3002–3013. [Google Scholar] [CrossRef] [PubMed]
  25. Haviv, B.; Bronak, S.; Kosashvili, Y.; Thein, R. Gender Effect on the Outcome of Partial Medial Meniscectomy. Orthopedics 2015, 38, e925–e928. [Google Scholar] [CrossRef]
  26. Hanson, C.L.; Neubeck, L.; Kyle, R.G.; Brown, N.; Gallagher, R.; Clark, R.A.; McHale, S.; Dawkes, S. Gender Differences in Uptake, Adherence and Experiences: A Longitudinal, Mixed-Methods Study of a Physical Activity Referral Scheme in Scotland, UK. Int. J. Environ. Res. Public Health 2021, 18, 1700. [Google Scholar] [CrossRef]
  27. Aprato, A.; Sordo, L.; Costantino, A.; Sabatini, L.; Barberis, L.; Testa, D.; Massè, A. Outcomes at 20 years after meniscectomy in young patients. Knee 2021, 29, 49–54. [Google Scholar] [CrossRef]
  28. Joshi, A.; Sable, A.S.; Usman, S.; Sabnis, B.; Sane, P.; Bagaria, V. Clinical outcomes of arthroscopic partial meniscectomy at 10 years follow up—A retrospective cohort study. J. Arthrosc. Surg. Sports Med. 2024, 5, 17–23. [Google Scholar] [CrossRef]
  29. Beletsky, A.; Gowd, A.K.; Liu, J.N.; Manderle, B.J.; Yanke, A.B.; Forsythe, B.; Cole, B.J.; Verma, N. Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis. Arthrosc. Sports Med. Rehabil. 2020, 2, e723–e733. [Google Scholar] [CrossRef]
  30. Noorduyn, J.C.; Van De Graaf, V.A.; Willigenburg, N.W.; Scholten-Peeters, G.G.; Kret, E.J.; Van Dijk, R.A.; Buchbinder, R.; Hawker, G.A.; Coppieters, M.W.; Poolman, R.W.; et al. Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People with Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial. JAMA Netw. Open 2022, 5, e2220394. [Google Scholar] [CrossRef]
  31. Masaracchio, M.F.; Kirker, K.; Loghmani, P.; Gramling, J.; Mattia, M.; States, R. The Prevalence of Tibiofemoral Knee Osteoarthritis Following Arthroscopic Partial Meniscectomy Is Variably Reported in General, and Over Time: A Systematic Review with a Minimum of 5-Year Follow-Up. Arthrosc. Sports Med. Rehabil. 2022, 4, e1203–e1218. [Google Scholar]
Surgeries 06 00079 g001
Figure 1. Flow diagram of patient inclusion, exclusions, and final study cohort allocation according to receipt of postoperative rehabilitation.
Figure 1. Flow diagram of patient inclusion, exclusions, and final study cohort allocation according to receipt of postoperative rehabilitation.
Surgeries 06 00079 g001
Surgeries 06 00079 g002
Figure 2. Functional performance analysis based on receipt of postoperative rehabilitation after meniscectomy. Note: Lower (better) TUG times indicate superior performance.
Figure 2. Functional performance analysis based on receipt of postoperative rehabilitation after meniscectomy. Note: Lower (better) TUG times indicate superior performance.
Surgeries 06 00079 g002
Table 1. Descriptive statistics of central tendency (mean) and dispersion (standard deviation) of the variables assessed in the study.
Table 1. Descriptive statistics of central tendency (mean) and dispersion (standard deviation) of the variables assessed in the study.
VariablesPostoperative RehabilitationSig.
YesNo
Age (years)41.19 (9.74)44.95 (10.33)0.13 †
Weight (kg)78.07 (12.42)80.67 (10.73)0.30 †
Height (cm)173.94 (8.24)170.14 (6.54)0.05 †
Body mass index (kg/m2)25.83 (3.98)27.91 (3.81)0.04 †
Functional performance (s)7.79 (1.24)8.44 (1.33)0.03 §
Joint pain intensity (0–10)2.18 (1.79)3.38 (1.98)0.02 §
Knee flexion (degrees)132.93 (5.86)128.57 (6.43)0.01 §
Knee extension (degrees)1.65 (2.84)2.81 (4.41)0.43 §
Knee range of motion (degrees)131.28 (7.44)125.76 (9.65)0.01 §
Kinesiophobia (11–44)23.29 (5.64)27.48 (5.05)0.00 §
Time since surgery (days)671.82 (383.62)1046.90 (471.67)0.00 †
n (%)n (%)
Sex (Female/Male)23/45 (33.8/66.2)9/12 (42.9/57.1)0.45 ‡
Occupational activity (Active/Sedentary)34/34 (50/50)9/12 (42.9/57.1)0.56 ‡
Exercise prior to surgery (No/Yes)38/30 (55.9/44.1)10/11 (47.6/52.4)0.51 ‡
Exercise following surgery (No/Yes)27/41 (39.7/60.3)9/12 (42.9/57.1)0.79 ‡
n: number of patients; %: percentage; Sig.: significance; †: parametric Student’s t-test for independent samples; §: non-parametric Mann–Whitney U test; ‡: chi-square test.
Table 2. Comparison of functional performance based on postoperative rehabilitation after meniscectomy.
Table 2. Comparison of functional performance based on postoperative rehabilitation after meniscectomy.
Postoperative RehabilitationMd (IQR)USESig.
Yes7.68 (1.25)490103.480.03
No8.33 (1.62)
Md: median; IQR: interquartile range; U: Mann–Whitney U; SE: standard error; Sig.: statistical significance.
Table 3. Summary of the multiple linear regression model based on the independent variables.
Table 3. Summary of the multiple linear regression model based on the independent variables.
ModelRR2Adjusted R2Standard ErrorFSig.
10.510.260.211.144.880.000
R: multiple correlation coefficient; R2: explained variance; Adjusted R2: adjusted explained variance; F: overall model test; Sig.: statistical significance.
Table 4. Multiple linear regression model based on the independent variables.
Table 4. Multiple linear regression model based on the independent variables.
ModelβSig.95% CIVIF
(Constant)6.850.005.29; 8.41
Postoperative rehabilitation−0.340.28−0.98; 0.291.26
Sex0.750.010.22; 1.291.12
Age0.020.020.00; 0.051.07
Time since surgery0.000.230.00; 0.001.27
Exercise before surgery−0.320.27−0.90; 0.261.44
Exercise after surgery−0.430.13−0.99; 0.131.33
β: standardised beta coefficient; Sig.: significance level; 95% CI: 95% confidence interval for the unstandardised coefficient (B); VIF: variance inflation factor (indicator of collinearity).
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Martínez-Fernández, J.L.; Cuesta-Barriuso, R. Postoperative Rehabilitation and Functional Recovery After Knee Meniscectomy: An Ambispective Cohort Study. Surgeries 2025, 6, 79. https://doi.org/10.3390/surgeries6040079

AMA Style

Martínez-Fernández JL, Cuesta-Barriuso R. Postoperative Rehabilitation and Functional Recovery After Knee Meniscectomy: An Ambispective Cohort Study. Surgeries. 2025; 6(4):79. https://doi.org/10.3390/surgeries6040079

Chicago/Turabian Style

Martínez-Fernández, Juan Luis, and Rubén Cuesta-Barriuso. 2025. "Postoperative Rehabilitation and Functional Recovery After Knee Meniscectomy: An Ambispective Cohort Study" Surgeries 6, no. 4: 79. https://doi.org/10.3390/surgeries6040079

APA Style

Martínez-Fernández, J. L., & Cuesta-Barriuso, R. (2025). Postoperative Rehabilitation and Functional Recovery After Knee Meniscectomy: An Ambispective Cohort Study. Surgeries, 6(4), 79. https://doi.org/10.3390/surgeries6040079

Article Metrics

Back to TopTop