Return to Activity After Knee Arthroscopy

James H. Lubowitz, M.D., Myna Ayala, S.T., and David Appleby, M.P.H.

Purpose: Although knee arthroscopy is described as minimally invasive, return to activity has been
poorly quantitated. Our purpose is to test the hypothesis that most patients return to unrestricted
activity within 4 weeks after knee arthroscopy. Methods: After prospective power analysis, 72
consecutive patients who underwent arthroscopic knee partial medial meniscectomy, partial lateral
meniscectomy, chondroplasty, loose body removal, or synovectomy (or some combination thereof)
by a single surgeon were included. Patients with Workers’ Compensation claims were excluded.
Postoperative instructions were standardized. Patients completed a diary preoperatively and at 1, 2,
3, 4, 8, 12, 16, 20, and 24 weeks postoperatively indicating their highest International Knee Documen-
tation Committee (subjective) level of activity, as well as whether activity was restricted for knee-related
reasons. Results: Preoperatively, 88% of patients described knee-related activity restriction. By 2 weeks
postoperatively, only 74% described knee-related activity restriction, a significant difference (P ! .039);
this improved to 38% at 4 weeks and was only 4% at 20 weeks. In addition, 82% returned to light activity
such as walking, housework, or yard work after 1 week, with 94% after 2 weeks and 100% after 4 weeks.
Conclusions: Our results support the hypothesis: Most patients had no knee-related activity restriction 4
weeks after arthroscopy. Level of Evidence: Level IV, therapeutic case series. Key Words: Knee
arthroscopy—Rehabilitation—Sports—Recovery—Activity.

P atients preparing to have knee arthroscopy want

to know: “How soon after surgery can I return to
activity? How soon can I walk?”
Unfortunately, return to activity after knee arthros-
copy has not been well quantitated. Knee arthroscopy
is considered a minimally invasive, low-morbidity
surgery with a rapid recovery,1 but few studies address
the rate of return to activity. Review of the published
literature reveals 2 studies quantitating knee arthros-
From the Taos Orthopaedic Institute Research Foundation
(J.H.L., M.A.), Taos, New Mexico, U.S.A., and Smith & Nephew
(D.A.), Andover, Massachusetts, U.S.A.
The authors have a financial relationship (grant funding, con-
sultant, or employee) with Smith & Nephew, Andover, Massachu-
setts, related to the topic of this manuscript.
Address correspondence and reprints requests to James H.
Lubowitz, M.D., 1219-A Gusdorf Rd, Taos, NM 87571, U.S.A.
E-mail: jlubowitz@kitcarson.net
© 2008 by the Arthroscopy Association of North America
0749-8063/08/2401-6372$34.00/0
doi:10.1016/j.arthro.2007.07.026
Note: To access the supplementary tables accompanying this
report, visit the January issue of Arthroscopy at www.
arthroscopyjournal.org.
copy recovery time in athletes. Lysholm and Gilquist2
reported that 68% of athletes resumed full athletic
training within 2 weeks of arthroscopic meniscec-
tomy, and Stetson and Templin3 reported that recre-
ational athletes having 2-portal or 3-portal arthroscopy
“return to work or normal activity” at a mean of 9 days
or 19 days after knee arthroscopy. However, neither of
these studies evaluated a diverse population including
athletes and nonathletes, and neither of these studies
evaluated whether study subjects had knee-related ac-
tivity limitation despite return to full athletic training
or return to work or normal activity.
The purpose of this investigation is to quantitate
return to unrestricted activity (no knee-related activity
limitation) after knee arthroscopy in a diverse popu-
lation of knee arthroscopy patients. We hypothesize
that most patients return to unrestricted activity within
4 weeks after knee arthroscopy.
METHODS
After sample size analysis and institutional review
board approval, consecutive patients undergoing rou-
tine knee arthroscopy by a single surgeon were in-

58 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 24, No 1 (January), 2008: pp 58-61
 RETURN TO ACTIVITY AFTER KNEE ARTHROSCOPY
cluded in this prospective case series. Routine knee
arthroscopy included the following procedures: partial
medial meniscectomy, partial lateral meniscectomy,
chondroplasty, loose body removal, or synovectomy.
Excluded were patients having meniscus repair, lateral
retinacular release, ligament reconstruction, or carti-
lage restoration procedures; patients unwilling to com-
plete study informed consent or follow-up; and pa-
tients with Workers’ Compensation insurance claims.
All patients had 2-portal knee arthroscopy performed
under general anesthesia in a hospital-based ambula-
tory surgery center.
Patients completed a diary preoperatively and at 1,
2, 3, 4, 8, 12, 16, 20, and 24 weeks postoperatively
indicating their highest level of activity, as well as
whether the level of activity was restricted for knee-
related reasons. Patient age and gender were also
recorded. Level of activity was defined according to
the 2000 International Knee Documentation Commit-
tee Subjective Knee Evaluation Form as follows:
“very strenuous activities like jumping or pivoting as
in basketball or soccer,” “strenuous activities like
heavy physical work, skiing or tennis,” “moderate
activities like moderate physical work, running or
jogging,” “light activities like walking, housework or
yard work,” or “unable to perform any of the above
activities due to knee pain.” A study coordinator con-
tacted each study subject by phone at the time of each
follow-up to confirm with the patient that the diary
had been completed (or to the patient to do so).
Postoperative instructions were standardized and
provided to each patient in writing. In addition, they
were provided with a “Patient Introduction to Knee
Surgery Rehabilitation and Return to Activity” de-
signed to minimize study bias by encouraging them to
determine their own return to activity (Table 1, online
only, available at www.arthroscopyjournal.org).
Patients were instructed to arrange their first fol-
low-up evaluation 1.5 weeks postoperatively. Physical
therapy was prescribed according to the following
algorithm: if a patient showed a tense knee effusion,
gross quadriceps muscle inhibition, flexion contrac-
ture, flexion less than 90°, or pain deemed out of
proportion to the magnitude of the procedure or if a
patient requested physical therapy, a written “Physical
Therapy Prescription” was completed in a standard-
ized manner designed to minimize study bias (Table 1,
online only, available at www.arthroscopyjournal
.org). If patients did not meet these criteria, formal
physical therapy was not prescribed.
59
Statistical Methods
A priori power analysis was performed. A sample
size of 70 was calculated to have greater than 90%
power to test the hypothesis that most patients would
have no knee-related activity limitations at 4 weeks
postoperatively. The Fisher exact test was applied to
detect a difference in the proportion of patients with-
out knee-related activity limitation from preopera-
tively to postoperatively. P " .05 was considered
statistically significant.
RESULTS
This study included 72 consecutive patients (36
male and 36 female; mean age, 44 years [range, 12 to
75 years]). No patients were lost to follow-up. No
patients had infection, deep venous thrombosis, or
other notable postoperative complications. Results are
indicated in Fig 1 and Tables 2 and 3 (online only,
available at www.arthroscopyjournal.org).
Preoperatively, 88% of patients indicated knee-
related activity restriction. By 2 weeks postopera-
tively, only 74% of patients described knee-related
activity restriction, a significant difference from pre-
operatively (P ! .039); this improved to 38% at 4
weeks and 4% at 20 weeks (Fig 1). In addition, 82%
of patients returned to (restricted or unrestricted) light
activities like walking, housework, or yard work (or
higher level of activity) after 1 week, with 94% after
2 weeks and 100% after 4 weeks (Table 2, online only,
available at www.arthroscopyjournal.org).
DISCUSSION
Knee arthroscopy is described as minimally inva-
sive surgery, and patients preparing to have knee
arthroscopy are often told that the procedure has a
rapid recovery.1 Patients preparing to have knee ar-
throscopy may be so counseled: our results show that
at 4 weeks postoperatively, most patients (62%) re-
turned to activity with no restrictions for knee-related
reasons. In addition, 82% of patients returned to walk-
ing by 1 week postoperatively, and all patients re-
turned to walking by 4 weeks postoperatively.
Our results also show that knee arthroscopy is effi-
cacious. Preoperatively, 88% of patients described
knee-related activity restriction. At 20 weeks postop-
eratively (and at final follow-up of 24 weeks), only
4% of patients described knee-related activity restric-
tion. We acknowledge as a limitation of our study,
however, that a minimum of 24 months’ follow-up
60 J. H. LUBOWITZ ET AL.
FIGURE 1. Percentage of patients with knee-related restriction of activity over time.
may be required to determine efficacy (as discussed
later) and evaluation of efficacy was not our purpose.
A paucity of literature specifically quantitates the
rate of return to activity after knee arthroscopy; rather,
a literature review generally revealed articles related
to the effectiveness of physical therapy4 or related to
return to activity after anterior cruciate ligament re-
construction and rehabilitation.5 However, Lysholm
and Gilquist2 did report that 68% of athletes resumed
full athletic training within 2 weeks of arthroscopic
meniscectomy. This is a faster return to activity than
in our investigation and may suggest that athletes
recover more quickly than a diverse population of
athletes and nonathletes.
Hau et al.6 evaluated driving reaction time after
right knee arthroscopy. Most patients had significant
improvement in reaction time from preoperatively to 4
weeks postoperatively. Bearing in mind that we report
return to unrestricted activity as compared with driv-
ing reaction time, our results are similar; future re-
search will include investigation of driving ability
after knee arthroscopy.
In patients who had knee arthroscopy using either a
2- or 3-portal technique, Stetson and Templin3 com-
pared the times from surgery to “return to work or
normal activities.” There were no Workers’ Compen-
sation patients in the study, and all patients were
recreational athletes. Patients in the 2-portal group
“returned to work and normal activities” at a mean of
9 days after surgery compared with 19 days in the
3-portal group. This is a faster return to activity than
in our investigation. (All patients in our study had
2-portal arthroscopy.) Again, this may suggest that
athletes recover more quickly than a diverse popula-
tion of athletes and nonathletes. In addition, this in-
vestigation does not consider whether study subjects
had knee-related activity limitation despite “return to
work and normal activities.”
Noyes et al.7 evaluated work-related activity limi-
tation as a result of knee disorders. Return to (non–
work-related) activity was not the purpose of their
study. Nevertheless, they did emphasize the impor-
tance of determining whether limitations were “knee-
related”; thus, our study design adapted this method.
Goodwin et al.8 evaluated the effectiveness of super-
vised physical therapy after arthroscopic partial me-
niscectomy. Although rate of return to activity was not
specifically quantitated, they did emphasize the im-
portance of “accurately reflect[ing] real life” by avoid-
ing tight “control over the activities performed by
subjects.” They also emphasized that “diaries to
record . . . activities for subjects . . . would have been
useful”; thus our study design adapted these methods.
Limitations of our study include examples of selection
bias: some patients required physical therapy, and some
did not. In addition, patients were of diverse age and sex
and had diverse pathology. By design, our series repre-
sents the real world of arthroscopic knee surgery prac-
tice, and we minimize selection bias by using strict
inclusion and exclusion criteria and a practical clinical
algorithm to determine indications for physical therapy.
Future research could use more rigorous inclusion or
exclusion criteria and could use physical therapy in all
patients (or in no patients). An additional limitation is
that different patients may have been encouraged to
return (or not return) to activity at different rates (despite
 RETURN TO ACTIVITY AFTER KNEE ARTHROSCOPY
our attempt to minimize this bias with standardized writ-
ten instructions). Another limitation is that follow-up
was 24 weeks (6 months). Although this follow-up is
suitable for quantitation of rate of return to activity, a
minimum of 24 months’ follow-up is required to deter-
mine efficacy. Future research will evaluate patient out-
come at 24 months’ follow-up.
Our study also has strengths. Transfer bias was
minimized: complete follow-up was obtained on all
patients. Performance bias was minimized: a single
surgeon performed all operations. Reporting bias was
minimized: the described levels of activity and the
terminology (“restricted due to knee-related reasons”)
have been validated by the International Knee Docu-
mentation Committee, which is widely reported.
CONCLUSIONS
Our results support the hypothesis that most patients
return to unrestricted activity within 4 weeks after
knee arthroscopy.
61
REFERENCES
1. Paulos LE, Rosenberg TD, Beck CL. Postsurgical care for
arthroscopic surgery of the knee and shoulder. Orthop Clin
North Am 1988;19:715-723.
2. Lysholm J, Gilquist J. Arthroscopic meniscectomy in athletes.
Am J Sports Med 1983;11:436-438.
3. Stetson WB, Templin K. Two- versus three-portal technique
for routine knee arthroscopy. Am J Sports Med 2002;30:108-
111.
4. Jokl P, Stull PA, Lynch JK, Vaughan V. Independent home
versus supervised rehabilitation following arthroscopic knee
surgery—A prospective randomized trial. Arthroscopy 1989;31:
285-290.
5. Schenck RC Jr, Blaschak MJ, Lance ED, Turturro TC, Holmes
CF. A prospective outcome study of rehabilitation programs and
anterior cruciate ligament reconstruction. Arthroscopy 1997;5:
298-305.
6. Hau R, Csongvay S, Bartlett J. Driving reaction time after right
knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2000;
8:89-92.
7. Noyes FR, Mooar LA, Barber SD. The assessment of work-
related activities and limitations in knee disorders. Am J Sports
Med 1991;19:178-188.
8. Goodwin PC, Morrissey MC, Omar RZ, Brown M, Southall K,
McAuliffe TB. Effectiveness of supervised physical therapy in
the early period after arthroscopic partial meniscectomy. Phys
Ther 2003;6:520-535.
 RETURN TO ACTIVITY AFTER KNEE ARTHROSCOPY 61.e1

TABLE 1. Standardized Patient Instructions

or Prescriptions
1. Postoperative instructions: Minimize activity the day of
surgery. Elevate the knee above the waist, on pillows, while
reclining. Walk with crutches for 1-2 days, and then
discontinue the use of crutches; bend the knee to tolerance.
Exercise the calf by pumping the foot for 5 minutes, 3 times a
day, and straight leg raising 10-15 times, 3 times a day. Do
not use exercise equipment (except stationary cycle if
available—wait 3 days and be gentle).
2. Patient introduction to knee surgery rehabilitation and return
to activity: After surgery, your body, including your knee,
may not respond as it has in the past. Be cautious and test
your body and knee before you resume activity. Each
patient’s recovery is different: if you have questions, check
with your doctor. There are no medical rules with regard to
when a patient may return to activity after knee surgery.
Patients must determine on an individual case-by-case basis
when they feel they are able to return to activity in
consultation with their physician and/or physical therapist.
Rehabilitation after knee arthroscopy: Patients having knee
arthroscopy must follow their “Postoperative Instructions”
sheets and may gradually resume activities. At their first
follow-up office visit (1.5 weeks), formal physical therapy
may be recommended for patients with significant swelling,
weakness, stiffness, or pain. (Formal physical therapy will not
be prescribed in all cases.)
3. Physical therapy prescription: Physical therapy evaluate and
treat. Diagnosis: knee arthroscopy.
 61.e2

TABLE 2. Number of Patients With and Without Knee-Related Activity Restriction by Level of Activity Over Time
Knee-Related Activity Limitation

Postoperatively

Preoperatively 1 wk 2 wk 3 wk 4 wk 8 wk 12 wk 16 wk 20 wk 24 wk

Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No

Level of activity
Very strenuous 3 2 0 0 0 1 0 3 0 3 0 5 0 5 0 6 0 6 0 6
Strenuous 0 1 0 1 0 1 0 3 1 4 1 7 1 8 0 8 0 10 0 10
Moderate 11 2 5 1 7 6 3 11 2 18 2 20 3 21 3 25 0 27 0 27
Light 36 4 48 4 42 11 35 15 24 20 16 21 11 23 5 25 3 26 3 26
J. H. LUBOWITZ ET AL.

Unable 13 0 13 0 4 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0
Total 63 9 66 6 53 19 40 32 27 45 19 53 15 57 8 64 3 69 3 69
 RETURN TO ACTIVITY AFTER KNEE ARTHROSCOPY 61.e3

TABLE 3. Cohort Demographics and Results

Preoperative
Knee-
Procedure Related Postoperative Knee-Related Activity Limitation
Patient Age Activity Physical
No. Gender (yr) MM Chondro LM LB Syno Limitation 1 wk 2 wk 3 wk 4 wk 8 wk 12 wk 16 wk 20 wk 24 wk Therapy

1 Male 53 X X X X X X
2 Female 17 X X X X
3 Male 44 X X X X
4 Female 22 X X X X X
5 Female 56 X X X X X X
6 Male 54 X X X X X
7 Female 73 X X X X X X
8 Male 63 X X X X X
9 Female 75 X X X X X X X X
10 Female 61 X X X X X X X X
11 Male 61 X X X X
12 Female 69 X X X X X
13 Male 44 X X X X
14 Male 54 X X X X X X X X X
15 Female 51 X X X X X X X X
16 Male 43 X X X X X
17 Male 55 X X X X X X
18 Female 17 X X X X X X X
19 Male 51 X X X X X X X
20 Male 55 X X X X X X X X X X
21 Female 54 X X X X X X X X
22 Male 51 X X X X X X X X X X
23 Female 40 X X X
24 Male 16 X X X X X X
25 Male 33 X X X X X
26 Female 12 X X X X X X X X
27 Female 58 X X X X X X X X
28 Male 58 X X X X X X X
29 Female 39 X X X X X
30 Male 56 X X X X X X X
31 Male 53 X X X X
32 Male 52 X X X X X X X X
33 Female 42 X X X X X
34 Male 15 X X X X X X
35 Female 62 X X X X X X X
36 Male 55 X X X X X X X
37 Male 51 X X X X X X X X X X
38 Female 38 X X X X X X X
39 Male 12 X X X X X X X X
40 Female 44 X X X X X
41 Male 17 X X X X X
42 Male 45 X X X X X X
43 Female 13 X X X X X X X X
44 Female 26 X X X X X X X
45 Male 55 X X X X X X X X
46 Male 27 X X X X X X X X
47 Male 54 X X X X X X
48 Male 36 X X X X X
49 Female 61 X X X X
50 Male 47 X X X X X X X
51 Male 16 X X X X X X
52 Female 67 X X X X X X X X
53 Female 21 X X X X X
54 Female 14 X X X X X X X X
55 Female 49 X X X X X X X
56 Male 49 X X X X X
57 Male 59 X X X X
58 Male 18 X X X X X X X X X X
59 Female 53 X X X X X X X X X X X
60 Female 28 X X X X X X X X X X X X
61 Female 38 X X X X X X X X X X X X X
62 Female 43 X X X X X X X X X
63 Female 60 X X X X X X X X X X X X
64 Female 42 X X X X X X X X X X X X X X
65 Male 35 X X X X X X X X X X
61.e4 J. H. LUBOWITZ ET AL.

TABLE 3. Continued
Preoperative
Knee-
Procedure Related Postoperative Knee-Related Activity Limitation
Patient Age Activity Physical
No. Gender (yr) MM Chondro LM LB Syno Limitation 1 wk 2 wk 3 wk 4 wk 8 wk 12 wk 16 wk 20 wk 24 wk Therapy

66 Female 38 X X X X X X X X X X X
67 Female 52 X X X X X X X X X X X
68 Female 60 X X X X X X X X X X
69 Female 61 X X X X X X X X X X
70 Male 44 X X X X X X X X X X X
71 Female 53 X X X X X X X X X X X X
72 Male 40 X X X X X X X X X

Abbreviations: Chondro, chondroplasty; LB, loose body removal; LM, partial lateral meniscectomy; MM, partial medial meniscectomy; Syno, synovectomy.