With increasing understanding of the detrimental effects of the meniscectomized knee on outcomes and long-term durability, there is an ever increasing emphasis on meniscal preservation through repair. Repair in the young athlete is particularly challenging given the goals of returning to high-level sports. A healed meniscus is only the beginning of successful return to activity, and the understanding of “protection with progression” must be emphasized to ensure optimal return to performance. The principles of progression from low to high loads, single to multiplane activity, slow to high speeds, and stable to unstable platforms are cornerstones to this process. Emphasis on the kinetic chain environment that the knee will function within cannot be overemphasized. Communication between the operating surgeon and rehabilitation specialist is critical to optimizing effective return to sports.