What is the recommended follow-up schedule 2.5 months after Anterior Cruciate Ligament (ACL) and meniscus repair surgery?

Follow-Up Schedule After ACL and Meniscus Repair Surgery at 2.5 Months

At 2.5 months post-ACL and meniscus repair surgery, patients should transition to the intermediate phase of rehabilitation with a focus on progressive strengthening, neuromuscular training, and functional activities, with follow-up appointments every 2-4 weeks until the 6-month mark. 1

Current Rehabilitation Status at 2.5 Months

At 2.5 months post-surgery, patients should have achieved:

• Full knee extension range of motion
• Near-normal knee flexion (≥95%)
• Minimal to no effusion
• Basic quadriceps control with LSI >80%
• Ability to perform basic closed kinetic chain exercises

Recommended Follow-Up Schedule

Immediate Follow-Up (2.5-3 months)

• Orthopedic surgeon visit: To assess surgical healing, knee stability, and ROM
• Physical therapy: 2-3 sessions per week with progression to:
  • Open kinetic chain exercises with full ROM progression
  • Advanced strengthening exercises
  • More challenging neuromuscular control exercises

Mid-Term Follow-Up (3-4 months)

• Physical therapy: 2 sessions per week
• Orthopedic surgeon visit: One visit at 4 months to:
  • Assess ligament stability (Lachman test, pivot shift)
  • Evaluate meniscal healing
  • Clear for running if appropriate criteria are met

Late Intermediate Phase (4-6 months)

• Physical therapy: 1-2 sessions per week
• Orthopedic assessment: One visit at 6 months for:
  • Comprehensive evaluation of knee function
  • Isokinetic strength testing
  • Functional performance assessment
  • Discussion of return-to-sport timeline

Key Rehabilitation Components to Monitor

Strength Training

• Progress from basic strengthening to:
  • Advanced closed kinetic chain exercises
  • Open kinetic chain exercises with full ROM
  • Eccentric training for greater strength gains 1

Neuromuscular Training

• Add plyometric exercises when appropriate
• Include agility training to improve subjective function 1
• Incorporate sport-specific movement patterns

Functional Activities

• Begin running program if criteria are met:
  • 95% knee flexion ROM
  • Full extension ROM
  • No/minimal effusion
  • LSI >80% for quadriceps strength
  • Pain-free repeated single-leg hopping 1

Assessment Criteria for Progression

At each follow-up visit, clinicians should assess:

1. Pain and effusion: Should be minimal to none
2. Range of motion: Full extension, ≥95% flexion compared to unaffected side
3. Strength: Progressive improvement in quadriceps and hamstring strength
4. Functional performance: Ability to perform increasingly complex movements
5. Psychological readiness: Monitor fear of reinjury and confidence

Common Pitfalls and How to Avoid Them

1. Neglecting quadriceps strengthening

   • A preoperative deficit in quadriceps strength >20% has significant negative consequences for outcomes 2 years after ACLR 1
   • Ensure progressive quadriceps strengthening remains a priority

2. Progressing too quickly

   • Progression should be goal-based rather than strictly time-based 1
   • Only advance when specific criteria are met for each phase

3. Overlooking psychological factors

   • Assess psychological readiness using validated tools (ACL-RSI, Tampa Scale of Kinesiophobia)
   • Address fear of reinjury through education and graduated exposure

4. Inadequate meniscus protection

   • Meniscal repair with ACL reconstruction requires careful monitoring as chondral damage may progress faster than with intact menisci 2
   • Ensure proper loading progression to protect the repaired meniscus

Special Considerations for Combined ACL and Meniscus Repair

The combined injury requires special attention as:

• Meniscal tears with ACL injuries increase the risk of early chondral damage 2
• The lateral meniscus shows greater translation with ACL deficiency compared to the medial meniscus 3
• Long-term consequences include increased risk of osteoarthritis 4

Therefore, follow-up should include careful monitoring of both ACL and meniscal healing to minimize the risk of long-term complications.

Conclusion of Intermediate Phase (6 months)

By the end of the intermediate phase (6 months), patients should achieve:

• No pain or swelling
• Full knee ROM
• LSI >80% for quadriceps and hamstring strength
• Ability to perform functional activities with good quality of movement
• Psychological readiness to progress to advanced training

This structured follow-up schedule ensures optimal recovery, minimizes complications, and prepares the patient for the advanced rehabilitation phase leading to return to sport or full activity.