What can I do to prevent chondral damage progression after ACL (Anterior Cruciate Ligament) reconstruction plus meniscus repair surgery?

Preventing Chondral Damage Progression After ACL Reconstruction and Meniscus Repair

Exercise-based rehabilitation should be the cornerstone of your recovery plan to prevent chondral damage progression after ACL reconstruction and meniscus repair. 1

Early Rehabilitation Phase (0-6 weeks)

Pain and Swelling Management

• Apply cryotherapy in the first postoperative weeks to manage pain and swelling 1
• Consider compressive cryotherapy if available, as it may be more effective than cryotherapy alone 1
• Avoid continuous passive motion as it shows no additional benefit for pain, range of motion, or swelling compared to active motion exercises 1

Early Mobility and Strength

• Begin immediate knee mobilization within the first week to increase range of motion and prevent extension deficit 1
• Start isometric quadriceps exercises in the first postoperative week when they provoke no pain 1
• Implement early weight bearing as tolerated if a correct gait pattern can be maintained 1
• Consider low load blood flow restriction training to improve quadriceps and hamstring strength and prevent disuse atrophy in the early phase 1

Progressive Strengthening Phase (6-12 weeks)

Neuromuscular Training

• Add neuromuscular training to strength training to optimize outcomes and prevent chondral damage progression 1
• Include balance and proprioception exercises to improve neuromuscular control 1
• Progress from isometric to concentric and eccentric exercises when the quadriceps is reactivated, provided there is no pain, effusion, or increase in temperature 1

Exercise Progression

• Begin closed kinetic chain (CKC) exercises, such as partial weight-bearing squats and step-ups, from week 2 1
• Start open kinetic chain (OKC) exercises from week 4 in a restricted range of motion of 90°-45° 1
• Gradually increase ROM in OKC exercises: 90°-30° in week 5,90°-20° in week 6,90°-10° in week 7, and full ROM in week 8 1

Advanced Rehabilitation Phase (12+ weeks)

Comprehensive Strengthening

• Implement eccentric training for greater strength gains and muscle hypertrophy 1
• Include core stability exercises to improve gait and knee function 1
• Focus on quadriceps strengthening as deficits >20% can have major negative consequences for long-term outcomes 2

Monitoring and Progression

• Monitor quality of movement during all exercises, and only progress if exercises do not provoke pain, effusion, or increase in temperature 1
• Use objective measures to evaluate progress, including strength testing and functional activities 1
• Follow a criteria-based rather than time-based rehabilitation approach 1

Return to Sport Considerations

Assessment Criteria

• Ensure no pain or swelling before advancing activities 1
• Achieve full knee range of motion 1
• Reach Limb Symmetry Index (LSI) >90% for strength and hop tests 1
• Verify stable knee on clinical examination 1
• Normalize patient-reported outcomes 1

Gradual Reintegration

• Begin with skill drills before full competitive activities 1
• Continue maintenance strength program and preventive neuromuscular training 1
• Avoid high-risk activities that could lead to re-injury 1

Important Considerations for Chondral Protection

• Research shows chondral damage may progress at a faster rate in patients who require ACL reconstruction and meniscal repair compared to those with intact menisci 3
• Patients with medial meniscal pathology tend to have lower functional and quality of life scores 4
• More severe chondral damage at the time of ACL reconstruction negatively impacts functional outcomes, activity levels, and return to sport rates 4
• Delaying mobilization can lead to complications, and immediate knee mobilization is critical to prevent extension deficit and osteoarthritis development 1
• Functional bracing is not recommended for routine use after primary ACL reconstruction as it confers no clinical benefit 1

Long-term Management

• Maintain a long-term strength program to support joint health 1
• Schedule periodic assessments to track progress and adjust your program as needed 1
• Focus on both strength and neuromuscular control to prevent poor movement patterns and reduce risk of reinjury 1
• Consider your BMI as a risk factor for meniscal or chondral injury, as research shows approximately 10% increase in injury prevalence per point BMI 5