Rehabilitation after knee arthroscopy
The recovery period after arthroscopy varies in duration for each patient, as it depends on the general condition, correctness and intensity of rehabilitation actions.
The early recovery period is counted from the moment the operation is completed until the drainage is removed. Local cryotherapy is used - a cooling pack or ice container is applied for 30-40 minutes. Thus, the risk of complications is reduced. To prevent swelling and disruption of blood vessels, elastic bandaging of the knee is done. Compression stockings may be used. In some cases, the use of rigid splints or orthopedic orthoses is indicated. You should treat your foot carefully for several days. It is recommended to place a pillow under it.
Belousov Evgeniy Ivanovich
traumatologist-orthopedist, surgeon
After arthroscopy, rehabilitation is faster than after arthrotomy (open surgery). Due to its low invasiveness, it is possible to begin muscle mobilization earlier, restore the range of motion in the knee joint and the ability to support the limb. After surgery, immobilization is indicated for 12 hours. Then isometric exercises are performed. From 3-5 days, active movements in the joint are shown, and after 2 weeks, training begins in the pool and on exercise machines to restore muscle tone.
Physical rehabilitation after arthroscopic surgery
Meniscal injury is a common knee injury.
The cause of a meniscus tear is an indirect or combined injury, accompanied by outward rotation of the tibia for the medial meniscus, inward for the outer meniscus.
Damage to the menisci occurs when the joint is sharply extended from a bent position, abducted and adducted, or, less commonly, when exposed to direct trauma - a blow to the joint on the edge of a step or a blow from some moving object.
Repeated direct trauma (bruises) can lead to chronic trauma to the meniscus (meniscopathy) and subsequently to its rupture after squatting or a sharp turn.
Meniscus tears occur in the posterior horn, in the body and in the anterior horn of the meniscus.
A rupture can lead to the fact that its torn off and dangling part will serve as a mechanical obstacle to movement, cause pain and, possibly, block the joint and limit movement.
In older people, injuries can occur without trauma due to degenerative changes in the meniscus, which are a consequence of arthrosis of the knee joint.
Any damage to the knee joint (traumatic or surgical)
can lead to the occurrence of post-traumatic deforming arthrosis with the presence of constant pain and impaired support function.
Therefore, correctly formulated restorative treatment of physical therapy, physiotherapy and massage procedures are important in the treatment of injuries to the knee joint.
Below is a program of physical rehabilitation after arthroscopic surgery.
Physical rehabilitation program
Rehabilitation terms (general)
· conservative treatment: 1 - 2 months;
· after resection of the meniscus (surgery): 1.5-3 months.
When creating a program for a patient after a meniscal injury, one should take into account the patient’s age, lifestyle, and the goal of rehabilitation (return to professional sports, amateur sports, return to the pre-injury lifestyle).
3-7 days after surgery
Contractions of the posterior thigh muscles. Position: lying on your back. Legs are bent at the knees as far as possible without pain. Press your heels to the floor, tensing your hamstring muscles. Hold the tension for 5 seconds, then relax. Repeat the exercise 10 times.
Contractions of the anterior thigh muscles. Position: lying on your stomach. Under the foot there is a cushion made from a rolled towel. Press your foot onto the roller, straightening your leg as far as possible. Hold the tension for 5 seconds, then relax. Repeat the exercise 10 times.
Straight leg raise.
- Position: lying on your back. The healthy leg is bent at the knee, the operated leg lies on the floor.
- Straighten the operated leg at the knee, tensing the anterior thigh muscles, and slowly lift it about 30 cm from the floor. Hold your leg up for 5 seconds. Then slowly lower it to the floor and relax. Repeat 10 times.
Straight leg raise.
- Position - standing against a wall (table or chair). Support yourself with your hand, if necessary, and slowly raise your straightened leg to about 45°. Hold your leg up for 5 seconds, then slowly lower it to the starting position. Repeat 10 times.
- Repeat this exercise with your foot turned outward.
2-3 weeks after surgery
Active extension of the leg at the knee.
- Position - lying on your back with a cushion of a bath towel (or a thick pillow) under the knee joint.
- Leaning on the bolster, straighten your leg at the knee as much as possible and hold it for 5 seconds. Slowly return to the starting position. Repeat 10 times Straight Leg Raise.
- Position: lying on your back. The healthy leg is bent at the knee, the operated leg is straightened and lies on the floor.
- Slowly raise your leg to 45°, holding it suspended for 5 seconds every 15 cm of lift. Continue lifting your leg at 15 cm intervals, holding it for 5 seconds each time. Slowly return your leg to the starting position. Perform 3 sets of 10 repetitions. Rest between sets is about 1 minute.
Half squats on a chair.
- Position: standing. Place a chair in front of you with its back facing you at a distance of approximately 30 cm.
- Holding the back of the chair with your hands, squat down to no more than a right angle. Hold the squat for 5-10 seconds. Then slowly return to the starting position.
- Stretching the anterior thigh muscles.
Position: standing in front of a chair. Stand on your healthy leg and lean against the back of a chair. Bend the operated leg at the knee and grab the foot with the same hand. Slowly pull your foot toward your buttock and hold it for 5 seconds, feeling the stretch in the front of your thigh. Then slowly lower your leg to the floor. Repeat the exercise 10 times.
Half squats on one leg. Position: standing with your hands resting on the back of a chair. Bend your healthy leg so that your toes touch the floor for stability. Squat on the operated leg to an angle of approximately 120-100°. Hold the squat for 5 seconds, then slowly return to the starting position. Repeat the exercise 10 times.
Extension at the knee joint. Position: sitting on a chair, the operated leg lies on a second chair. Place a bag of sand weighing 1-2 kg on the lower thigh. Straighten your knee as much as possible and hold the tension for 5-10 minutes.
Stretching the posterior thigh muscles.
Position: lying on your back in front of a wall. Raise your leg and rest your heel on the wall, move your pelvis closer to the wall. Straighten your leg at the knee joint until you feel tension in the muscles under the knee. Hold the tension for 5 seconds. Repeat the exercise 10 times.
Stretching the posterior thigh muscles.
- Position: lying on your back. Bend your leg at the hip and knee joints, supporting your thigh above the knee with your hands.
- Slowly straighten your leg at the knee and hold for 5 seconds. Repeat the exercise 10 times.
Exercise bike.
If the range of motion in the knee joint allows you to complete a full cycle of pedal rotation, then you can exercise on an exercise bike 2-4 weeks after surgery. Start exercising for 10 minutes a day with “light” pedal resistance. Increasing the duration of classes by 1 minute per day, bringing it to 20 minutes. Gradually increase the pedal resistance to the “heavy” level.
Training walking.
You can start walking or walking on a treadmill 2 weeks after surgery. Walk for 10 minutes a day, gradually increasing the duration and speed of walking. Control of the level of physical activity is the reaction of the joint: after training there should be no swelling or increased pain in the joint.
Run.
Avoid running for 6-8 weeks after surgery. Shock loads on the operated joint, which inevitably occur when running, adversely affect the condition of the articular cartilage, weakened by postoperative inflammatory swelling of the joint. Running training should be started gradually.
Physical training should not lead to worsening of the condition of the operated knee joint.
Therapeutic exercises for the leg
Physical therapy allows you to restore flexibility and mobility to the operated joint:
- At the first stage, the exercises should be performed while lying on your back with a fixed knee. The loads are minimal. You can exercise already on the first day after surgery. It is recommended to make smooth movements of the ankle joint, as well as strain and contract the muscles of the thigh and buttocks, and slightly extend the leg at the knee. As a result, correct coordination of the joint is restored.
- With the permission of the doctor, the patient can move on crutches, which not only provide support, but also develop a sense of balance. Physical exercises are shown in a sitting position with legs raised parallel to the floor. As a rule, exercises are performed under the supervision of a physician on an outpatient basis after discharge from the hospital. Typically takes four days.
- After stopping crutches, you need to do stretching exercises. To increase the load, shin weights can be used. Sometimes the doctor prescribes exercise bike classes. It is recommended to carry out up to 20 days.
- At the final stage of rehabilitation, physical therapy is used to warm up muscles and joints. Exercises are performed with increased load on the knee joint. Walking and cycling are also useful, 10-15 minutes a day. The stage can last up to six weeks.
If you neglect the doctor’s recommendations, there is a high probability of complications, including the appearance of adhesions, contractures, infection, hemorrhages in the joint, tissue swelling, and inflammation of the scar.
Contraindications
Like any other operation, arthroscopy has a list of contraindications, in the presence of which it cannot be performed. These include:
- Intolerance to anesthetics.
- Adhesive or purulent-inflammatory processes inside the joint.
- Lack of joint mobility.
- Open joint injuries, accompanied by hemorrhage into its cavity or damage to individual structures.
In addition, arthroscopy cannot be performed if the patient has diabetes mellitus, bleeding disorders, acute viral infections, or pathologies of the cardiovascular system.
Physiotherapy after arthroscopy
Most patients undergo physical therapy while recovering from surgery. Various methods are used, among which the most common are massage, ultrasound therapy, UHF therapy, magnetic laser treatment, lidase electrophoresis, and magnetotherapy.
But physiotherapy has contraindications, including pregnancy, fever, exacerbation of chronic diseases, bleeding, and neoplasms.
When preparing for knee arthroscopy, you need to remember the need for rehabilitation, which will take some time. If you strictly follow all the doctor’s recommendations and prescriptions, then each stage will pass without complications, after which you will be able to quickly return to your normal life.
Features of the operation.
Arthroscopic intervention is represented by several fundamental stages:
- First of all, at a doctor’s appointment, the patient is examined, the specialist collects an anamnesis, and sometimes it is necessary to take additional urine and blood tests, undergo an x-ray, and an electrocardiogram. The result of collecting information and determining the clinical picture is a referral for arthroscopy.
- The patient is given local anesthesia, placed on the operating table and the damaged limb is fixed so that the doctor has the most convenient access to the affected area.
- Next, the doctor makes two small holes (unlike traditional surgery, where the joint cavity is completely opened). An arthroscope with a camera is inserted through one incision (a high-resolution image is broadcast on the screen in real time), and through another, instruments are inserted, with the help of which the cavity is washed, and all other manipulations are performed.
You can read more about joint arthroscopy here -
