MBBS(Lon) FRCS (Eng) FRCS (Tr & Orth)
“To be pain free almost immediately and walking normally in 6 weeks is close to a miracle”

Aftercare & Rehabilitation

Your experience and care before your knee surgery, during and post surgery is at the forefront of Chan Jeer Orthopaedics activities. 

Chan Jeer will explain in detail before your surgery what the recovery and aftercare will be. General health, your profession and severity of knee issue will impact the length of your recovery and the exercises needed.

One of our rehabilitation methods is ACL Reconstruction Rehabilitation. You can learn more about ACL Reconstruction Rehabilitation here with one of Chan Jeer's case studies.

The guidelines described below are not a strict protocol and can vary for each individual.

PRE-OP
Rehabilitation begins before surgery in the pre-operative phase to ensure that you and your knee are ready for the operation.

  • You will be asked to attend a pre-assessment clinic
  • Ensure a full range of movement and keep quadriceps/hamstrings muscles strong before surgery.
  • Assessed and examined in the pre-assessment clinic, by the surgeon, where you will be required to provide consent for surgery.
  • Admitted on the day of surgery for general fitness examination for general anaesthetic – opportunity to ask questions.
  • You maybe asked to complete outcome measure questionnaires.

Day of Operation

  • Light dressing: Mepore + gauze + crepe bandage.
  • Analgesia: Intra-operative local anaesthetic into wounds and knee joint. Regular coproxamol tablets and voltarol or Tramadol injections/tablets.
  • Cryo-Cuff (iced water compression cuff) may be applied to knee to reduce pain and swelling.
  • Start exercises: static quads and hamstring tightening – Quads to force leg straight.
  • Aim to stand out of bed on the evening of the operation with supervision and using crutches for support.

Day 1 and 2 Post-Op

  • DAY 1: Dressing removed and long leg Tubigrip applied.
  • Swelling in knee is normal and controlled by the Cryo-Cuff if required.
  • Mobilise weight bearing as tolerated using crutches.
  • Exercise as instructed by a physiotherapist to be performed approx. 5 times per day and including:
    • Static quads and hamstrings
    • Extension exercises “pillow” hangs”: resting the ankle on a pillow and pushing leg into extension to match normal side to prevent build up of scar tissue around the graft.
    • Patella mobilisation to prevent tethering of patella in scar tissue.
    • Discharge from the hospital on DAY 1 if progressing well.

Aims on Discharge

  • Full passive extension
  • Comfortable knee flexion 0-90°
  • Weight bearing as pain allows
  • (You can Fully Weight Bear FWB)
  • Pain controlled on tablets

Your rehabilitation within the physiotherapy department will commence approximately two weeks after discharge and once the clips, (used to hold wound together), have been removed. The rehabilitation programme provided within the Physiotherapy department aims to safely progress you through the milestones. You will be shown the exercises which will most effectively allow you to achieve these milestones. Most of the exercises require very little equipment and have been developed to allow you to continue your rehabilitation at home. You will be expected to continue the exercises taught to you by the physiotherapist until you are seen in the outpatient physiotherapy department for further rehabilitation. Pain and swelling should be your guide with regards to the amount of exercise you can undertake.

You will have a Consultants review 2 weeks post surgery where your clips will be removed and an x-ray taken on arrival.

Precaution - for the first 6 weeks following your orthopaedic surgery do not:

  • Bend your leg more than 90°

  • Fully straighten your leg from the last 30° without support of your other leg

  • Straighten your knee more than possible with your non-operated leg

Ongoing Exercise Program

The exercise programme consists of five main phases namely:

  • Phase 1: Initial phase – first 2 weeks post op
  • Phase 2: Proprioception phase – weeks 3- 6
  • Phase 3: Strengthening phase – weeks 6 – 12
  • Phase 4: Pivoting and cutting (early sport) phase – 3 – 6 months
  • Phase 5: Advanced strength and endurance (return to sport) phase 6 – 9 months

It is advisable to perform the exercises described below on a daily basis and not only within the physiotherapy department.

Aim:
The aim of this phase is to regain movement in the knee, allow swelling to settle and to encourage a normal gait pattern.

Week 1:

  1. Static gluts in lying, standing or sitting – squeeze bottom muscles together and hold for 5secs. Repeat 10 times 3 times daily.
  2. Gently bend your knee keeping your foot in contact with the floor. Ensure you DO NOT bend your knee beyond 90° Do Repeat 10 times 3 times daily
  3. Static quadriceps – push knee down into bed. Hold for 5secs. Repeat 10 times 3 times daily.
  4. Knee sags with heel resting on rolled up towel. ALWAYS match knee straightening with your good leg – Hold for approximately 20 minutes 3 times a day.
  5. Patella Mobilisations. Relax straight knee and move knee cap with clean fingers. 5 minutes 3 times a day

Week 2:

  1. Calf Stretch with Towel – 3 x 30secs
  2. Calf push-downs against towel – 3 x 10 repetitions
  3. Double leg wall squat to 45°. 10 repetitions 3 times a day.
  4. Single leg balance with eyes open. Hold for 10 repetitions of 10secs a day.
  5. Double leg calf raises. 10 repetitions 3 times a day.

2 Week Orthopaedic Review

Phase 1 Goals:
  • Full extension to 90° flexion
  • Wound healed
  • Minimal swelling
  • Normal Gait

Aim:
The aim of this phase is to introduce proprioceptive exercises and gradually improve strength and endurance. By the end of 6 weeks your knee should feel normal in activities of daily living.

Week 3 - 6:

Week 2 exercises including:

  1. Lateral leg raises with weight
  2. Inner leg raises with weight. Min resistance.
  3. Leg extensions with weight
  4. Half circles on stationary bicycle with minimal resistance

6 WEEK ORTHOPAEDIC REVIEW

PHASE 2 GOALS:
  • Full range of movement
  • Minimal swelling
  • Minimal discomfort

Aim:
At this stage the hamstring graft will have become solidly fixated within the femur and tibial tunnels. This allows for more vigorous strength training to commence. There are no specific precautions at this stage, but it is important to avoid too rapid progress as there is a risk of developing complications associated with overloading. The physiotherapist will monitor your strength and control, and progress as appropriate.

Example exercises week 6-12

  1. Power walking on treadmill
  2. Progression of Single leg step work
  3. Squat work on wobble board
  4. Mini trampet balance work
  5. Progression of Closed chain exercises (foot in contact with floor) with weight
  6. Outdoor cycling on flat ground

12 Week Orthopaedic Review

Phase 3 Goals:
  • No swelling
  • Full range of movement
  • Increased feeling of stability

Aim:
The aim of this phase is to introduce pivoting and cutting exercises which play an important role in returning to sporting activities. This stage includes agility and power training starting slowly and progressing to moderate speeds.

If your occupation involves manual work it should be possible at this stage depending on the requirements of the occupation.

Example exercises Month 3 - 6

  1. Walk – Jog on treadmill with increased gradient
  2. Lunges
  3. Double leg skipping
  4. Hopping on both legs progressing to one leg
  5. Lateral shuffle leg to leg
  6. Lateral figure of eights
  7. Start jogging on flat terrain

6 Month Orthopaedic Review

Phase 4 Goals:
  • Functional and strength tests at 85% of normal side
  • Return to non-contact sport/training

Aim:
This phase is aimed at progressing training to create a foundation for the return to full sporting activity.

It is not recommended to return to full contact sport until the functional and strength outcomes are measured at greater than 85% of the normal side. To build up the confidence and regain pre-injury level of skill and performance is variable and can take 3 to 4 months of training and playing. It is recommended that you progress your training within your specific sporting environment.

Progress is best achieved in conjunction with a general fitness programme and full contact is best avoided until you are able to tolerate full training sessions and are confident with your fitness and endurance.

No Contact Sports Until After 9 Months

Kent Knee Surgery
 
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