Patients often ask me in the patient group: why is my recovery slower or faster than others, is this good? In response to this general problem, I will talk about my experience and some general principles, the specific rules may still need to be analyzed in my clinic after surgery.
1, about the joint flexion and extension angle recovery fast and slow problem.
I think for fast and slow are relative. When I say relative, it is not only the difference in speed, but also the important influence of the speed of recovery on the reconstructed ligament. For example, the recovery of joint flexion and extension angle after surgery, we say that generally speaking, about 4 weeks after surgery, we should recover to 90 degrees of flexion and extension, which is based on the prevention of joint adhesions, but on the other hand, if some people recover more slowly and do not reach such an angle, it is good for the healing between the tendon and the bone surface after ligament reconstruction. Of course, not to say that the slower the better, everything has its own inherent rules, but to master the general standard is good, a difference of 10 to 20 degrees, a difference of two or three weeks is not bad. After flexion and extension to 90 degrees, the chance of joint adhesions is generally much smaller, and then we should focus on static, otherwise excessive movement will lead to joint laxity. Therefore, it is appropriate to keep the joint within 110 degrees of flexion and extension between one month and three months after surgery.
In addition, there is a difference between ACL reconstruction and posterior cruciate ligament reconstruction. After posterior cruciate ligament reconstruction, the general rehabilitation should be more conservative, with as little activity as possible to allow the ligament to reestablish blood flow, because the posterior cruciate ligament is particularly prone to laxity, which is recognized internationally. Therefore, the postoperative period should be kept within 60 to 90 degrees of flexion and extension for three months.
There is another group of patients who have an avulsion fracture of the ACL inferior stop, and their recovery is also slower. The healing is much slower because the fracture is fixed in the joint after repositioning.
2.On the issue of joint weight-bearing
Generally speaking, if the ligament reconstruction is not accompanied by meniscal damage or if the meniscus is only repaired and not sutured, as long as the brace is carried, the lower extremity can be weighted on the ground within two to four weeks, but the requirement is that the knee joint of the lower extremity is straightened, because at this time the weight bearing of the lower extremity is dependent on the structure of the skeleton, and does not pull on the ligament and make the ligament lax. Such weight-bearing is good for the nutrition of the cartilage in the joint.
In the case of patients with meniscal sutures or other injuries such as cartilage injuries, weight bearing should be done only after 6 to 8 weeks to give the meniscus a stable environment to heal.
Usually, after 2 weeks of weight bearing, you can walk slowly with the knee flexed, but the amount of exercise should be small to large, from small weight bearing to whole body weight bearing, and trained slowly.
3 I am often asked by patients in patient groups: Why is my recovery slower or faster than others, is this good? In response to this general problem, I will talk about my experience and some general principles, but the specific details may need to be analyzed in my clinic after surgery.
1, about the joint flexion and extension angle recovery fast and slow problem.
I think for fast and slow are relative. When I say relative, it is not only the difference in speed, but also the important influence of the speed of recovery on the reconstructed ligament. For example, the recovery of joint flexion and extension angle after surgery, we say that generally speaking, about 4 weeks after surgery, we should recover to 90 degrees of flexion and extension, which is based on the prevention of joint adhesions, but on the other hand, if some people recover more slowly and do not reach such an angle, it is good for the healing between the tendon and the bone surface after ligament reconstruction. Of course, not to say that the slower the better, everything has its own inherent rules, but to master the general standard is good, a difference of 10 to 20 degrees, a difference of two or three weeks is not bad. After flexion and extension to 90 degrees, the chance of joint adhesions is generally much smaller, and then we should focus on static, otherwise excessive movement will lead to joint laxity. Therefore, it is appropriate to keep the joint within 110 degrees of flexion and extension between one month and three months after surgery.
In addition, there is a difference between ACL reconstruction and posterior cruciate ligament reconstruction. After posterior cruciate ligament reconstruction, the general rehabilitation should be more conservative, with as little activity as possible to allow the ligament to reestablish blood flow, because the posterior cruciate ligament is particularly prone to laxity, which is recognized internationally. Therefore, the postoperative period should be kept within 60 to 90 degrees of flexion and extension for three months.
There is another group of patients who have an avulsion fracture of the ACL inferior stop, and their recovery is also slower. The healing is much slower because the fracture is fixed in the joint after repositioning.
2.On the issue of joint weight-bearing
Generally speaking, if the ligament reconstruction is not accompanied by meniscal damage or if the meniscus is only repaired and not sutured, as long as the brace is carried, the lower extremity can be weighted on the ground within two to four weeks, but the requirement is that the knee joint of the lower extremity is straightened, because at this time the weight bearing of the lower extremity is dependent on the structure of the skeleton, and does not pull on the ligament and make the ligament lax. Such weight-bearing is good for the nutrition of the cartilage in the joint.
In the case of patients with meniscal sutures or other injuries such as cartilage injuries, weight bearing should be done only after 6 to 8 weeks to give the meniscus a stable environment to heal.
Usually, after 2 weeks of weight bearing, you can walk slowly with the knee flexed, but the amount of exercise should be from small to large, from small weight bearing to whole body weight bearing, and train slowly.
3. About resuming daily life
Generally speaking, patients with ACL reconstruction with meniscal suture should be able to return to daily life in about 8 weeks, while those without meniscal suture can return to self-care in about 6 weeks. Of course there are a small number of people who have joint effusion or other pain and are a little slower, it doesn’t matter much. If there is a lot of fluid in the joint, I usually aspirate the joint during the two-week outpatient follow-up visit, otherwise the large amount of fluid can be present for a long time, causing damage to the cartilage in the joint and slow recovery. If you resume your daily life, you still need to ice the joint well to reduce swelling in the joint when you are more active.
4.About exercise
Usually, in good condition, two months can be appropriate to participate in slow walking, etc., or even swimming, cycling and other non-weight-bearing exercises, but the amount of exercise should be particularly small, especially to not cause joint swelling as the standard. Swelling is very important to determine. If there is swelling in the joint, it is usually accompanied by discomfort that the joint becomes heavy, sore, or swollen, so reduce the amount of exercise and apply ice.
The best exercise is still swimming and cycling, which are non-weight-bearing exercises.
5.On the question of ice or hot compress
Every time I see a patient in clinic, they ask whether it is better to apply ice or heat. I think for intra-articular problems, I will always say: ice! If there is some muscle soreness outside the joint, I always recommend applying heat! Why? Because the discomfort in the joint is usually manifested in the synovial membrane swelling, excessive fluid secretion causes swelling and discomfort, in this case ice can make the synovial membrane swelling, pain relief and symptom relief, but hot compress will cause joint fluid aggravation, is absolutely contraindicated! Extra-articular does not have this problem.
Usually, most patients with ligament reconstruction will have their joints completely swollen after 4 weeks. For some patients with stubborn joint swelling, they need joint aspiration treatment, in this case it is to still insist on icing several times a day after 4 weeks!
There are other problems, if you need to feel free to consult in the QQ group. I will not discuss them all. About resuming daily life
Generally speaking, patients with ACL reconstruction with meniscus suture should be able to resume their daily life in about 8 weeks, while those without meniscus suture can resume their daily life in about 6 weeks. Of course there are a small number of people who have joint effusion or other pain and are a little slower, it doesn’t matter much. If there is a lot of fluid in the joint, I usually aspirate the joint during the two-week outpatient follow-up visit, otherwise the large amount of fluid can be present for a long time and lead to cartilage damage in the joint and slow recovery. If you resume your daily life, you still need to ice the joint well to reduce swelling in the joint when you are more active.
4.About exercise
Usually, in good condition, two months can be appropriate to participate in slow walking, etc., or even swimming, cycling and other non-weight-bearing exercises, but the amount of exercise should be particularly small, especially to not cause joint swelling as the standard. Swelling is very important to determine. If there is swelling in the joint, it is usually accompanied by discomfort that the joint becomes heavy, sore, or swollen, so reduce the amount of exercise and apply ice.
The best exercise is still swimming and cycling, which are non-weight-bearing exercises.
5.On the question of ice or hot compress
Every time I see a patient in clinic, they ask whether it is better to apply ice or heat. I think for intra-articular problems, I will always say: ice! If there is some muscle soreness outside the joint, I always recommend applying heat! Why? Because the discomfort in the joint is usually manifested in the synovial membrane swelling, excessive fluid secretion causes swelling and discomfort, in this case ice can make the synovial membrane swelling, pain relief and symptom relief, but hot compress will cause joint fluid aggravation, is absolutely contraindicated! Extra-articular does not have this problem.
Usually, most patients with ligament reconstruction will have their joints completely swollen after 4 weeks. For some patients with stubborn joint swelling, they need joint aspiration treatment, in this case it is to still insist on icing several times a day after 4 weeks!
There are other problems, if you need to feel free to consult in the QQ group. I will not be one to discuss.