I. Early – inflammatory response period (0-1 week)
Purpose: To reduce pain and swelling; early muscle strength exercises; early weight bearing; early mobility exercises to avoid adhesions and muscle atrophy.
In the early stage of functional exercises and the initial stage, the muscle strength level is low, the tissue has a more obvious inflammatory response, and the reconstructed ligaments are still relatively fragile. Therefore, the endurance exercises with small loads are the main ones. Choose a light load (the amount of load to complete 30 movements that can feel fatigue), 30 times/group, 2-4 groups of continuous exercises, 30 seconds rest between groups, until fatigue.
(i) On the day of surgery.
After the anesthesia subsides, start to move the toes and ankles; if the pain is not obvious, try to contract the quadriceps.
(ii) One day after surgery.
1. Ankle pump – forceful, slow, full range flexion and extension of the ankle joint, 5 minutes/group, 1 group/hour.
2. Quadriceps isometric exercises (anterior thigh muscle group) – i.e. thigh muscle tensing and relaxation. Should be done as much as possible without increasing pain. At least > 500 times / day 3 N rope muscle isometric exercises (posterior thigh muscle group) – the affected leg force down the padded pillow, so that the posterior thigh muscle tension and relaxation. The requirements are the same as above.
(iii) 2 days after surgery: drainage removal
1.Continue the above exercises.
2.The ankle pump is changed to anti-gravity exercise (can be assisted by others or hold the thigh with hands).
3.Start to try straight leg lift – straight leg lift after knee extension until heel is 15M from bed, hold until exhaustion.
4.Start side leg lift exercises.
(iv) 3 days after surgery.
1.Continue the above exercises.
2.Weight bearing and balance – separate both feet under protection and move the center of gravity alternately from side to side within the range of slight pain. 5 min/time, 2 times/day. Separate both feet anteriorly and posteriorly and move the center of gravity.
(v) 4 days after surgery.
1.Continue the above exercises.
2.Strengthen the weight-bearing and balancing exercises, gradually until you can stand on one foot with the affected leg.
3.If this can be done, start walking with a single crutch (holding on the healthy side).
(vi) 5 days after surgery.
1.Continue and strengthen the above exercises.
2.Start stretching exercises (sitting suspension).
(vii) 1 week postoperatively: Start joint mobility exercises at the discretion of the surgeon.
1.Start flexion exercises (within the range of 0°-90° of slight pain. (This should be done by the rehabilitation physician or by yourself with the permission of the physician and under the guidance of the rehabilitation program. Because early exercises are still dangerous, they should not be done blindly without permission, otherwise they may cause adverse consequences.) 2. Apply ice for about 20 minutes immediately after the flexion exercise. If there is usually a clear feeling of heat and swelling in the joint, ice can be applied again 2-3 times / day.
3. If you can stand on one foot, you can walk with a single crutch.
Second, the initial period: (2-4 weeks)
Purpose: strengthen mobility and muscle strength exercises: improve joint control ability stability; gradually improve gait.
(i) 2 weeks after surgery.
1.Passive flexion to 90-100°.
2.Intensive muscle strength exercises. (Straight leg lift up to 6 minutes) 3. If there is no significant instability of the joint, indoor walking can be off the crutches.
4.Extension up to the same as the healthy side.
5.Start to practice flexion on your own with guidance, see remarks for method.
(ii) 3 weeks after surgery.
1.Passive flexion up to 110°.
2.Strengthen active flexion and extension exercises and strengthen muscle strength exercises.
3.Adjust splint to 0°- 45° range of flexion and extension, and gradually increase the angle. Walk off the crutch.
4.Start to hold the knee in sitting or lying position to practice flexion. Hold the knee until you start to feel pain for 10 seconds, relax slightly (do not straighten to rest) for 5 seconds, then hold the knee again and repeat the exercise for 20 minutes, once a day.
5. Start the “leg hook” exercise in the standing position. 30 times/group, 4 groups/day.
(iii) 4 weeks after surgery: (without splinting during sleep)
1.Passive flexion up to 120°.
2.Adjust the splint until it can be flexed and extended in the range of 0°-90°.
3.Start anterior-posterior and lateral straddle exercises, 30 times/set, 4 sets/day.
4.Start static squatting or sliding exercises against the wall. Strive to reach normal gait walking.
5.Stretching exercise DD remove splint, put a pillow at the heel, make the affected leg completely leave the bed, relax the muscles to make the knee joint extend naturally. 30 minutes/time, 1-2 times/day. The interval with the flexion exercise is as far as possible.
III. Mid-term: (5 weeks – 3 months)
Purpose: Strengthen the joint mobility to the same level as the healthy side.
Strengthen muscle strength and improve joint stability.
Restore the ability to perform all activities of daily life.
With the improvement of muscle strength level, absolute strength exercises will be the main focus in the middle stage. Choose a medium load (the amount of load that makes you feel fatigued after completing 20 movements), 20 times/group, 2-4 groups of continuous exercises, with 60 seconds rest between groups, until fatigue.
(i) 5 weeks after surgery.
1.Passive flexion up to 130°.
2.Start affected side single leg 0°-45 range semi-squat flexion and extension knee exercises. 5 min/time, 4 times/day.
3. Start stationary bike exercises. No load to light load. 30 min/time, 2 times/day.
(ii) 8-10 weeks postoperatively.
1.Passive flexion angle up to the same as the healthy side.
2.Progressively try full squat under protection.
3.Strengthen the muscle strength, (but not increase the load, only increase the angle, number and time of exercises.)
(iii) 10 weeks-3 months after surgery: (splint may be removed)
1, Active flexion and extension of the knee angle is basically the same as the healthy side, and there is no significant pain.
2, Daily prone position flexion so that the heel touches the hip and continuous stretching for 10 minutes/time.
3.Start kneeling exercises 4 Start stirruping exercises IV? Later stage: (4 months-6 months) Purpose: To fully resume all activities of daily life. Strengthen muscle strength and joint stability.
Gradually resume exercise.
In the later stage, improve the maximum strength, choose a large load (complete 12 movements that is the fatigue of the load), 8-12 times / group, 2-4 groups of continuous exercises, rest 90 seconds between groups, until fatigue.
1.Start the knee ring exercise
2.Start jumping up and down exercises
3.Start lateral jumping exercises
4.Start swimming (breaststroke is prohibited in the early stage), rope skipping and jogging.
5.The athlete starts the special exercises of the base movement.
During this period, the rebuilt ligaments are not strong enough, so the exercises should be gradual, not forced or blindly adventurous. The knee joint should be strengthened to ensure the stability and safety of the knee joint in sports, and the knee brace can be worn for protection if necessary, but only during strenuous sports.
V. Recovery period: (7 months – 1 year)
Purpose: Full return to sports or strenuous activities.
Gradually resume strenuous activities or special training.
Strengthen the muscle strength and the stability of the joints in running and jumping.
Through the test, the affected muscle strength reaches 85% or more of the healthy side, then can fully resume sports.