Table 1 Postoperative rehabilitation training program in the 1st week
1.Training program
Training time
Daily
Number of training sessions
2.Muscle strength training
Quadriceps isometric contraction
15 minutes
2
N cord muscle isometric contraction
15min
2
Hip adductor isometric contraction
15 minutes
2
3.Mobility training
Patellar internal thrust
15 minutes
2
4.Physiotherapy
Medial femoral muscle electrical stimulation
15 minutes
2
Table 2 Postoperative rehabilitation program in the 2nd week
1.Program
Time
(minutes)
Daily
Number of training sessions
2.Muscle strength training
Isometric contraction of quadriceps
15
2
Isometric contraction of the cord muscle
15
2
Hip adductor isometric contraction
15
2
3.Mobility training
Knee passive activity 0o～90o
30
2
Patellar internal thrust
15
2
4.Physiotherapy
Medial femoral muscle electrical stimulation
15
2
5. proprioceptive training
Stationary bike
15
2
Table 3 Postoperative rehabilitation training program in the 3rd to 4th week
1. Program
Time
Daily
Number of training sessions
2.Muscle strength training
Straight leg raise (internal rotation, external rotation, external booth rotation)
30 minutes
2
N cord muscle resistance contraction
15 minutes
2
Heel Lift
15 minutes
2
3.Mobility training
Full range of passive activity (0o～120o)
30 minutes
2
4.Proprioceptor training
Stationary bike
30 minutes
2
Balance board or cushion (both legs, support to limit the range of motion from 0o to 40o)
15 minutes
2
5.Muscle tension training
Posterior knee muscle retraction
15 minutes
2
Peripatellar muscle, peripatellar muscle stretching
15 minutes
2
In the second postoperative week, passive extension and flexion activities in the range of 0o to 90o of the knee joint and short duration of proprioceptive training (Table 2) were started, with a total of 4 hours of training time per day.
Table 4 Rehabilitation training program for the 5th to 6th postoperative week
1. Program
Time
Daily
Number of training sessions
2.Muscle strength training
Straight leg raise (internal rotation, external rotation, external booth rotation)
30 minutes
2
N cord muscle resistance contraction
15 minutes
2
Heel lift
15 minutes
2
0o～40o half squat
30 minutes
2
3.Mobility training
Full range of passive activity (0o～120o)
30min
2
4.Proprioceptor training
Stationary bike
30 minutes
2
Balance board or cushion (both legs, support to limit the range of motion)
range of motion from 0o to 40o)
15 minutes
2
Backward walking
15 minutes
2
5.Muscle tension training
Posterior knee muscle
15 minutes
2
Peripatellar muscles, peripatellar muscles
15 minutes
2
In the third and fourth postoperative weeks, full range of passive mobility training was performed, increasing proprioceptive training to 90 minutes per day and adding lower extremity muscle distraction training for a total of 5 hours and 30 minutes per day (surface quenching). Patients are generally advised to use a stationary bike on a home gym or use a child’s bike flipped over as a stationary bike. Make your own balance board, or use your home couch for proprioceptive training.
In the fifth and sixth postoperative weeks, 0o to 40o half-squat activities were added to train both quadriceps and rouge muscles (Table 4); backward walking was started; exercises were performed on a balance board with one leg supported on the affected side, for a total of 7 hours per day.
Table 5 Postoperative rehabilitation training program from the 7th to 12th week
1.Program
Time
Daily
Number of training sessions
2.Muscle strength training
Straight leg raise (internal rotation, external rotation, external booth rotation)
30 minutes
2
N cord muscle resistance contraction
15 minutes
2
Heel lift
15 minutes
2
0o～40o half squat
30 minutes
2
3.Proprioceptor training
Stationary bike
30min
2
Balance board (single leg, support to limit the range of motion from 0o to 40o)
or jogging on a soft mat
30 minutes
2
Backward walking
30 minutes
2
4.Muscle flexibility training
Lateral activity
30 minutes
2
The duration of proprioceptive training was further increased in the 7th to 12th postoperative weeks, and muscle flexibility training was added (Table 5) for a total of 6 hours.
Table 6 Postoperative rehabilitation training program in the 13th to 6th month
Program
Time
Daily
Number of training sessions
1.Muscle strength training
0o～40o half squat training
30 minutes
2
2.Physical receptor training
Balance board or soft mat
30min
2
3. Flexibility training
Lateral running
30 minutes
2
Backward running
30 minutes
2
For the first 6 weeks, the emphasis is on immobilizing the knee in full extension at rest and using a brace to lock the knee in full extension when walking on the ground. During the 7th to 12th week, the knee can be freely extended and flexed under the protection of a brace, but the use of a brace is emphasized to reduce the lateral stress during training activities. If meniscal repair was performed or subchondral bone drilling was performed, CPM machine exercises were performed for 1 to 2 hours per day in the first postoperative week and weight bearing was started in the seventh postoperative week.
Table 7 Postoperative rehabilitation program from the 7th to 12th month after surgery
Program
Time
Daily
Number of training sessions
1.Proprioceptive training
Balance board
30 minutes
2
2.Flexibility training
Lateral running
30 minutes
2
Backward running
30 minutes
2
Forward speed running
30 minutes
2
From 13 weeks to 6 months postoperatively, proprioceptive and flexibility training was the main focus, with 4 hours per day (Table 6). From 7 to 12 months postoperatively, proprioceptive training and flexibility training were the main focus, and variable speed running activities were added (Table 7).
In the middle and late stages of rehabilitation (4 to 12 months postoperatively), the 4-hour-per-day rehabilitation training program was not a harsh prescription and was appropriately adjusted during the follow-up visits according to the recovery of each ability. In addition, this program is aimed at restoring the patient’s ability to perform activities of daily living and general motor abilities, and for patients who play sports, a specific flexibility training program needs to be developed according to the characteristics of the sport they play.