Immediate postoperative rehabilitation – 1 week postoperative:
(1) Immediately after surgery, the knee is immobilized in a 30° flexion position with a mobile splint or cast.
(2) Do not perform straight leg raising exercises after surgery to prevent the abnormal posterior tibial tendency to pull the reconstructed posterior cruciate ligament during the elevation of the affected limb. Ren Yizhong, Department of Joint and Sports Medicine Surgery, Second Affiliated Hospital of Inner Mongolia Medical University
(3) Ankle pump exercises. Start from the first postoperative day. The method is as follows: with both lower extremities straightened in bed, the patient should first relax both ankles naturally and then do dorsiflexion, which must reach the maximum when dorsiflexion. Then do plantarflexion from the maximum dorsiflexion state, and plantarflexion should also reach the maximum. Do this repeatedly. You can keep doing plantarflexion and dorsiflexion exercises while the patient is in bed watching TV, reading a book or newspaper and talking with family members.
(4) Contraction and relaxation exercises for the quadriceps muscle: From the first day after surgery, perform a moderate amount of contraction and relaxation exercises for the quadriceps muscle every day. The method of quadriceps contraction and relaxation exercises is: the patient lies on the bed, with legs naturally straight, and repeatedly contract the thigh muscles of both lower limbs for 5 seconds and then relax for 2 seconds. The number of contraction and relaxation is 3 sets per day, 50 times per set, 150 times in total. If the exercise is performed simultaneously on both legs, it can increase the contraction force of the quadriceps muscle on the affected side by 30%.
(5) Most of the negative pressure drains are removed within 48 hours after surgery, but there are also cases where no negative pressure drainage is placed after surgery.
(6) Flexion and extension of the knee joint is not required for 4 days after surgery. On the 4th postoperative day, the cotton pad for wound compression can be removed and the first knee flexion exercises to 60° can be performed at this time. After the exercise, you can put on the knee support club with 30° of knee flexion.
(7) Auxiliary training of the hip and calf muscles: straight leg raising exercises in all directions are available. In particular, do movements that make the hip joint abducted.
(8) Walking on the toes with partial weight-bearing with crutches (continue until 8 weeks postoperatively before full weight-bearing).
(9) Muscle strength training of the healthy limbs and both upper limbs.
(10) During the exercise of the lower extremities and placement in bed, attention should be paid to the posture and position of the lower leg so as not to put it in a state of excessive anterior-posterior displacement.
(11) One week after surgery, remove the cast and flex the knee to 60° and complete the exercise within 20 minutes. After the exercise is completed, the cast should also be put on to maintain the knee in a 30 degree flexed position.
Rehabilitation 2 weeks – 6 weeks after surgery.
(1) Continue the above exercises.
(2) Knee flexion to 90° at 2 weeks postoperatively. Non-weight-bearing knee flexion and extension (e.g., using a gymnastic ball) is beneficial to reduce swelling. Knee extension activity at 90-20° is permissible (i.e., stopping each time you are 20° short of straightening during the activity), but repeated exercises for knee extension are recommended in the range of 70-40°. Very active knee flexion should be avoided for up to 9 weeks postoperatively.
(3) Knee flexion to 100° at 3 weeks postoperatively, extension should be 15° short of extension.
(4) Knee flexion to 110° at 4 weeks postoperatively with 10° short of extension.
(5) 5 weeks postoperatively the knee is flexed to 115° short of extension and 10° short of extension.
(6) At 6 weeks postoperatively, knee mobility should be between 10-120°. Muscle strength training at this time.
a.Knee presses in the range of 10-60° are allowed in order to practice the strength of the N cord muscle.
b. Weight-bearing exercises are at the discretion of the therapist, taking into account joint edema and the patient’s ability to control the stability of the joint. Care should be taken when increasing weight bearing on the lower extremities: the knee should be relaxed and good stability of the knee joint should be maintained. However, avoid full weight bearing until 8 weeks postoperatively, even if the patient is pain-free, it is best to bear only one-third of the body weight.
c. Shear forces on the knee should be avoided for 8 weeks after surgery.
7 weeks postoperative – 3 months postoperative:
(1) Continue and strengthen the above exercises.
(2) At 7 weeks postoperatively, do not yet fully weight-bearing and straighten the exercises to a level that is still 5° short.
(3) At 8 weeks postoperatively, daily knee extension to 0° should be maintained. Flexion of the knee can be practiced up to 125° and normal walking with full G crutch weight bearing can be started.
(4) At 9 weeks postoperatively, full range of joint mobility should be achieved. If there is difficulty in straightening the joint at this time it should be practiced in one of two ways: First, while placing a towel roll under the heel, a certain amount of weight should be pressed over the knee joint, the amount of weight pressed should be such that the knee joint can be fully straightened 10 minutes after the weight is pressed. Second, the patient lies face down on the bed with the knee joint on the side of the bed, with the weight hanging from the foot, and practices straightening. If the weight is too light, the knee extension will not reach the requirement after 20 minutes of practice, and if the weight is too heavy, the patient will not be able to stick to it after less than 3-5 minutes of practice, so the weight size should be gauged to practice for 20 minutes and the knee joint can be completely straightened as good. Number of exercises: once a day is sufficient. After practicing knee extension, do not then practice knee flexion, because it is more difficult to flex the knee at this time. For example, if you practice knee extension in the morning, you should practice knee flexion in the afternoon. Do not force yourself to bend the knee to its natural angle for a short period of time after practicing knee extension, as it is better to let the knee return to a relaxed state naturally after practicing extension.
(5) Knee mobility should be reduced by at most 10-20 degrees at 10-12 weeks postoperatively (i.e. 3 months postoperatively) and should ideally be completely normal.
3 months-6 months postoperatively.
(1) The same rehabilitation as 6 weeks-3 months postoperatively, with more emphasis on strength and endurance training, the specific program should be changed according to the patient’s condition.
(2) Muscle strength training.
a. Closed chain training: that is, what people usually call half-squat exercises, the angle of knee flexion can be between 0-80 degrees. The posture is the same as the crotch riding action in Chinese martial arts or become a standing pile action. The patient’s legs are separated, the distance between the two feet is slightly wider than the shoulders, the body remains upright position, can not lean forward, then the knees began to bend squat. The bending angle of both knees varies according to the patient’s physical condition and muscle strength. If the patient’s physical condition is good, good thigh muscle strength, squatting angle can reach 80 ° flexion, if the patient’s body is poor and thigh muscle strength is weak, both knees can be lightly flexed, which is a half squat position higher, the patient more effort, with the practice of muscle strength and then increase the angle of the knee flexion. According to their physical condition to determine the number of exercises.
b. lying or sitting under the leg press exercises N rope muscle, knee flexion can be greater than the range of 0-90 degrees.
c. Open chain training: you can do 0-70 degrees of centripetal and centrifugal movements in the extended knee state, which is centripetal for the N cord muscle and centrifugal for the quadriceps. In the bent knee state, 90-0 degrees of centripetal and centrifugal exercise, it is centripetal for the quadriceps and centrifugal for the N cord.
(3) Reactive exercises: Acceleration exercises, deceleration exercises and directional exercises can be performed to restore the original coordinated movement ability.
(4) Holistic exercises: individualized training should be arranged by the therapist depending on the patient’s condition.
For non-athletes.
Rehabilitation should end 4-6 months after surgery, and we recommend that even for non-athletes, adaptive training to various activities should continue for 2-3 weeks at this time. Thereafter, training for full recovery of muscle function should be performed with a specially trained rehabilitation therapist. In this way, it will take approximately one year for muscle strength, innervation and coordination to be fully restored.
Specialized pre-sports habilitation.
For specialized athletes, a test of athletic ability and some specialized training is required. This program should be tailored to the different sports and should be done in consultation with the team physician and coach.
Other schedule.
8-10 months after surgery: Alpine skiing, cross-country skiing, tennis, jazz dance, aerobics.
One year after surgery: ball games and other strenuous sports.
Specific instructions from the doctor should be followed for different individual special cases.