Phase I: Within 2 weeks after surgery
1.On the day of surgery, an epidural tube was left in place for continuous analgesia to reduce nociception and preserve proprioception and tactile sensation to facilitate early exercise, knee gauze and elastic bandage for compression, adjustable chuck support for 30b knee flexion and 0 seconds extension for fixation, elevation of the affected limb, local cold therapy to facilitate swelling and reduce pain.
2. Normal pressure drainage tube should be removed within 24 seconds or less than 50 mm within 48 seconds to prevent blood leakage from the joint and adhesions. After drainage tube removal, the knee joint was extended and flexed within the limits of the adjustable chuck support to protect the tendon anastomosis from tearing and to prevent adhesions in the knee joint and to speed up the dissipation of the accumulated blood in the joint.
3, 1 day after surgery, start to do isometric contraction training of the quadriceps muscle, supine position, straighten the knee joint, plantar flexion of the foot, raise 30 degrees to 45 degrees at a uniform rate, and stay in the air for 5 to 10 hours and then slowly lower. Straight leg raise not more than 45 degrees is appropriate, if more than 45 degrees, the quadriceps muscle will lose tension strength, and become exercise hip flexor strength. 15 to 30 seconds each time, 20 times to the group, rest 30 seconds between groups, continuous practice 2 to 3 groups for 1 section, 3 sections per day, to prevent muscle atrophy, strengthen muscle strength.
4.Passive knee extension exercise: air cushion under the heel, so that the affected knee is suspended, maintain a neutral position, relax the muscles so that the knee joint is naturally extended. At the same time, strengthen the ankle pump exercise: pause for 10 seconds after maximum rhythmic dorsiflexion of the ankle joint, slowly relax, then pause for 10 seconds after maximum plantar flexion, and so on repeatedly, the frequency should not be too fast, the action must be in place to promote blood circulation, reduce swelling, and prevent deep vein thrombosis.
5. On the second postoperative day, the patient was instructed to continue the ankle pump, quadriceps isometric contraction and straight leg raising exercises, plus passive patellar movement. Push the patella up and down and medially with the hand on the edge of the patella. After reconstruction, it is strictly forbidden to push the patella outward, and it is important to move the patella medially as gently as the patient can tolerate. 10 times in each direction, 3 times a day. Ultrashort wave physiotherapy, 15 minutes each time, once a day, 3 days after the expenditure device to increase infrared therapy.
6. On the third postoperative day, the patient was instructed to continue the above exercises and assisted with active knee flexion and knee exerciser/passive extension and flexion exercises. Active knee flexion exercise: heel is not lifted off the bed and knee is flexed. Patients may be partially weight-bearing with the aid of a crutch, as long as the patient can tolerate the weight, but not more than 50% of body mass. Patients must wear a brace during weight-bearing or walking exercises. The duration of full weight bearing is usually 4 weeks postoperatively, and the brace is worn for 6 weeks.
Phase 2: 2 to 4 weeks
Strengthening of joint mobility and muscle strength exercises. When the stitches are removed at 2 weeks and the patient is reviewed at 1 month after surgery, the nurse gives the patient a training plan and instructs him/her on the next step of training. At this stage, the patient was instructed to continue the rehabilitation exercises in the previous stage, strengthen active flexion and extension exercises, enhance muscle strength exercises, and strengthen the mobility training of the affected knee to achieve active knee flexion of 90 degrees or more.
1. Transcutaneous electrical nerve stimulation and functional electrical stimulation were applied to the quadriceps and medial femoral muscles to improve local blood circulation, relieve pain and strengthen muscle strength.
2.Continuous passive training of the knee joint within the restricted range of motion of the adjustable chuck brace (on the CPM machine), with passive movement of the affected limb in the pain-free state wearing the adjustable chuck brace, starting at an angle of 0b and ending at an angle of 60b, at a slow speed of 4h per day, to prevent the formation of knee contractures and adhesions, to maintain the length of the muscles at rest, to stimulate the flexion and extension reflexes, to increase proprioception, and to prepare for active movement.
3. Combine with progressive resistance training for knee extension exercise. Do knee extension exercises against gravity in a range of less than 30 degrees of knee flexion. Place a soft pillow under the knee, keep the knee flexed at 30 degrees, and then lift it off the bed until the affected knee is straight, and so on repeatedly. The intensity of the exercise is 10 to 15 minutes twice a day, and according to the functional status of the affected knee, the sequence of isotonic contraction of the quadriceps, straight leg raising, terminal knee extension, and progressive resistance training should be followed.
4.With the help of tucking cane or walker to support the weight, increase stability, to meet the requirements of partial weight bearing of the affected limb.
5.Active short arc exercises: pillow under the knee, active extension exercises, make the heel leave the bed. 20 times per group, 30 seconds rest between groups, 2 consecutive sets of exercises for 1 session, 3 sessions per day.
Phase 3: 4 to 6 weeks
After removal of the brace, functional rehabilitation, weight-bearing and proprioceptive training are performed to improve joint control and stability, and to gradually improve gait. Straight leg raising exercises and knee flexion exercises are reserved for this phase.
1.Increase the range of motion of the joint, prevent joint adhesions, continuous passive movement of the joint, starting angle, ending angle of 90 degrees, slow movement speed, 4 per day, require passive knee flexion angle of 90 degrees or close to 90 degrees within 1 week, when not doing continuous passive activity, urge the patient to do active knee flexion and extension activities, 3 times a day, 10 minutes each time.
2. Strengthen muscle strength and increase joint stability. Train the quadriceps and N cord muscles on the quadriceps training chair and net frame, gradually increase the resistance.
3.Walking and stair training: gradually increase the walking time and distance, adjust the gait and posture in the process of walking, and complete the transition of the center of gravity from the lower extremity of the healthy side to the affected side, should be maintained when going up and down the stairs, pay attention to safety, and walk according to the ability.
4, active long arc exercise: the patient sits on the edge of the bed, bend the knee 90 degrees, the lower leg drops naturally, contract the quadriceps with force, straighten the knee joint, make the lower leg straight up, rest for 1 second, hang down the lower leg, so repeatedly practice, 20 times per group, rest 30 seconds between groups, continuous practice 2 to 3 groups for 1 section, 3 sections per day.
5, weight-bearing and balance exercises: separation of the feet and shoulder width alternately move the center of gravity, strive to achieve a single leg completely weighted standing, 5 minutes each time, 2 times a day. Separate the front and back of the feet, alternately move the center of gravity in front and behind, and strive to achieve a single leg completely weighted standing, 5 minutes each time, 2 times a day. Stand on one foot for 1 minute. Forward and backward striding exercises, with the affected leg in front and on the striding side with weight.
Phase 4: 6 weeks to 12 months after surgery
Gradually transition from partial weight-bearing to full weight-bearing of the affected limb; strengthen weight-bearing and balance exercises, walking with double crutches, if you can easily complete the single-leg stand, then start using single crutches.
1, back against the wall static squat exercises: feet and shoulder width, toes and knees are forward, with the power to gradually increase the angle of the squat, 1 minute each time, 5 seconds interval, 5 times each group, 2 to 3 times a day.
2, single-leg half squat flexion and extension exercises: the affected leg standing on one leg, slowly squat to 45 degrees of flexion, and then slowly and smoothly straighten the knee joint, 20 times per group, 30 seconds rest between groups, 2 to 4 groups per day. Patients can come in for instruction as needed before the 3-month post-operative review.
Phase 5: 4 to 12 months after surgery
To strengthen joint mobility, muscle strength and joint stability, and to resume daily life and all activities. Therefore, the main focus of this phase is on exercise, and most patients can complete the exercise at home with guidance. Active flexion and extension are performed at the same angle as the healthy side. Begin resistance strengthening exercises, full squat exercises, kneeling exercises, pedaling exercises, strengthening exercises, knee wrapping exercises, jumping up and down exercises. Lateral jumping exercises, trampoline exercises, and jogging and bicycling exercises can be performed to increase joint flexibility. The progress of resistance training depends on the patient’s recovery and should not be rushed. It is important to emphasize that the reconstructed ligaments are not strong enough at this stage, so the exercises should be performed gradually, and the muscles should be strengthened to ensure the stability and safety of the knee joint during sports.