Post-operative rehabilitation plan for meniscal repair (sutures, meniscal staples, meniscal arrows and other fixation methods)
In order to achieve satisfactory rehabilitation results, the patient should have a clear understanding of his or her condition so that he or she can better cooperate with the physician to ensure the smooth implementation of the rehabilitation program.
Before using the exercises in this program, you should read all the contents carefully and obtain the doctor’s permission before implementing the program.
1. The methods and data provided in this plan are based on general practice. The specific implementation should be done under the guidance of a doctor depending on your condition and surgery.
2. Pain during functional exercises is unavoidable. If the pain can subside to the original level within half an hour after the exercise stops, it will not cause damage to the tissue and should be tolerated.
3, muscle strength exercises should be concentrated until the muscles have a sense of soreness and fatigue, and then proceed to the next group after sufficient rest. The number of exercises, time, load depending on their own situation, and should be practiced at the same time the healthy side. The improvement of muscle strength is a key factor for joint stability, and must be practiced carefully.
4. In addition to the surgical limb braking protection, the rest of the body parts (such as upper limb, waist and abdomen, healthy side leg, etc.) should be practiced as much as possible to ensure the physical quality, improve the overall level of circulation and metabolism, and promote the recovery of the surgical local.
5. Early joint mobility (flexion and extension) exercises should be performed under the guidance of a rehabilitation physician, not independently, to avoid danger.
6. Immediately after the mobility exercises, ice should be applied for 15-20 minutes. If you feel swelling, pain and fever in the joint after the exercise, you can apply ice again 2-3 times a day.
7. The side with shadow in the appendix is the affected side.
Full text
The meniscus body, anterior and posterior horn injury stitches are not weight-bearing for 6 weeks after surgery and no flexion exercises for 1 week after surgery, passive flexion exercises within 0-90 degrees for 4 weeks, and no active flexion exercises for 4 weeks.
I. Protection period (1 day to 4 weeks after surgery)
(i) On the day of surgery and 1 day after surgery.
(b) Immediately after surgery, apply pressure bandages, elevate the affected limb and immobilize it with a straight splint.
After anesthesia subsides, begin to try.
1. ankle pump – forceful, slow, full-range flexion and extension of the ankle joint for 5 minutes/group, 1 group/hour. (Important for promoting circulation, decreasing swelling, and preventing deep vein thrombosis)
2, quadriceps (anterior thigh muscle group) isometric exercises – that is, thigh muscle tensing and relaxation. Do as many as possible without increasing pain. (Greater than 500 times/day)
3, N rope muscle (posterior thigh muscle group) isometric exercises – the affected leg force down the padded pillow, so that the posterior thigh muscle tensing and relaxation requirements as above, more than 500 times / day
(ii) Two days after surgery.
1. Start to try straight leg lift – straight leg lift after knee extension to heel 15M from the bed, hold until exhaustion. 10 times/group, 2-3 groups/day
2. Start leg raising exercises in all directions, 30 times/group, 2-4 groups/day, with 30 seconds rest between groups.
(iii) 1 week after surgery.
1. Continue and strengthen the above strength exercises.
(iv) 2-4 weeks postoperatively.
1. Continue and strengthen the above strength exercises.
2.Start “kicking” exercises to strengthen the legs. 30 times/group, 30 seconds rest between groups, 4 groups in a row, 2-3 times/day.
3. Increase the passive knee flexion angle by about 10° per week (60° for one week, 70° for two weeks, 80° for three weeks, 90° for four weeks)
(v) 4 weeks postoperatively.
1. Intensive strength exercises.
2. Passive knee flexion to 90°.
3. start active knee flexion.
4. start exercises to rotate the lower leg, range until just natural stop.
5. start partial weight-bearing, with a load of approximately one-third to one-half of body weight.
Second, resume the weight-bearing period (5-7 weeks after surgery)
This period should not be too much walking, otherwise it is very easy to cause joint swelling and fluid accumulation, which will affect the functional recovery and tissue healing.
1. 6 weeks after surgery, the weight-bearing of the affected limb is gradually increased, and full weight-bearing is possible eight weeks after surgery.
Weight-bearing and balance exercises – separate both feet under protection, move the center of gravity alternately from side to side within the range of slight pain, gradually transition to fully weight-bearing standing on one leg, 5 minutes/time, 2-3 times/day. Separate both feet anteriorly and posteriorly, move the center of gravity, and gradually transition to full weight-bearing standing on one leg.
2. 5-7 weeks postoperatively, continue passive knee flexion exercises, progressing 10 degrees per week, but maintaining a passive movement angle of 120°.
3. flexion-extension knee 0-30° strength exercises, 30 reps/set, 2-4 sets/day, with 30 seconds rest between sets.
4. Flexion and extension knee 30° half squat: 2 minutes/repetition, rest 5 seconds, 10 consecutive times for 1 group, 2-3 times/day.
Third, the recovery period (8 weeks after surgery to 8 weeks after)
1. The affected limb can be fully weight-bearing 8 weeks after surgery.
2. 8 weeks after surgery, the knee can be passively flexed more than 120°, and the knee joint can be actively exercised by itself.
3, can start “hook leg” exercises. To strengthen the posterior thigh muscles. Should be static exercises, bend to a painless angle for 10-15 seconds, 10 times / group, 4 groups / day.
4. Can start the front and back, lateral straddle exercises. 20 times / group, 4 groups / day.
5. Stationary bicycle exercises, no load to light load. 10-20 minutes/set, 2 sets/day.
6. The athlete can start the training of basic technical movements of special sports three months after surgery. But must be progressive!
※ Knee pads can be worn for protection if necessary, but are only advocated for use during strenuous exercise.
IV. Recovery sports period (after 3 months)
Purpose: Full return to sports or strenuous activities.
1. Gradually resume strenuous activities or special training.
2. Strengthen the muscle strength and the stability of the joints in running and jumping.
3. Through the test, the affected muscle strength reaches 85% or more of the healthy side, no pain during exercise, no obvious swelling, then can fully resume sports.
Remark.
I. Flexion exercise methods.
The following methods in accordance with their own flexion angle, any applicable method, 1-2 times a week, and strive to angle growth can be. If you have any special discomfort during or after the exercise, you should promptly inform your doctor. The exercise process should not be straight rest, repeated flexion and extension, otherwise it will affect the healing of the meniscus, and it is very easy to cause swelling.
1. Sitting (or supine) position leg drop (for 0-95° range)
Sit or lie on the edge of the bed with the below knee hanging outside the bed. Relax the thigh muscles under protection and allow the calf to drop naturally to the limit for 10 minutes. If necessary, add load at the ankle joint.
2. Supine leg drop: (for more than 100 ° range)
Lie on your back with your thighs perpendicular to the bed (hold your legs with both hands to fix), relax your thigh muscles and let your calves sag naturally, add load at the ankle joint if necessary (the load should not be too large, otherwise the muscles cannot relax, i.e. no effect). The requirements are the same as above.
3, sitting position “top wall” (for 90-105 ° range)
Sitting on the chair, the affected side of the toe against the wall or fixed, slowly move the body forward to increase the bending angle of the knee, feel the pain and keep still, after a few minutes the pain disappears or lower, then move forward to the limit.
4. Sitting knee hold (for the range of 100° or more)
Sit on the bed and hold the ankle with both hands so that the heel slowly approaches the buttocks, starting in the third week after surgery. Measure the distance between the heel and hip before starting and use 6-8 weeks to hold until the angle is the same as the angle of the healthy side leg. This exercise should be done gradually, do not venture blindly or fear pain.
5. Prone knee flexion (for the range of 110 ° or more)
Prone position (face down on the bed), legs naturally extended, hold the ankle joint of the affected leg by yourself, so that the knee joint is flexed (a long towel or a wide band can be tied around the ankle to facilitate pulling). Or by the help of others, but absolutely prohibited violent pushing.
II. Exercise method of extension and flexion.
Patients with preoperative extension limitation (leg cannot be fully straightened) should choose the following methods to strengthen the exercises The pulling sensation and slight pain in the muscles and posterior joints are normal, and the muscles should not be contracted against, and should be completely relaxed, otherwise it will be ineffective. The weight of the load used in the exercise should not be too large, but should make the affected knee dare to relax and last until 30 minutes to the limit, when a clear pulling sensation is appropriate. No breaks should be taken in the middle of the exercise, otherwise the effect will be affected.
1. Seated knee extension (within 3-4 weeks in the early postoperative period): Sitting position, foot pads elevated, weight above the knee joint. Relax the muscles completely and hold for 30 minutes. 30 minutes/time, 1-2 times/day.
2. Prone suspension (after 4 weeks in the middle and late postoperative period, or if the extension angle is obviously limited): prone, hanging below the knee outside the bed, with weight at the ankle joint.