Rehabilitation after arthroscopic meniscus injury-related surgery of the knee
Arthroscopic meniscal injury-related surgery in the knee is characterized by no incision of the joint capsule, minimal trauma, low rate of joint adhesions, and rapid postoperative recovery. The implementation of systematic functional rehabilitation after surgery is an important guarantee for the success of the surgery and the restoration of normal knee function.
Early phase (0~1 week after surgery)
In the early stage of functional exercises, the muscle strength level is low and the inflammatory reaction is obvious, so small load endurance exercises are mainly used to reduce swelling and pain and to avoid muscle adhesions and atrophy.
After the anesthesia subsided on the day of surgery, we started to move the toes and ankle joints, doing ankle pump exercises, i.e. ankle dorsiflexion, knee extension, contraction of the quadriceps muscle, hard, slow, full range of flexion and extension of the ankle joint, 5min/each time, 1 group/h; quadriceps isometric contraction exercises, i.e. contraction of the quadriceps muscle at a uniform rate in the resting state of the affected limb, tensing and relaxing should be done more often without increasing pain; N cord muscle isometric contraction exercises, the affected leg should be done more often without increasing pain. Contraction exercises, the affected leg force down the padded pillow, so that the posterior thigh muscle tensing and relaxation, all exercises in the premise of not increasing pain as much as possible to do.
On the first postoperative day, the above exercises were continued, and the ankle pump exercise was changed to anti-gravity exercise, which could be assisted by others or by holding the thigh with hands, and the straight leg raising exercise was started, that is, straight leg raising after knee extension until the heel was 15cm from the bed, holding for 5 seconds, 30 times/group, 3~4 groups/d; the back leg raising exercise was started, that is, prone, straight leg raising after knee extension until the toe was 5cm from the bed, holding for 5 seconds, 30 times/group; the side leg raising exercise was started at the same time. If the pain and swelling are not obvious, the patient can walk on the ground with or without crutches, but walking is not encouraged.
On the third postoperative day, the above exercises were continued, and the flexion exercises were started to be slightly painful and to reach the largest possible angle. Sitting (or lying) on the edge of the bed with the knee hanging outside the bed, relaxing the thigh muscles under protection and allowing the calf to sag naturally to the limit of protection for 10 minutes; also sitting knee, that is, sitting, the foot does not leave the bed, holding the hands at the ankle joint, slowly and forcefully bending the knee.
On the 4th postoperative day, the above exercises were continued and single-leg standing balance exercises were started, 5min/time, 2~3 times/d. The prone position “leg hook exercises” were started, with sandbag as the load, in the range of 0~45° flexion/extension, and ice was applied immediately after the exercises if the joint was swollen and painful, 30 times/group, 2~4 groups/d, with active knee flexion up to 90°.
On the 5th postoperative day, the above exercises were continued and intensified, and the standing weight-bearing exercises were started, with active extension and flexion in the range of 0~45°, 30 times/group, 2~3 groups/d.
In the first postoperative week, active flexion was greater than 90°, you can stand on one foot, walk short distances without crutches, and start squatting against the wall (back against the wall, feet shoulder-width apart, toes and knees squarely forward, no “internal and external figure of eight”, gradually increase the angle of squatting with increasing strength, less than 90°), 2 min/time, 5 seconds interval, 5~10 consecutive/group, 2~3 groups/d; start standing “leg hook exercise”, to resist the maximum angle of flexion without pain to maintain 10~15 seconds, 30/group, 4 groups/d.
Initial period (week 2~1 month)
With the improvement of muscle strength level, this period is mainly to improve the absolute strength of the exercise, choose medium load (complete 20 movements that is the amount of fatigue), 20 times / group, 2 ~ 4 sets of continuous exercises, rest 60 seconds between sets, until fatigue, in order to improve joint control ability and stability. If the joint feels swollen or hot after the exercise, ice should be applied promptly.
In the second week of postoperative period, strengthen the muscle strength exercise (one straight leg lift up to 6 minutes), active flexion to 120°~130°, i.e., sitting position, foot does not leave the bed, slowly, forcefully, maximum knee flexion, hold for 10 seconds and then slowly straighten, 10~20 times/group, 1~2 groups/d. If there is no obvious swelling and pain in the joint, then walk as normal as possible.
In the third postoperative week, we continued to strengthen the muscle strength exercise, passive flexion to 140°, and started anterior-posterior and lateral striding exercises.
Mid-term (1st to 2nd month)
Strengthen the joint mobility to the same level as the healthy side, improve the stability of the joint, and restore the ability to perform various activities of daily life and light movements.
At the 5th week after surgery, the active flexion reached the full range of 150° (the same as the healthy leg), and was basically pain-free; started the 45° half-squat exercise on the affected side, 5min/time, 4 times/d; started the fixed bicycle exercise, 30min/time, 2 times/d.
In the 6th~8th week after surgery, the active flexion and extension angle reached the same as that of the healthy side without pain; they could complete daily activities, such as walking up and down stairs, cycling, walking more than 5,000 meters without swelling and pain; they started kneeling exercises; they started pedaling exercises; they started swimming, skipping rope and jogging.
Later period (2nd to 3rd month)
Resume all activities of daily life, strengthen muscle strength and joint stability, and gradually resume sports. Increase the maximum strength, choose a large load, start knee wrapping exercises, jumping up and down exercises and lateral jumping exercises, 8~12 times/group, 2~4 groups of continuous exercises, rest 90 seconds between groups, until fatigue. However, there should be a limited amount of physical activity, and it takes about 6 months to achieve full recovery.
After discharge from the hospital, the patient should follow the postoperative functional rehabilitation program and insist on functional exercises, regular follow-up, check and record the functional recovery of the knee joint.