Patient: I am an athlete, on May 6, during a basketball game, due to excessive force, I broke my right knee anterior cruciate, one month later is June 8 in Xiamen First Hospital for reconstructive surgery, according to a rehabilitation plan given to me by the doctor, as of today, June 24, I can bend between 90 degrees and 105 degrees, I feel that my right foot is quite strong, but now I am still on crutches and dare not land, sometimes after bending the foot for a while, it is a little difficult to straighten it all out. Sometimes after bending my foot for a while, it is a little difficult to straighten it all out, and I have to wait a while before I can straighten it slowly, similar to the healthy side. And is my current bending angle normal? Can I land on my feet? Ma Zhao, Department of Rehabilitation, Beijing Hospital, Ministry of Health: You are now in your third week post-operatively, and it is ideal to reach an angle of 105 degrees. When practicing flexion and extension, the slow straightening that occurs after flexion and stretching is normal and will gradually disappear with time. Also, the fact that you are still on crutches and cannot land is not ideal. If your surgeon did not give you a weight-bearing contraindication, you should be able to try walking off crutches now. I don’t know if you have trained in weight-bearing in your previous rehabilitation, but if you have not practiced weight-bearing, don’t try to take off the crutches directly, first try to put on a small amount of weight, and gradually increase it to reach the weight-bearing of the whole leg before taking off the crutches. As long as you master the principle of gradual progress in rehabilitation training, you will not hurt yourself. Your current rehabilitation training should focus on strength exercises and flexion and extension angle exercises. I wish you a speedy recovery. Patient: Thank you, Dr. Ma! Your answer has given me a lot of confidence in my own recovery. Now I am training with a splint, is this considered weight bearing? My doctor did not give me a contraindication to weight bearing, nor did he require weight bearing, so can you give me some advice on weight bearing?
I read your reply in the evening and tried it myself, probably because of the burden in my heart. I am still afraid to exert force on my injured right foot, but I just turn around and touch the ground gently. Ma Zhao, Department of Rehabilitation, Beijing Hospital, Ministry of Health: You still need splint protection at this stage. The weight training is like this: you should not take any painkillers during the training. Train under the protection of a splint. Stand by a stable support, hold the support and maintain full balance. First place all the weight on the good side of the leg. Afterwards transfer a small amount of weight to the surgical side leg. At this time pain is your monitoring indicator, if it is not painful, continue to increase the weight. If it hurts, but not very much, continue for 1 minute and then observe the pain after relaxation, if it disappears completely within 5 minutes, it is also safe. If the weight is painful, then hold off on weight training. Follow the above procedure to gradually increase the weight-bearing capacity of the lower extremity on the surgical side. When you have reached the point where you can bear all the weight (i.e., stand on one leg) on the operated side for 1 minute without pain, you can safely drop the crutches. Use crutches as a walking aid during this procedure. Patient: Thank you Dr. Ma! But now when I stand up, there seems to be a slight lack of straightening of the right foot on the affected side, so is it possible to do the exercises you mentioned? Can I now do static squats to increase the strength of my upper limbs? Ma Zhao, Department of Rehabilitation, Beijing Hospital, Ministry of Health: If your extension is still limited, then you should focus on extension training at this stage. You will have a limp if extension is not fully restored. Now you can increase the strength of your lower limbs by squatting. Patient: Dr. Ma, according to your advice, I have been slowly strengthening weight-bearing exercises for my right foot, and now I can stand for more than a minute. Is this normal? Should I stick to it?
Also, when I put on the splint, I can walk more easily, but when I take off the splint, my foot doesn’t feel as natural as when I put on the splint. Now that I am in my 5th week, should I still put on the splint and exercise, or should I take off the splint and exercise? Ma Zhao, Department of Rehabilitation, Beijing Hospital, Ministry of Health: There are several questions you need to clarify: 1. Can you stand on one leg for one minute or stand still for one minute? If you are able to stand for one minute without pain, you can take off the crutches and walk.
2. I remember the last time you asked a question, the joint was not fully extended, so can it be fully extended now? If extension is still limited, then straightening exercises are the first priority now.
3. Is your splint a fixed splint or an adjustable splint? If it is adjustable, it can now be fixed at 0-110 degrees. The splint may be worn for a few more days and will need to be removed after a review by your doctor in about 8-10 weeks. If your joint is not significantly swollen and painful when you move it, you can now also add cycling exercises to improve your knee flexibility. Good luck with your recovery. Patient: Thank you Dr. Ma for your reply. I can now stand for more than 1 minute without shaking, is this considered stable? I can now straighten my foot and I do exercises with a pillow under my foot every night before I go to bed. My splint has an adjustable angle, now I have been fixed 0-120 degrees, which is the highest degree of this splint, so how should I practice the next degree again? The doctor told me that the swelling will last for 3-6 months, so it won’t affect my knee, right? When I walk off the crutches, the right knee is a little bit uncomfortable and sometimes it hurts, should I stick to it? Ma Zhao, Department of Rehabilitation, Beijing Hospital, Ministry of Health: You are not able to feel the pain of the repaired ligament yet because it takes longer for the nerves of the rebuilt ligament to recover. Now you are to take the splint off when you train the angle, and the purpose of wearing the splint in daily life is to prevent accidental sprains. Because the knee is not functioning well enough right now, in case of a sprain, it might pull the new ligament that has grown not quite strong enough again. For that little bit of swelling, it does take 3-6 months for it to go away completely. You can try pedaling training, but for the first time only pedal for one minute without load, then experience the pain at that time and observe the swelling that day and the swelling the next morning. If the pain is not significant and the swelling does not increase, you can gradually increase the load and time the next day. For the discomfort and pain you describe, it should not be a big problem. I think it may be caused by the lack of flexibility in the knee joint now. If the pain and discomfort increase, stop in time. If it does not increase or even decrease, continue to walk, but not more than 10 minutes, and observe the pain and swelling of the knee the next morning.