The following is the post-surgical rehabilitation program of the Hospital of Special Surgery (HSS) in the United States for patients who need it. For the full text, please refer to the book “Post-surgical Rehabilitation Guidelines for the Orthopedic Clinician”, which was translated by our department.
Preoperative rehabilitation
Objectives.
1.Patient education
2.Restoration of normal
3.Normal gait
4.Maximum strength/function
5.Walking up/down stairs without assistive devices
Precautions.
1.Avoid heat therapy
2.Avoid prolonged standing/walking/slowing down and rotational movements.
3.For combined medial collateral ligament injury, avoid valgus stress during treatment training and functional activities
Treatment measures.
1.KT1000 examination
2.Isometric test/functional test/balance test
3.Customized postoperative brace
4.Dressing and removal education
5.Cold therapy instruction
6.Progressive gait training
7. Brace locking at 0° using crutches for partial weight bearing within the tolerable range (patellar tendon)
8.Family plan: postoperative rehabilitation education
9.Quadriceps training
10.Straight leg lift exercise (brace locked at O°)
11.Patellar release
12.(towel pad) passive extension
13.Active flexion/assisted active extension with 90°-0° training
14, Active ROM and assisted active ROM exercises
15.Progressive resistance exercises and functional activities
16.Electrical stimulation/biofeedback (muscle relearning)
Before surgery to achieve.
1.Normal ROm
2.Normal gait
3.Ability to walk up and down stairs without assistance
4.Independence in post-operative rehabilitation
Postoperative stage 1 (0-2 weeks postoperative)
Objectives.
1.Emphasis on complete passive extension
2.Control of postoperative pain and swelling
3.ROm (0o-90o)
4.Early progressive weight-bearing
5.Prevention of quadriceps inhibition
6.Independent completion of home treatment program
Precautions
1.Avoid active knee extension 40°-0°
2.Walk with the brace locked at 0°
3.Avoid heat therapy
4.Avoid prolonged standing and walking
Treatment measures.
1.Padded towel roll stretching, prone suspension training
2, quadriceps relearning (quadriceps electrical stimulation or EMG)
3, brace locking in 0° position progressive partial weight bearing to abduction weight bearing within tolerable range (patellar tendon)
4, patellar luxation
5, active flexion/assisted extension under 0°-90°
6, Straight leg raising exercises (SLRs) (all directions)
7.Support locking in 0o position SLR (supine position)
8.Short arm power bicycle exercises
9.Hip progressive resistance training
10.Proprioception training (bilateral weight-bearing)
11.Stirrups (bilateral/70o-5o) (if ROM>90o)
12.Upper extremity cardiovascular system training
13.Cold therapy
14.Home exercise program based on assessment
15.Emphasis on patient compliance with planned training and weight-bearing considerations/progressivity
Promotion criteria.
1.No quadriceps sluggishness during SLR
2.ROM 0°-90°
3. No pain during unilateral weight-bearing of the affected limb
Postoperative phase 2 (2-6 weeks postoperative)
Objectives.
1.ROM 0°-125°
2.Good patellar mobility
3.Low swelling
4, Return to normal gait (pain free)
5, pain free and well controlled step up to 8″ high step
Precautions.
1.Avoid repeated descents until adequate quadriceps control and lower extremity force lines are restored.
2.Avoid pain during training and functional activities
Treatment measures.
1.When quadriceps control is good (no pain or delay in straight leg raising), adjust the angle of the brace (0°-50°) progressive weight bearing/weight bearing within tolerable range
2. When walking is painless, remove crutches
3.Change the brace according to the operator’s medical advice
4. If joint mobility is >115o, muscle strength is routinely measured
5.Stirrups (80°-0°)
6.AAROM
7.Small range static squat/weight shift
8.Proprioception training
9.Start up the ladder exercise before starting
10.StairMaster (using electric pedals for hard downward stepping exercises)
11.If the wound is good, underwater training
12.Progressive resistance down straight leg lift exercises
13.N rope muscle / gastrocnemius flexibility training
14.Progressive resistance exercises for hip / N cord muscle
15.Active knee extension to 40°
16.KT1000 examination at 6 weeks after surgery (do not do maximum tension examination)
17. Home rehabilitation exercises on the basis of assessment
Promotion criteria.
1. ROM 0°-125°
2. Normal gait
3.Can step up to 8 inches high
4.Good patellar mobility
5.Functional progress at KT1000 and functional assessment
Postoperative stage 3 (6-14 weeks postoperative)
Objectives.
1.Restoration of normal ROM
2. Pain-free and good control of lower extremity stepping down from the 8-inch high step
3.Improve ADL endurance
4.Improve lower extremity flexibility
5.Protect the patellofemoral joint
Precautions.
1.Avoid pain during training and functional activities
2.Avoid running and sports training until adequate muscle strength and operator permission
Treatment measures
1.Progressive static squat exercises
2.Start downward stepping exercises
3.Stirrups
4.Straddle
5.90°-40° isotonic knee extension (open chain)
6.Advanced (interference) proprioceptive training
7.Flexibility training (exercise band)
8.Versa climbing ladder
9.Backward walking or backward running running platform exercises
10.Quadriceps stretching
11.Anterior downstroke test (NeuroCom)
12.KT1000 at 3 months after surgery
13.Family rehabilitation exercises on the basis of assessment
Promotion criteria.
1.ROM within the normal range
2. Pain-free and good control of the lower leg from 8 inches high
3. Functional progress at KT1000 and functional assessment
Postoperative stage 4 (14-22 weeks postoperative)
Objectives.
1.Be able to run without pain
2. Able to meet ADL maximum strength and flexibility
3. The affected knee reaches more than 75% of the healthy side during the jump test
Precautions.
1.Avoid pain during therapeutic training and functional activities
2. Avoid exercise until sufficient muscle strength is recovered and the operator allows it
Treatment measures
1.After being able to step down the 8-inch ladder successfully, start running exercises forward on the running platform
2.Continue lower extremity strength and flexibility exercises
3.Strengthen flexibility/specificity of movement
4.When the strength is sufficient, start the functional reciprocal exercise
5.Isotonic knee extension (full arc pain-free) (closed chain preferred)
6, Isometric training (from fast to medium speed) (closed chain priority)
7. KT1000 at 3 months after surgery
8. Home rehabilitation training on the basis of assessment.
Promotion criteria.
1.No symptoms when running
2.Jump test of the affected knee reaches 75% or more of the healthy side
3. Functional progress at KT1000 and functional assessment
Postoperative stage 5 (after 22 weeks postoperative)
Objectives
1. No fear of specific sports movements
2. Achieve maximum strength and flexibility to meet the requirements of specific sports
3. The affected knee reaches 85% or more of the healthy side during the jump test
Precautions.
1.Avoid pain during training movements and functional activities
2. Avoid sports until sufficient muscle strength has been restored and the operator has given permission.
Treatment measures
1. Continue to strengthen the lower limb strength, flexibility and agility
2.Enhance functional reciprocal movement
3.Specialized sports support
4. Monitor the patient’s activity level during the rehabilitation process
5. Reassess the patient’s complaints (i.e., pain/swelling – adjust the program accordingly)
6. Encourage compliance with the home treatment plan
7. KT1000 at 6 months post-operatively
8. Adjust the home treatment plan based on the assessment
Rehabilitation completion criteria.
1. The affected knee reaches 85% or more of the healthy side during the jump test
2.No fear during special sports
3.Flexibility to the level required for sports
4.Can complete the movements independently to maintain and improve the treatment effect