Arthroscopic autologous semitendinosus femoris thin tendon ACL reconstruction precautions.
1. Except for the braking protection of the operated limb, the rest of the body parts (such as the upper limb, waist and abdomen, and the healthy leg) should be practiced as much as possible to ensure physical quality, improve the overall circulatory metabolic level, and promote the recovery of the operated local area. Gong Shiguo, Department of Orthopedics, Jiujiang First People’s Hospital
2, early joint mobility (flexion, extension) exercises, only once a day, and strive to improve the angle can be, avoid repeated flexion and extension, multiple exercises. If the flexion angle does not progress for a long time (>2 weeks), there is a possibility of joint adhesion, so we should pay great attention to it and insist on completing the exercises.
3.Ice packs should be given for 20-30 minutes immediately after the mobility exercises. If you usually feel swelling, pain and heat in the joint, you can apply ice again, 2-3 times a day. The exercises should be completed in accordance with the requirements of the rehabilitation program and should not exceed the prescribed angles or fail to reach the prescribed angles.
I. Early stage – inflammatory reaction period (0-1 week)
(i) On the day of surgery.
After the anesthesia subsides, start to move the toes and ankle; if the pain is not obvious, try to contract the quadriceps. That is, tensing and relaxation of the anterior thigh muscles.
(ii) One day after surgery.
1. Ankle pump – forceful, slow, full range of flexion and extension of the ankle joint. No time is specified for ankle flexion and extension exercises, which can be performed while reading newspaper, watching TV, reading books or resting in bed, the more the better, which is 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 exercise – the affected leg force down the padded pillow (the height of the pillow in a loose state not more than 5cm), so that the posterior thigh muscle tense and relaxed. The requirement is the same as above, more than 500 times/day.
(4) The first day after surgery, you can walk on the ground with the help of crutches, but the affected leg should be protected under the splint, with the help of crutches, and the affected limb should not bear weight.
(C) 2 days after surgery: remove the drainage, if no drainage tube is placed in the joint, joint swelling after surgery can be considered serious joint cavity puncture to draw out the accumulated blood.
1.Continue the above exercises.
2.The ankle pump exercises are the same as the first postoperative day.
3.Start to try straight leg lift – extend the knee and lift the leg straight up to the heel 15M from the bed and hold it until the force is exhausted. 2-3 times/day. Pain at the surgical incision during the exercise is normal and should be tolerated. Special attention should be paid to the exercise: before starting the leg lift, the muscles in front and behind the thigh should be tensed so that the whole leg forms a whole under the protection of the muscles, and the knee joint should be ensured to be completely straight before lifting the leg, which can prevent the newly reconstructed ligaments from being pulled loose during the straight leg lift.
4.Start side leg raise exercise, 10 times/group, 2 groups/day, you can do one group in the morning and one in the afternoon.
5.Walk on the ground with the help of crutches, but the affected leg should be protected under the splint, with the help of crutches and no weight-bearing on the affected limb.
(iv) 3 days after surgery.
1.Continue the above exercises.
2.Weight-bearing and balance – separate both feet under protection, alternately move the center of gravity left and right within the range of slight pain, and strive to achieve the same weight-bearing when both feet stand on the ground. 5 minutes / time, 2 times / day. (Note: Do not walk with weight, walk with crutches, and only one-third of the weight-bearing weight of the surgical knee).
3. Start flexion exercises. The patient can try to sit on the edge of the bed and lower the knee naturally to within 30° of slight pain. If the patient has difficulty completing this on his or her own, ask a family member or competent physician to assist in completing it. If the affected limb is in a splint or cast at this time, the cast or splint should be removed during the exercise and put back on after the exercise.
(E) 4 days after surgery.
1.Continue the above exercises.
2.Strengthen the weight-bearing and balancing exercises, gradually until you can stand on one foot with the affected leg. If this can be done easily, start walking with a single crutch (holding on the healthy side) (note: do not walk with full weight, walk with only one third of the weight).
4. Flexion exercises to 0°-60° range. (If basically pain-free can reach close to 90°)
(F) 5 days after surgery.
1.Continue and strengthen the above exercises.
2.Flexion exercises to 70°-80°, and can start active flexion and extension exercises.
3.Start extension exercises (sitting suspension): put a pillow at the heel, make the affected leg leave the bed completely, relax the muscles to make the knee joint extend naturally. 10 minutes/time, 1-2 times/day.
(vii) 1 week after surgery.
1. Flexion angle to 90°, active flexion can also be 90°.
2. Other exercises as before.
II. Initial period: (2-4 weeks)
(i) 2 weeks postoperatively.
1.Passive flexion to 100°.
2.Intensive muscle strength exercises (straight leg lift up to 6 minutes)
3. At this time, the affected limb should still not be fully weight-bearing, and the affected limb should be one-third weight-bearing when walking with crutches.
(B) 3 weeks after surgery.
1.Passive flexion to 110°.
2.Strengthen active flexion and extension exercises and strengthen muscle strength exercises.
3.At this time, the affected limb still should not be fully weight-bearing, walking with crutches, one-third of the weight-bearing of the affected limb.
4.Start to practice flexion by holding the knee in sitting or lying position. Hold the knee until you start to feel pain and hold it for 10 seconds, then relax slightly (do not rest in full extension during the whole exercise) and rest for 5 seconds, then hold the knee again and repeat the exercise for 20 minutes, once a day.
(iii) 4 weeks after surgery: (sleep without splinting)
1.Passive flexion up to 115°.
2.Start static squatting or sliding exercises against the wall.
3.Strive to achieve normal gait walking.
4.At this time, the affected limb still should not be fully weight-bearing, walking with crutches, one-third of the affected limb weight-bearing.
5.The movable splint can be changed to the range of 0-60°.
III. Mid-term: (5 weeks-3 months)
(i) 5 weeks after surgery.
1.Passive flexion up to 120°.
2.Fixed bicycle exercises, no load to light load. 30 min/time, 2 times/day. No condition can be omitted.
3.At this time, the affected limb still should not be fully weight-bearing, walking with crutches and one-third weight-bearing of the affected limb.
4.The movable splint can be changed to the range of 0-90°.
(II) 6-8 weeks after surgery.
1.Passive flexion angle reaches the same as that of the healthy side.
2.Start full weight-bearing at 6 weeks after surgery.
3.Progressively try full squat under protection.
4.Strengthen the muscle strength and increase the number of straight leg raising exercises and static squat exercises.
5.Maintain the movable splint in the range of 0-90°.
(C) 10 weeks-3 months after surgery: (splint can be removed)
1.The active flexion and extension knee angle is basically the same as that of the healthy side, and there is no significant pain.
2, Daily prone position flexion so that the heel touches the hip, continuous stretching for 10 minutes/time.
3.Start kneeling exercises.
4.Start pedaling exercises.
IV? Later stage: (4 months – 6 months)
Purpose: Fully resume all activities of daily life. Strengthen muscle strength and joint stability. Gradually resume exercise.
Late stage to improve the maximum strength, choose a large load (complete 12 movements that is the amount of fatigue load), 8-12 times / group, 2-4 sets of continuous exercises, rest 90 seconds between groups, until fatigue.
1.Start the knee ring exercise.
2.Start jumping up and down exercises.
3.Start lateral straddle exercise.
4.Start swimming (breaststroke is prohibited in the early stage), rope skipping and jogging.
5.The athlete starts the special exercises of the base movement.
During this period, the reconstructed ligaments are not strong enough, so the exercises should be done gradually, not reluctantly or blindly. The knee joint should be strengthened to ensure the stability and safety of the knee joint in sports, and the knee brace can be worn for protection if necessary, but only during strenuous sports.
V. Recovery period: (7 months – 1 year)
Purpose: Full recovery from sports or strenuous activities.
To strengthen muscle strength and joint stability during running and jumping.
Gradually resume strenuous activities or special training.
If the mobility of the affected joint reaches normal and the muscle strength reaches 85% or more of the healthy side, the exercise can be fully resumed.