Standard post-arthroscopy rehabilitation
The following represents the typical post-arthroscopy rehabilitation required by most patients at London Knee Clinic after arthroscopy. For more serious cases a modified approach is required and is referred to below.
Most patients are able to walk normally without a brace or crutches within an hour or so after an arthroscopy and go home within four hours of surgery. The majority of procedures do not change the main structural weight bearing parts of the knee and for example may involve removal of a small loose body, trimming of a relatively small part of a meniscus or removal of a synovial plica.
In common with most surgeons, we no longer use sutures to close arthroscopy incisions. The tiny incisions used to insert the arthroscope and instruments are about 4 to 5 mm long and these are held closed by Steristrips which are small reinforced pieces of self-adhesive fabric. These are then covered by small self-adhesive wound dressings. Over the top of these is a Gamgee pad which is applied to soak up any leakage from the wounds. The Gamgee pad is then held in place by a full length elastic stocking. The stocking serves two purposes. It lessens the risk of a deep vein thrombosis and supports the wound. It is very simple to remove the gauze pad. Just pull down the upper half of the stocking and remove it usually at 24 hours.
It is important to keep the knee moving after arthroscopy which means that on a daily basis you should try to bend it as far as comfortably possible, best done in a sitting position. You should also maintain extension by trying to lock it out straight on a regular basis. There is a tendency for muscle wasting to occur quite rapidly if extra muscle exercises are not performed and it is essential to do regular quads exercises by straightening the knee and lifting the whole leg with the knee as straight as possible. Swelling of the knee can limit flexion. However, if you regularly bend the knee as fully as possible this will also help the swelling. It is also quite useful to ice the knee for 10-15 minutes a couple of times a day during the first few days after surgery.
While many of these exercises can be done yourself, it is often useful in the immediate post-operative stage to see a Physiotherapist. It is best to make contact before the actual surgery and arrange post-operative Physiotherapy to start about 48 hours after the procedure.
This standard regime applies to the following procedures:
- Partial meniscectomy or meniscal trimming
- Partial removal of fat pad
- Removal of loose bodies
- Removal of plicae
Modified rehabilitation in more major cases
If a bigger operation has been performed it is natural that it will take a little longer to rehabilitate. In the case of meniscal repairs there are further differences and these are described in a separate paragraph below.
Lateral release: A lateral release often gives rise to greater swelling than usual and movement returns a little less rapidly. You will need to take things more quietly for the first 6 weeks and it is even more important to work with a Physiotherapist. While doing so it is also important to keep in regular contact with your Surgeon and for regular liaison between Surgeon and Physiotherapist to occur Often you will be unable to resume sport for a period of 3 months.
Microfracture: Where microfracture has been performed, you may need to be partial weight bearing with crutches for several weeks post-operatively and a brace may be prescribed. You will need to obtain guidance on this from your Surgeon.
Protocol after meniscal repair
- Initially: Gentle walking with crutches partially weight bearing. Remove the Gamgee pad after 48 hours. Maintain quadriceps and hamstring muscle power with static strengthening from the beginning.
- Weeks 1 to 6: Continue crutches, partially weight bearing. No knee flexion beyond 45 degrees. Continue static quadriceps and hamstring exercises.
- At 6 weeks: Gradually wean off crutches and increase knee flexion progressively to 90 degrees over a two week period. Full weight bearing is re-established. The range of motion is gradually improved non-weight bearing.
- At 12 weeks: Gradually introduce weight bearing knee flexion activities including a limited number of squats but no single leg squats or lunges until approved by your surgeon. Take great care to increase activity only very slowly. It is important that there is good continued liaison between your Surgeon and Physiotherapist.
Copyright London Knee Clinic 2014