Pain and swelling are controlled with analgesics and anti-inflammatories for 5-7 days.
To immobilize the knee, we use a removable splint that locks the knee in extension. With the splint in place, the patient can support himself on the leg using
two crutches.
The brace can be removed during rest, and we encourage limiting its prolonged use to minimize quadriceps atrophy.
The emphasis is on extension recovery.
Two easy-to-follow exercises can be performed
With the patient on his or her stomach and knee protruding from a table, he or she tries to extend the knee and relax the thigh muscles to push for maximum extension.
For flexion recovery
The use of an exercise bike is recommended. Swimming can also help maintain good muscle tone.
The patient must understand the ins and outs of the operation. They need to arrange for post-operative rehabilitation sessions with their physiotherapist.
The patient must arrange for an absence from the workplace of between 6 weeks and 3 months, depending on the type of activity.
A return to sport cannot be envisaged before 6-9 months.
Use of analgesics and anti-inflammatories
Ice is recommended for reducing inflammation. If using cryotherapy with a sleeve (plastic envelope with cold water), the rhythm is 3-4 times a day with 30-minute sessions.
Patients will wear compression stockings prior to surgery.
Removable splints are used with the knee in extension (the same as those used prior to surgery), or articulated splints may be used which are initially locked in extension.
The patient, at home, will try to use ice as often as possible to reduce knee inflammation.
It would be advisable to maintain a slightly sloping position, with a cushion placed under the leg when the patient is in the supine position.
Avoid sitting with your leg dangling as much as possible.
Painkillers can be adjusted by the patient according to the level of pain felt. Crutches are used for walking, and the patient is advised to limit his or her movements.
You can start using the exercise bike (without a brace, of course); at the start, the saddle should be well up and the effort should be effected by the leg on the opposite side. On the operated side, only the foot is placed on the pedal without forcing or pushing.
The removable splint should be worn day and night for the first two weeks. Then only during the day for another 1-2 weeks.
The rehabilitation itself will include trophic massage, mobilization of the patella, prevention of phlebitis, active and assisted mobilization in flexion/extension with or without arthromotor, tonification of the quadriceps and learning to walk with splints and English canes.
The knee brace is removed for 2-3 hours. The heel rests on a rolled towel or pillow, with the knee not touching the bed surface. The knee is held in this position for 10-15 minutes, relaxing the thigh muscles. This exercise can also be effected in a seated position with the heel on a stool.
Active assisted extension using the opposite leg. The patient sits on the edge of the table, with the foot on the healthy side under the ankle on the operated side (legs crossed). The healthy leg is used to lift the operated leg.
Passive flexion of the operated knee. Sitting on the edge of the table, the legs are crossed and with the leg on the healthy side the operated leg is pushed afin to obtain maximum flexion. This position is maintained for 6 seconds, the exercise is effected 4-6 times a day for 10 minutes.Normally after a week a flexion of 90° is obtained.
Isometric quadriceps contraction, supine position, we effect quadriceps contractions without lifting the heel from the plane of the bed. Three times 10 contractions are effected, to be repeated 3 times a day. Each contraction lasts 6 seconds. This exercise is important for waking up the quadriceps muscle, it also helps drain fluids from the knee.
The straight leg is lifted 8 times, 10 lifts, 3 times a day, while the knee is still held by the splint. In the supine position, raise the knee to 45°-60° and hold for 6 seconds. Gently lower the foot and relax the muscles. This exercise can also be effected without a splint, as long as you are able to maintain the knee in full extension by contracting the quadriceps (the quadriceps locks the knee perfectly).
In the supine position we fléchit the knee on the operated side by 10-15° and hold this position for 5 seconds. Then we fléchit again by 10-15° and hold for another 5 seconds. This is continued in 15-20° increments until a flexion of 90° is achieved. Complete extension and release. Repeat this exercise 10 times, 3 sessions a day.
After three weeks, apply Vaseline or other healing ointments to the wound to enhance healing.
The scar should be kept out of the sun for one year.
It is important to remove the splint 4-6 times a day for 10-15 minutes afin order to maintain full extension.
Continue with passive extension exercises, working towards a flexion of around 90-100°. Improve muscle control (partial squat).
The splint is left outside the house, initially with only one crutch, then, as the muscles recover, the second crutch can be gradually abandoned. If you have to keep one crutch, you always keep the crutch on the opposite side.
We continue to exercise on the exercise bike, initially without resistance, and after six weeks we start to pedal normally or even with light resistance. Sessions last 5 minutes at first, then can go up to 20 minutes.
Driving can be envisaged after 4-6 weeks. Patients who have an automatic car and in whom the surgery concerns the left foot may be able to drive sooner (or even after 2-3 weeks).
Standing upright about 30-40 centimetres from a table, touch the table with your fingers to maintain balance. We fléchit the knee slightly to 30-40° and hold this position for 6 seconds, then return with the knee in extension. Repeat 10 times in 3 daily sessions.
In the same position as exercise n°7 near a table, we contract the leg muscles and stand on tiptoes, holding the position, 6 seconds. Effect the same exercise 10 times over 3 sessions.
At this stage, we expect to exceed a flexion of 120° with full extension. We continue with exercises to strengthen the quadriceps as well as squats.
From the sixth week onwards, you can go to the gym and effect exercises with the press (pushing weights with the foot), you can also use the elliptical bike for 15 to 20 minutes a day. Swimming is recommended fairly quickly from the fourth week onwards.
You need to be able to go up and down stairs easily.
You can start walking on the treadmill. Continue with the squat, exercise bike and leg presses for the quadriceps. For the treadmill, we'll use normal walking speed without resistance.
The tonification continues. We can start running slowly; running should be effected on flat ground and we can gently start rapid changes of direction when running.
This is followed by the intensive rehabilitation phase, for maximum recovery of knee amplitude, strength and stability afin preparation for the return to sport.
For sports recovery, you need maximum recovery of the closed-chain quadriceps and the open- and closed-chain hamstrings.
In fact, the quadriceps must be 80% recovered (if compared with the leg on the healthy side), the hamstrings also 80%, and there must be complete recovery of mobility. The knee must not be gonflé and be quite stable. The patient must be able to effect jogging programs with rapid changes of direction.
At this stage, recovery of active and passive mobility should be complete. The home self-education program is continued.
Daily activities