Rehabilitation after arthroscopic knee surgery

After knee arthroscopy surgery, the recovery period is much faster compared to open joint surgery. However, experts recommend thoroughly following the rules of the rehabilitation period. Properly organized recovery reduces the risk of complications and speeds up the tissue healing process. If you comply with all the doctor’s requirements, you can shorten the rehabilitation period and quickly return to your normal lifestyle without restrictions.

Features of knee surgery

Arthroscopy of the knee joint is performed in the presence of cysts, arthritis, arthrosis, intra-articular fractures or deformation of the articular cartilage. Before the operation, the patient will have to undergo a series of tests to ensure there are no contraindications. Surgery is performed under general anesthesia or conduction anesthesia. The uniqueness of arthroscopy lies in the fact that today it is the only option for minimally invasive intervention that allows you to diagnose and eliminate the pathological process simultaneously. In general, the operation lasts from 1 to 2 hours, depending on the severity of the diagnosis.

Preparing for surgery

Knee replacement involves a series of procedures - preoperative preparation, medical consultations and physical examination usually begin one month before the scheduled date of surgery.

Preparatory and diagnostic tests will include blood tests, an electrocardiogram (ECG), and urine tests.

Surgery is usually performed under general, spinal or epidural anesthesia.

During the procedure, an orthopedic surgeon will remove damaged cartilage and bone and then install a new metal-plastic implant to restore the alignment and function of the knee joint.

Structure of the knee joint

The knee joint is formed from the base of the femur and the top of the tibia. The patella is located on the front surface of the knee joint. Around the joint are muscles, ligaments and tendons. A huge role is played by the joint capsule, in which the natural production of fluid occurs for normal gliding of the joint. Most often, diseases and damage to joints occur in athletes or people leading a sedentary lifestyle. As a rule, any pathology is accompanied by pain and impaired motor activity; a person cannot independently extend the lower limb and move normally.

Types of meniscal tears

Types of meniscal tears of the knee joint.

The meniscus is damaged both in isolation and in combination with other anatomical formations. When exposed to an external force, the rupture is called traumatic. It is usually found in athletes. If changes occur due to arthrosis, this is a degenerative damage that is more common in people of the older age group. Moreover, both of these options are often multiple, affecting articular cartilage. They are, one way or another, interconnected and one does not exclude the other or is its consequence.

A distinction is made between complete and partial rupture. In the first case, free fragments become mobile and can cause blocking (“jamming”), namely the occurrence of impingement syndrome. A sharp immobilization occurs, which can only be eliminated by specialists and mainly by surgical means. If the part where there is active blood circulation is damaged, hemarthrosis is most likely - the accumulation of blood inside the joint. It manifests itself externally by a rapid increase in swelling.

Recovery after surgery

From the first minutes after surgery, due attention should be paid to the rehabilitation period. You must follow all the doctor’s recommendations and not neglect important rules. Under no circumstances should the situation be left to chance: in order to avoid consequences and speed up the recovery process, you need to make every effort: massage, physiotherapy, therapeutic exercises, exercise therapy, etc. Let's take a closer look at the stages of rehabilitation after knee arthroscopy.

Early rehabilitation period

Rehabilitation begins as soon as the surgery is completed. In the first hours after arthroscopy, medications are indicated to prevent complications and possible consequences. A course of antibiotics and anti-inflammatory drugs is usually prescribed. On the first day, any load on the joint is prohibited; it is fixed with an immobilizing bandage. To avoid swelling, you need to place your foot on a high pillow. Let's look at the general recommendations that need to be followed during the week after the operation: Place your feet on a hill while sleeping. This will significantly reduce swelling. It is highly recommended not to wet the postoperative suture. Each case is individual, so the issue of taking a bath is decided individually with a doctor. If pain occurs, you can apply a cool compress to your knee. The stitches are removed after about 5-7 days. During this time, you need to visit a doctor to monitor the dynamics of recovery and exclude possible complications. Sometimes experts prescribe a course of chondroprotectors. This advice should not be ignored. Take all medications prescribed by your doctor. If necessary, you can take painkillers. Please note that mild aching pain after surgery is normal. Even if it seems to you that the pain and discomfort has passed, you should not exercise ahead of time. Any exercises must be agreed with a doctor, and the first exercise therapy sessions are carried out only under the supervision of a specialist.

Rehabilitation after 2-3 weeks

Remember that final recovery occurs after 4-8 months, in some cases it may take a year. After knee arthroscopy, you can fully recover and return to your normal lifestyle, and even return to your favorite sports. If a month after the operation it seemed to you that everything had healed, it’s just your imagination. Wrong actions can lead to disastrous consequences that will invalidate the result of the operation. So, after 3 weeks the patient can move independently, that is, without crutches and other auxiliary elements. You should still consult with a specialist and pay attention to exercise therapy every day. During this period, you need to consider the following: Go for therapeutic massages, pay attention to physical procedures. Walk more at a slow pace, develop your gait. When doing exercise therapy, do not overexert yourself, exercise until the first signs of fatigue. Do weight training every day (only under the supervision of a specialist!). Pay attention to the muscles of the whole body, do not focus only on the knee joint.

Final recovery period

This rehabilitation period begins 6 weeks after knee arthroscopy. Please note that in case of complex operations, this period begins only from the 10th week. Everything is individual, you need to consult your doctor. As a rule, in the final period there is no longer any pain or discomfort, and the range of movements increases significantly. If there are no complications or complaints from the patient, the set of exercises is significantly expanded. Fixators (bandages) are used only when performing physical activity. In ordinary life, fixing devices are no longer needed. Physical activity should include: Shallow squats. Climbing stairs. Swimming. Exercise bikes. Power loads with minimal weight. Long walking. Under no circumstances should you rush. This will not speed up the healing process; on the contrary, rash actions can lead to dire consequences. Strictly follow the specialist's recommendations.

First aid for meniscus injury

When a meniscus ruptures, a sharp pain occurs in the first minutes, which intensifies when the leg is extended.

If pain occurs as a result of an injury, care must be taken to ensure that the victim gets to a medical facility as soon as possible. The injured leg must be immobilized. To avoid bending during transportation, it is better to apply a splint or splint. It is strictly not recommended to eliminate the blockade, if it occurs, on your own. In order to alleviate the condition and avoid the increase in swelling, cold is applied to the knee, for example, an ice pack. Aerosol coolers, used more often among athletes, are optimal. As a last resort, you can offer the victim a non-steroidal anti-inflammatory drug. The sooner the patient gets to the clinic in compliance with all transportation rules, the less complications can be expected.

Possible consequences after arthroscopy

Arthroscopy is considered a modern method for diagnosing and treating joints. This technique is one of the few where the risks of complications are reduced to almost a minimum. But still, like any operation, surgery on the knee joint has certain risks: Infectious complications. Damage to articular cartilage. Thrombosis of blood vessels. Bleeding Such consequences occur infrequently, in approximately 0.1% of cases. To avoid complications, we strongly advise you to contact only trusted medical centers where real specialists work. Monitor your health carefully after surgery. If severe pain, increasing swelling, shortness of breath and other worrying signs appear, consult a doctor immediately.

If your temperature rises

Many people, after arthroscopy of the knee joint, observe that the body temperature has reached 37. The first reaction is that patients begin to panic and suspect complications. In fact, low-grade fever is normal after surgery. This is a peculiar reaction of the body. This temperature can reach 37.3 and is not dangerous. As a rule, it goes away on its own and does not require treatment. If the temperature is higher, this is a good reason to consult a doctor and rule out complications.

Arthroscopy as a method of surgical treatment of the consequences of injuries and diseases of the knee joint

Shulepov Dmitry Alexandrovich

Traumatologist-orthopedist

May 25, 2020

Arthroscopy is a method of surgical treatment of large joints of the limbs. The operation involves performing various manipulations and techniques under the control of endovideosurgical equipment. Arthroscopic interventions are performed through several small incisions or punctures using a specialized set of instruments.

Arthroscopic surgery has a number of undeniable advantages and disadvantages compared to open operations:

• Minimally invasive and low-traumatic
• Reducing the rehabilitation period after surgery
• Detailed visualization of anatomical structures and landmarks and, as a result, more accurate surgical procedures
• Minimal and invisible incisions
• The ability to perform most operations on an outpatient basis without the need for the patient to be in the hospital (one-day surgery)
• High functional results of surgical treatment

A wide range of pathologies and injuries of the knee joint are amenable to arthroscopic surgical treatment:

• Traumatic injuries - Damage to the ligamentous apparatus (damage to the cruciate and collateral ligaments, medial patellofemoral ligament (MPFL) with patellar dislocations, "posterolateral angle", etc.) - Damage to the meniscus - Damage to cartilage and osteochondral damage
• Diseases (synovitis, osteochondritis dissecans, chondromatosis, etc.)
• Degenerative changes (osteoarthritis and concomitant damage to the menisci, cartilage, synovium)

Meniscal injuries

Menisci are cartilage discs that are located between the condyles of the femur and tibia. They are shaped like crescents and provide a number of functions necessary for the joint to function properly.

The main functions of the menisci include:

• adaptation of the articular surfaces of the knee joint, uniform distribution of the load on the limb;
• damping and partial repayment of loads, i.e. protection of the articular surface;
• additional provision of joint stability, along with the capsular-ligamentous apparatus, especially in the anteroposterior direction;
• providing “lubrication” during movements of joint elements due to the redistribution of joint fluid.

The reasons leading to damage to the meniscus can be different.

The most common injuries are associated with a sharp dislocation of the tibia relative to the thigh or extension of the knee joint.

In patients older than middle age, degenerative damage to meniscus tissue is common. It occurs without any visible traumatic factor: often the patient cannot associate the appearance of pain with any type of previous physical activity or injury.

The main causes of degenerative meniscus damage include:

• A prolonged squatting position, often followed by a sharp extension of the knees. Typical for a number of professions associated with long-term forced stay in such a position.
• Weighted squats, deep squats with a barbell. These loads are extremely traumatic for the knee joint, and the accumulated “microtraumas” in the posterior sections of the meniscus result in its complete rupture.
• Running loads, primarily running in bad shoes, on a hard surface (asphalt) and/or without prior preparation.
• Professional heavy loads typical of furniture assemblers, tire workers, roofers, etc.
• OSTEOARTHRosis is a disease that leads to wear and tear of articular cartilage and menisci.
• Chronic instability is long-term untreated knee ligament damage.

True damage or rupture is characterized by the formation of an unstable fragment of the meniscus, which plays the role of a mechanical irritant. This leads to pain and disruption of the biomechanics of the knee joint.

The medial (internal) meniscus is most often damaged (more than 70% of cases), less often the lateral one.

What does such damage lead to?

• Development of chronic pain syndrome of varying degrees of intensity.
• The occurrence of secondary synovitis.
• Damage to the cartilage cover by an unstable fragment with subsequent formation of osteoarthritis.
• Decreased functionality and quality of life of the patient.

The diagnosis of meniscus injury/tear is made based on the patient’s history, clinical picture and physical examination and is necessarily confirmed by the results of magnetic resonance imaging (MRI) of the knee joint.

Conservative treatment of meniscus damage is ineffective and ultimately leads to the formation of osteoarthritis of the knee joint. Today, the “gold standard” for treating this pathology is arthroscopic surgery.

In principle, two surgical solutions are possible:

1. Meniscus suture. It is performed only in case of acute injury (no more than 2-3 weeks) in case of a tear in the paracapsular (blood-supply) zone of the meniscus. This operation involves immobilizing the knee joint and walking on crutches without supporting the operated limb for several weeks. Return to sports is possible no earlier than after 4 months.
2. Sectoral or marginal resection of a damaged meniscus fragment. This is the most frequently performed operation. It allows the patient to get back on his feet within a few hours after surgery, and after 4 weeks to return to sports physical activity. After the sutures are removed, the patient is prescribed a course of rehabilitation treatment (physical therapy, physical therapy) and maintenance therapy aimed at maintaining the elastic properties of cartilage (chondroprotectors, intra-articular injections of hyaluronic acid).

Fig.1. Arthroscopic picture of a whole, intact meniscus.

Rice. 2. Arthroscopic picture of a meniscus tear.

Rice. 3. Arthroscopic picture after resection of the damaged part of the meniscus.

Preventive actions

Joint diseases have a genetic predisposition. If one of your relatives has problems with joints, there is a high risk that this problem will affect you too. If you follow several rules of prevention, this can be avoided: Avoid hypothermia. Don't overdo your workouts. Work with heavy weights should only be carried out under the supervision of a specialist. If pain or discomfort occurs, consult a doctor immediately. Remember that any pathology is much easier to treat at an early stage. Try to move more, walk and do exercises daily. If you couldn’t avoid troubles with your joints, don’t despair. Arthroscopy is a unique way to eliminate the pathological process in a minimally invasive way. There are no scars or scars left after the operation, and the recovery period is also relatively fast. Patients soon return to their normal lifestyle and even continue their sports career.

Doctor's answers to common questions

Is it possible to practice swimming during the rehabilitation period? Swimming is a great way to speed up the recovery process and develop the knee joint. Doctors approve breaststroke swimming when the patient's brace is removed. It is important that swimming does not cause pain or discomfort. How should you eat during recovery? It is recommended to change your daily diet slightly. Be sure to include Omega-3, protein, and vitamins C and B in your menu. Please note that due to reduced physical activity, weight gain may occur. Therefore, it is recommended to exclude fatty, smoked and high-calorie foods. We recommend giving preference to low-fat varieties of fish and meat, fresh vegetables and fruits, as well as fermented milk products. What physical procedures will speed up the healing of the joint? Experts recommend after arthroscopy to undergo a course of electrical stimulation, magnetic therapy and laser therapy. These physical procedures improve blood circulation and ensure speedy rehabilitation of the knee joint.

— Does the bone near your thumb hurt in November 2021?

The leading clinic on the basis of the Sechenov First Moscow State Medical University is GarantClinic Moscow.