Rehabilitation after arthroscopic knee surgery

Surgical treatment of injuries is carried out in the presence of significant tears, crushing of the cartilage tissue of the meniscus, separation of its horns and body, as well as in case of ineffectiveness of conservative therapy. Surgical intervention is performed openly - arthrotomy (with opening of the joint cavity) and endoscopic - arthrotomy. Arthroscopic partial meniscectomy is a surgical procedure during which the meniscus is partially removed. Regardless of what kind of surgery was performed, patients in the postoperative period need to restore movement in the knee joint. All conditions for the rehabilitation of patients after meniscectomy (removal of the meniscus) have been created at the Yusupov Hospital:

rehabilitators draw up an individual rehabilitation plan for each patient;
senior instructor-methodologist of exercise therapy conducts individual and group therapeutic exercises, taking into account the age, physical fitness of the patient and the presence of concomitant diseases;
candidates and doctors of medical sciences use original rehabilitation methods and the best achievements of modern rehabilitation therapy;
patients carry out development of the knee joint using the latest simulators from the world's leading manufacturers;
Physiotherapists prescribe effective procedures to speed up the process of restoring knee joint function after meniscus removal.

During recovery, patients are kept in wards of European comfort level. They are provided with individual personal hygiene products and dietary meals.

PERIOD OF INPATIENT TREATMENT:

Intraoperative antibiotic prophylaxis is a single intravenous administration of a broad-spectrum antibiotic, if necessary, repeated administration after 24 hours.
Prevention of thromboembolic complications - compression hosiery, or elastic bandaging of the limbs during surgery and in the postoperative period (up to 3-5 days), administration of low molecular weight heparin (up to 5-10 days), tableted anticoagulants.
Cryotherapy in the postoperative period - local cold, 30-40 minutes, 3-4 times a day, during the first 3 days.
Ensuring joint rest in the early postoperative period. If necessary, the joint is fixed with an orthotic bandage. Usually the limb is in a straight position. When plasticizing the cruciate ligaments, the joint is fixed with a hinged orthosis in a closed position, or with a flexion angle of 20-30 degrees.
Pain therapy, non-steroidal anti-inflammatory drugs (NSAIDs).
Lymphatic drainage.
Physical therapy for the first period 1 day - isometric tension of the thigh muscles, movements of the foot in the ankle joint. Day 2 - passive movements in the knee joint are added, in a painless range, flexion of 20-30 degrees and full extension of the joint. The patient is activated and walking is allowed with a measured load on the leg.
When activated, additional support/cane or crutches are used, depending on the degree of permitted load on the leg

Principles of rehabilitation after meniscectomy

Recovery after meniscus removal at the Yusupov Hospital includes:

careful planning of rehabilitation taking into account the specific medical problem and the condition of the patient’s body;
a developed individual rehabilitation plan, which includes medication support, physiotherapeutic procedures, and gymnastic exercises;
the principle of balance, gradualism and dosing of physical activity;
careful medical supervision of the patient’s performance of all treatment and rehabilitation procedures.

For each patient after meniscectomy in the rehabilitation clinic, a team of specialists (rehabilitologist, orthopedist, neurologist, physiotherapist, senior instructor-methodologist in exercise therapy) draws up an individual recovery program. Rehabilitation after removal of the posterior horn of the medial meniscus has the following goals:

early activation of the patient;
rapid elimination of pain syndrome;
prevention of congestion in the lungs and the development of pneumonia;
stimulation of regional blood circulation and lymph outflow in the lower extremities;
reduction in the secretion of pathological fluid in the knee;
active prevention of muscle wasting, adhesions and contractures;
stimulation of metabolism and tissue repair;
prevention of infectious process in the operated tissues;
restoration of lost functions of the lower limb.

Rehabilitation after meniscectomy at the Yusupov Hospital is carried out under the supervision of leading specialists in the field of rehabilitation therapy. Professors and doctors of the highest category at a meeting of the Expert Council discuss all cases of complications of the postoperative period and collectively develop tactics for managing patients.

OUTPATIENT TREATMENT PERIOD, 1-3 WEEKS:

Dressings. Typically, examination by a traumatologist and dressings are carried out on day 1 after surgery, days 3-4, and days 7-12. Aseptic dressings are changed and, if necessary, a joint is punctured to evacuate fluid. Sutures are removed within 7-12 days.

Use of anti-inflammatory and vascular drugs.

Elastic bandaging of the limb for up to 3-7 days.

Cryotherapy up to 3-5 days.

Lymphatic drainage.

Depending on the type of operation performed, one or another degree of activity is allowed. After meniscectomy, walking with a dosed load on the leg is allowed from the first day after the operation.
It is recommended to limit the load, use a cane or crutches with support under the elbow until 5-7 days after surgery. When performing a meniscus suture, it is recommended to walk with crutches without supporting the leg for up to 4 weeks. When performing ACL plastic surgery in the early postoperative period, walking with crutches is also recommended (it is possible to use crutches with support under the elbow) for up to 3 weeks. First, you walk without putting any weight on your leg. Then, when walking, the foot (not the toe) is placed on the floor, but without transferring weight to the operated limb. In the absence of pain, a gradual increase in the axial load on the straight leg is carried out.

Additional fixation of the knee joint. During operations on the meniscus, elastic bandaging of the joint area is used, or wearing a soft (or semi-rigid) knee pad. When ACL plastic surgery is performed, the joint is fixed with a postoperative hinge orthosis, with a gradual increase in the allowed flexion angle. Movements can begin within 3-5 days after surgery; the angle of allowed flexion is gradually increased to 90 degrees within 2-3 weeks after surgery. At night, the orthosis can be locked in the extension position.

Electrical stimulation of the thigh muscles (optional).

Physiotherapy.

Light massage, mobilization of the patella by passively moving it up and down and to the sides.

Full extension of the knee joint in a supine position (without hyperextension of the joint!).

Passive movements in the knee joint. The use of the Arthromot apparatus for developing passive movements in the joint has a good effect.

Therapeutic physical education by periods. Isometric tension of the muscles of the hip flexors and extensors, gluteal muscles, and foot movements continue. Active movements in the knee joint, flexion and extension in a painless range are added. Movements are carried out in a “closed loop”, that is, in such a way that the heel is in contact with the surface all the time during movements. For example, lying on your back, bend the knee joint so that the heel slides along the surface of the couch; you can help bend with your hands, grabbing the lower third of the thigh. Exercises are added to gradually strengthen the muscles of the limb, but without significant loads and taking into account the pain syndrome: slowly raising a straight leg, in a lying position (toes towards you), and holding the weight for 5-7 seconds. Standing straight leg raise. Exercises with a tourniquet for the calf muscle. Possible exercises in the pool. Classes are conducted 2-3 times a day, 10-15 repetitions.

What type of doctor performs surgery for a torn meniscus?

One of the features of the Gelenk Clinic is the trusting relationship between doctors and patients. That is why your attending physician will take care of you from the first examination until the operation of the meniscus tear. He will also monitor your condition after the operation. This way you will have a contact person at the Gelenk-Klinik whom you can contact at any time convenient for you. The best and highly qualified specialists in the treatment of diseases of the knee joint are Prof. Dr. Ostermeier and privatdozent M.D. Dr. Markvas.

WEEK 4-6:

It is possible to walk with full support on the leg (in an orthosis), walking with one crutch, or without additional support.

Development of range of motion in the joint. The allowed range of flexion is more than 90 degrees (up to full range of motion). By this time, full extension should be achieved and preferably 90 degrees of pain-free flexion.

Formation of correct gait. You need to walk slowly, not with long steps, trying not to limp on your operated leg.

Physical therapy aimed at strengthening the thigh muscles. It is advisable to conduct classes under the supervision of a physical therapy doctor and taking into account the reaction of the joint to the load.

Classes are held 2-3 times a day, 10-15 repetitions. Raising and holding a straight leg (toes towards you). Not deep slow spring squats (flexion 30-40 degrees), exercises with light resistance (rubber band), an exercise bike with minimal load and a small angle of flexion in the joint, strengthening the adductor and abductor portions of the quadriceps femoris muscle, exercises in the pool - swinging leg movements, walking in the water.

If the joint swells, pain in the joint increases after exercise, and the joint does not recover by morning, the load should be reduced and consult with your doctor.

How can a foreign patient make an appointment for surgery for a torn meniscus?

To begin with, Gelenk Clinic specialists will need current MRI and X-ray images to assess the condition of the knee joint. Once you submit the required documents to us through our website, we will send you patient information and cost estimates within 1-2 days. .

Foreign patients can make an appointment for meniscus tear surgery in a short time. We will be happy to assist in obtaining a visa after the advance payment indicated in the estimate has been received into our account. If a visa is not issued, the amount received is returned to you in full.

Due to sometimes long flights, we try to keep the time between the first examination and surgery to a minimum. During outpatient and inpatient treatment of the knee joint, you will be able to use the services of qualified medical personnel who speak several foreign languages (eg English, Russian, Spanish, Portuguese). Payment for a translator (for example, into Arabic) is carried out separately. We also organize transfers, we can book a hotel room and tell you how to spend time in Germany for you and your relatives.

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WEEK 6-8:

It is possible to walk and exercise in a functional orthosis, with full range of motion.

Continue strength training. Exercise bike, active flexion and extension, abduction and abduction with elastic resistance (rubber band), not deep slow squats (flexion up to 60 degrees), exercises in the pool, walking and running in the water, breaststroke swimming is possible. It is possible to exercise on block simulators, without using a simulator that loads the muscles of the anterior thigh.

Training aimed at coordination of movements. Swaying the body on half-bent legs, stepping onto a step, exercises on a platform, with a safety net, holding onto a support.

It is necessary to avoid sharp extensions and hyperextensions of the legs, swing movements, jumping, and twisting loads. Despite the reduction in pain, the ligament at this time is in the process of restructuring, its strength is reduced and the joint needs protection.

What type of anesthesia is used for surgical treatment of a meniscus tear?

Typically, surgery for a torn meniscus is performed under general anesthesia. To avoid risk, there is the possibility of spinal anesthesia. To do this, the surgeon injects an anesthetic into the spinal canal of the lumbar spine. In this case, the patient is fully conscious. What type of anesthesia is most suitable for the patient is determined during a conversation with the anesthesiologist. Our doctors are true masters of their craft, who during your appointment will offer you the best method that meets all the indicators of previous examinations.

4-6 MONTH:

Continuation of activities aimed at strengthening muscles and coordination of movements.

Jogging on a flat surface is possible.

Using a knee brace during loads, the danger of awkward movements (transport, travel) and exercise therapy.

It is necessary to avoid premature increased loads, early return to sports, sudden leg extensions, especially straight leg movements, jumping, running on hard or uneven surfaces, twisting loads, falls, and uncontrolled movements during sports exercises.

Limiting sports activities after ACL surgery is necessary for up to 4-6 months. Limiting contact or team sports to 9-12 months.

I would also like to emphasize that the selection of a rehabilitation program should be carried out individually and take into account many factors. This is a fairly long and important stage of treatment, without which it is unlikely that good functional treatment results will be achieved.

Reconstruction of the anterior cruciate ligament of the knee joint

The anterior cruciate ligament is one of the most sensitive muscles that contributes to the activity of the knee. Thanks to it, the upper part of the articular surface of the tibia and the posterior part of the intercondylar surface of the lateral condyle of the femur are connected. It also protects against strong displacement of the lower leg during active movement, dislocations, and sprains.

A torn cruciate ligament cannot be restored without surgery. It can be left without medical intervention, but naturally, it will no longer work normally and will cause constant pain. In this case, it is worth remembering that you cannot play sports or dance with such a knee. If left untreated, it will provoke the development of arthrosis.

People who are elderly and have an inactive lifestyle can avoid having surgery, but simply avoid placing heavy loads on the sore leg and do a light set of exercises. Younger people who want to live actively and not feel pain cannot do without surgery.

Anterior cruciate surgery involves replacing the ligament with a substitute (graft). Nowadays, modern medicine allows us to take part of the patient’s own patella for a ligament transplant. If this cannot be done, donor tendons are taken. The operation can be performed under various types of anesthesia, which is prescribed by the doctor. Medication-induced sleep may also be used for your comfort. During the operation, the surgeon makes small incisions of 0.5 in diameter to replace the ligament. The duration of such an operation is no more than two hours.