Knee rehabilitationRehabilitation after knee surgery is vital to the success of the surgery. In this section are various rehabilitation protocols and principles following different knee operations.
The general principles of rehabilitation after knee surgery are:
- Control pain
- Reduce swelling
- Increase range of motion
- Normalise gait
- Increase strength and improve balance
- Functional exercises, including sports specific drills
- Return to full training, for athletes
- Return to full play, for athletes
These principles are also used before knee surgery in what is called "pre-habilitation", which is aimed at normalising the knee prior to surgery after an acute injury. This allows the inflamatory response in the knee following an injury to settle down prior to surgery, which then allows the knee to rehabilitate and recover following the surgery, much quicker. This is especially important prior to ACL reconstruction.
With all operations, rehabilitation begins before the surgery. The pre-operative preparation for surgery involves two stages:
- Physical preparation for surgery.
This entails the "pre-habilitation" refered to above and making sure, when possible, the knee is in the best condition to undergo the operation. The knee should be as "normal" as possible with:
- Litttle, if any, swelling
- Good muscle control and normal gait pattern
- Normal, symetrical, motion including hyperextension and flexion.
In order to achieve this, we may need to arrange some pre operative physiotherapy to work on various aspects of the above. It may not always be feasible to complete this stage of pre-operative preparation, for example as in people with fractures or dislocations. However, as most operations are not emergencies, there is time to commence this aspect.
Swelling is contolled with ice, compression (or by using a Cryocuff), elevation and anti-inflammatory tablets.
A normal gait pattern means walking normally without a limp. If needed, crutches are used pre- and/or post- operatively so as to walking with normal weight transference and gait with the crutches, rather than try and hobble and limp with out the crutches. Limping is a bad habit for the body to get used to and puts abnormal stresses on the other joints in the affectd limb, the other limb and the back.
Motion exercises include:
- Mental preparation for surgery
This is as important as the physical preparation. It is now well accepted that people do much better after surgery and rehabilitate quicker if they know what to expect after their operation. This is especially true after operations with complex rehabilitation protocols such as ACL reconstruction, cartilage transplantation, knee replacements and so on.
Therefore, prior to surgery, I will explain the operation to you, including what I will be doing, what pain killers you will get in hospital and at home, what exercises to do and how often, if there will be any restriction on how much weight you can put through your leg and if you will need crutches, when your dressings will be changed and stitches removed, when you will commence your out patient physiotherapy and when I will see you in the clinic after the operation. The physiotherapists will also go over much of this with you.
With certain operations, I arrange for you to have a formal talk before the operation such as the ACL talk. I can also arrange for you to speak with other patients of mine who have had similar operations to get a first hand view of what to expect.
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