post-operative-knee-arthroscopy.pdf

POST OPERATIVE KNEE ARTHROSCOPY (Partial

Meniscectomy/Chondroplasty/Synovectomy)

This five-phased program approach can be utilized for both conservative and surgical patellofemoral

clients. This systematic approach allows specific goals and criteria to be met; once goals and criteria

are attained, the rehabilitation process can progress safely.

Ultimate Goal of Program

1. Improve Functional Status

2. Normalize Biomechanical Forces

3. Improve Strength/Power/Endurance

4. Decrease Pain/Inflammatory Status

Acute Phase (usually post-op days 1-5): Maximal Protection

Goals :

1. Relieve pain, swelling and inflammation

2. Retard muscle atrophy

3. Increase ROM and flexibility

• FWB, unless otherwise specified by physician

• Ice, Compressions, Elevation

• Strengthening exercises

• Quadriceps setting and multi-angle isometrics (non-painful) 91o, 75o, 60o,

45o

• Straight leg raises (Hip abduction not done with lateral compression

syndrome)

• Gentle standing or prone hamstring curls as tolerated

• Electrical Stimulation if needed (EMS, TNS, HVGD, Biofeedback)

• Flexibility, LE stretches (especially hamstrings/gastroc and also ITB if needed)

• ROM exercises- Heel slides to tolerance, prone/supine ”knee hang” for extension

• Patient education regarding activities, pathomechanics

• Avoidance Program

• Squatting, Kneeling, Excessive Knee Flexion, Stairs

Sub-acute Phase (usually 1 to 2 weeks post-op): Moderate Protection

Progress to phase two when:

1. Pain and swelling reduce

2. ROM is increased

3. Strong visible quadriceps contraction

Goals:

1. Increase muscle strength and ROM without exacerbation

• Initiate weights for SLR (Hip abduction not done with lateral compression

syndrome)

• Initiate weights for short arc quadriceps exercises, non-painful ROM

• Initiate mini-squats (0-30/40o) non-painful ROM

• Bicycle (low resistance, seat high)

• Continue isometrics, ROM, and flexibility exercises as needed

• Continue ice therapy

• Avoidance program

• Squatting, Kneeling, Stairs

Chronic Phase (usually 2-4 weeks post-op): Minimal Protection

1. Progress to phase three when:

2. ROM and swelling WNL

3. Pain is minimal to none

Goal:

1. Achieve maximal strength and endurance

• Continue SLR and other isotonic knee exercises

• Continue mini-squats

• Advance closed kinetic chain activities (leg press, shuttle)

• Initiate proprioceptive exercises (unilateral balance, contra-kicks)

• Emphasis on increased functional activities, (example: step-ups)

• Cryotherapy post exercise

• Avoidance program

• Full Squatting, Kneeling, Painful ADL’s

Maintenance Program

Patient is usually discharged from therapy at 4-6 weeks post-op.

Goal:

1. Continue strengthening without detrimental affects on patellofemoral joint

• Continue flexibility daily (part of warm-up and cool down)

• Continue HEP program 3 times per week

• Endurance training is continued

• Continue to be active (walking, swimming, pool running, possible biking)

Advanced Strengthening Phase

Patients with physical work requirements or a goal to return to high levels activities may

remain in therapy for the advanced strengthening phase.

Goals:

1. Increase strength/increase power

Criteria for advanced strengthening phase:

1. Increase endurance

2. Full ROM

3. Increase neuromuscular control

4. Strength 5/5

5. Fast speed training

6. No episodes of giving way

Exercises:

4 Quad Program

4 Endurance Program

1. Isotonic knee extension

(100-140o)

2. 1/2 squats (gradually

increase weight)

3. Progress Leg press

4. Increase height of step up

1. Bicycle (30 mins or more)

2. Elliptical

3. Pool Running

4. Stairmaster

Balance/Agility Drills

Fast Speed Training

1. Breg Kat system

2. Balance board (single leg)

3. Unilat. Balance on unstable

surface

4. Agility training (lateral shuffle,

carioca, etc)

1. Exercise tubing (Breg)

2. Fast hamstring curls

3. Fast hip ext/flex

Return to Sport

Criteria to Participate:

1. full non-painful ROM

2. Proprioception test 95% of opposite leg

3. Isokinetic Test

4. 65% Quad Torque/BW ratio (180o/s)

5. 70-75% Hamstring/Quad ratio (180o/s)

6. 95% Work/BW ratio (180o/s)

7. Hop Test (optional)

Continue Strengthening Program:

• 4 Quad Program

• 4 Endurance Program

• Continue Balance/Agility Drills

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