After procedure instructions
ARTHROSCOPIC RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT
Arthroscopic reconstruction of the anterior cruciate ligament is a minimum invasive procedure which allows early mobilization. Immediately after the procedure there is usually some mild to moderate pain in the knee, as well as a swelling. Non-steroidal anti-inflammatory drugs are usually prescribed and rests with elevated legs are essential for reducing the swelling; the cooling of the knee joint with ice or a cold compress several times a day is also a must. On the first day after the procedure there can be some feeling of tiredness and nausea due to analgesics, but this gradually wears off.
It is very important that the patient realizes and understands that the absence of pain, swelling and complete mobility of the knee does not mean that the knee is completely healed and ready to take full strain. With arthroscopic surgery we do achieve that post-operative pain is smaller, that the swelling of the knee passes faster and complete mobility is achieved more quickly in comparison with a classic open procedure. However, the growing into of the tendon graft in the bone cannot be speeded up. The same applies for the revascularization process of the tendon. Both mentioned processes need several months. As these are biological healing processes, adequate physical therapy and controlled strain do stimulate them, but they cannot be significantly shortened. Only complete growing into of the tendon graft and revascularization, which has for its consequence the restoring of the tendon vitality, enable that a reconstructed cruciate ligament can withstand the strains which appear during sports activities. This is usually achieved in 6 months after the surgery. Early uncontrolled and excessive straining of the knee in the first months after the operation can cause the tendon graft to stretch. This consequently means instability of the knee or even the loosening of the bone fixation of the graft.
Rehabilitation after the reconstruction of the anterior cruciate ligament is difficult and long. It is of key importance that it is done under control, under the supervision of a physiotherapist who is qualified and well familiar with the limitations and the goals of different recovery phases. It is highly recommended that physical therapy is individual and that the program is adjusted, to the extent that biological processes of tissue healing allow, to the progress and the abilities of the individual.
Physical activity after the surgery:
· Using crutches while walking is recommended only in the first few days after the surgery. Is it advisable to stop using them as soon as possible, as they significantly contribute to the unwanted atrophy of thigh muscles, which can appear after the surgery. In some cases (e. g. in certain procedures on the cartilage) longer use of crutches is necessary in order not to overstrain the leg. In such cases, you will receive precise instructions how to do that.
· In general, walking with fully straining the leg is allowed after the surgery. However, it is important to avoid longer walks and standing for a long period of time in the first few days after the operation, as this can increase knee pain and cause swelling. In case the nature of the procedure necessitates non-straining of the knee, detailed instructions will be provided.
· Wearing of a 4-point knee brace after the surgery in order to additionally protect the reconstructed anterior cruciate ligament is advisable only in the first few months. In the late phase of rehabilitation, the use of the brace should be completely abandoned.
· In order to retrieve the function of the knee quickly, it is very important to carry out all the prescribed exercises every day.
Wound care after surgery:
· Immediately after the surgery, wound care is very important as it reduces the risk of post-surgery infection. The bandage or the sticking plaster has to be dry and clean. Usually the bandage is first changed 1-2 days after the surgery. Depending on how the healing of the wound progresses, your personal physician can decide about the subsequent bandage changes. If the wound is dry and there are no signs of infection, the bandage is again changed after 5-7 days. Stitches are removed 10-14 days after the surgery, usually be your personal physician.
· It is very important that the wound does not get wet. If the bandage gets wet or if blood oozes through it, the bandage has to be changed. In case the wounds are covered with water-resistant sticking plasters, showering is allowed, but direct wetting of the wound must be avoided.
Pain control:
· Repeated cooling of the knee after the surgery using cold compresses or ice reduces post-surgery swelling and pain.
· Rests with elevated legs contribute to reducing the swelling of the knee.
· Take analgesics regularly, as they were prescribed. While taking analgesics, you must not drink alcohol.
Exercises after knee arthroscopy
· After knee arthroscopy, we must begin with exercises for strengthening thigh muscles and improving knee mobility as soon as possible. It is very important to achieve full knee extension as soon as possible.
· The exercises described below must be done 2-3 times a day.
· In case of severe pain, it is recommended to take the prescribed analgesic 30 minutes before doing the exercises. If swelling occurs and there is pain in the knee, it is advisable to slightly reduce the intensity of the exercises and adjust them to your capabilities.
· After doing the exercises, cool your knee with ice. In the first days after the operation, cooling should be done 3-5 times a day with 2 hour breaks in between. If the cooling is done using ice, it must not last more than 3 minutes, as it can cause ice burns. If ice is wrapped into a towel, the cooling can be performed to up to 15 minutes.
· In the first few days after the operation, the exercises described below should be accompanied only by short-distance walks.
· Along with the exercises described below, which you do by yourself, the program of guided physical therapy should begin in the first week after the surgery. The therapy includes passive exercising of the knee using a knee brace, electrical stimulation of the thigh muscles and doing therapeutic exercises under supervision.
POST-OPERATIVE EXERCISE PROGRAMME AFTER THE RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT
PHASE ONE OF THE POST-OPERATIVE PERIOD (0-2 WEEKS)
INSTRUCTIONS:
- Knees bent to 90˚ until the end of the 2nd week
- Perform exercises at home once to twice a day
- After each exercise use cold compress to cool the knee
- Full weight bearing is allowed
- First 3 days use crutches than gradually discontinue
- Don’t put anything under the injured knee (problems with straightening out)
- When showering protect your operated area
- Take regular breaks
Exercises on the day of the operation
- Knee cooling with cold compress every hour and a half for 10 minutes
- Exercises for tibia muscles, feet and toes
- Isometric quadriceps strain
1. Sit on the floor, bend your healthy leg, stabilize your body completely, place a ball or a towel under the heel of the injured leg. Straighten your knee completely, pull your foot and toes towards yourself and press down the ball or towel with your heel. Hold the exercise for 15 seconds, than relax for 15 seconds. Repeat 10 times.
Exercises 1-7 days after the operation
- Continue with all the exercises described above
- Quadriceps electrostimulation (if you own the machine)
- Stand up with perfectly straightened leg only
- Active knee bent with foot on the mat or ball
- Passive muscular bent of the back thigh muscles
- Active exercises with straightened leg on your back, hips and stomach
- Standing toe raise
2. Sit or lie on the floor, stabilize your body entirely, bend your healthy leg, maximally straighten your injured knee, pull your feet and toes towards yourself. Repeat each exercise 10 times, 2-3 sets.
Exercises:
- Leg lifting
- Leg movement to the side and back together
- Circles drawing
- Writing letters V, T and L
- Sawing
- Writing recumbent 8s
- Writing numbers 1 to 10
3. Lie down on your healthy hip, healthy leg is slightly bent. Stabilize your body entirely; injured knee should be straightened completely, feet and toes pulled towards yourself. Repeat each exercise 10 times.
Exercises:
- Leg lifting
- Leg movement forward and backward
- Circles drawing
- Writing recumbent 8s
- Writing letter L
4. Stand on your injured leg (straightened completely or slightly bent) and struggle for balance. Gradually increase the difficulty of the exercise by putting under your foot different exercise tools (foam mat, balance board, stick …). Hold the exercise for 30 to 60 seconds, 2-3 sets.
PHASE TWO OF THE POST-OPERATIVE PERIOD (2-6 WEEKS)
INSTRUCTIONS:
- Knee bent to 105˚ until the end of the 3rd week, 120˚ until the end of the 4th week. After that gradually up to 135˚
- Do the exercises twice a day
- Knee cooling is mandatory after each exercise and anytime needed
EXERCISES:
- Continue with all the exercises mentioned above
- Active exercises with weights
- Active exercises with elastic band attached to the gym ladder
- Standing toe raise on one leg at a time
- Lifting of the pelvis with active knee bending
- Increase of the stabilizing exercises
- Start with friction massage
- Squats against the wall (after 4th week)
- Squats toe raise (after 5th week)
5. Lie on your back, bend your knees to 90˚, press heels with force against the mat, lift the pelvis off the mat and lower it back again. Repeat the exercise 15 times, 3 sets.
6. Stand up against the wall, place the ball between the wall and your back, legs are in width with the pelvis, stabilize your body entirely and bend both knees to 90˚. Pay attention: the knees should not extend beyond your toes! Repeat exercise 15 times, 3 sets.
7. Before starting and after finishing the exercise it is mandatory to warm up/cool down the muscles with stretching exercises for 40-60 seconds, 2-3 sets.
If you have any additional questions or doubts regarding physiotherapy consult it with your physiotherapist every working day from 7.30 to 15.30 on the telephone number +386 1 620 7472 or after working hours on mobile phone +386 41 331 348.
IN CASE OF HEAVY KNEE SWELLING, STRONG PAIN, DISTINCT KNEE REDNESS OR BODY TEMPERATURE RAISE, CONTACT US IMMEDIATELY DURING WORKING HOURS ON TELEPHONE NUMBER +386 1 518 70 63, OR AFTER WORKING HOURS ON MOBILE PHONE +386 40 799 622.
WE WISH YOU FAST AND COMPLETE RECOVERY!
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