Suggested Home Maintenance for the Postsurgical Patient 26-1

Maxey: Rehabilitation for the Postsurgical Orthopedic

Chapter 26: Patella Open Reduction andInternal Fixation

Suggested Home Maintenance for the Postsurgical Patient

Weeks 1 to 4

Goals for the Period:

Control pain, manage edema, gain 0° to 90° of PROM, improve quadriceps and hamstring contraction

Elevate and ice at home two to three times per day (preferably after exercises).

Perform ankle pumping and hamstring stretches with the extremity elevated and on ice (20 to 30 minutes).

Perform supine wall slides (when appropriate)—one set of five repetitions three to four times a day.

Perform active heel slides—one set of 10 repetitions performed three to four times per day.

Perform quadriceps sets (on clearance from the physician)—two sets of 10 repetitions performed three to four times per day. Even though general guidelines such as this may prescribe a number of sets and repetitions, if the patient fatigues and cannot continue to recruit a quality quadriceps contraction, then the exercise is over. Patients are only to count repetitions with quality quadriceps contractions. The heel should stay on the floor. Quadriceps sets also may be performed standing if the patient finds it easier to activate the quadriceps in this position. The key to early strengthening is to find which position the patient is most successful in recruiting a quality quadriceps contraction.

Weeks 5 to 8

Goals for the Period:

Self-manage pain, increase strength, increase ROM to 90%, initiate quadriceps AROM (6 to 8 weeks), have minimal gait deviations on level surfaces

Perform the same exercises as in weeks 1 to 4, increasing the number of repetitions. Exercises should generally be performed in two sets of 10 to 20 repetitions per day (based on fatigue).

Initiate closed-chain exercises based on patient tolerance to resistance. Spider killers are initiated in pain-free ranges. In addition, simulated leg press exercises with elastic tubing can be performed. Patients begin with two sets of 10 repetitions and progress based on tolerance.

Perform self-taping as deemed appropriate by therapist.

Continue use of ice after exercises.

Weeks 9 to 12

Goals for the Period:

Return to full ADL function, develop endurance and coordination of the LE, continue to address limitations with steps and running (with physician clearance)

Depending on remaining deficits, continue exercises from the previous 8 weeks. The need for taping should be minimal; if continued taping is required, then patients are instructed in self-taping techniques.

Progress closed-chain exercises to include stepping exercises at home using threshold of doorway for balance.

Gradually return to functional activities while monitoring for pain and joint effusion.