Knee Arthroscopy

 Knee Arthroscopy including Lateral Release, Chondral shaving, and partial meniscectomy

Generally, following knee arthroscopy, an aggressive rehab approach can be taken.  No major precautions or contra-indications are present and ROM and strength can be progressed as tolerated.  This includes the following procedures: partial medial or lateral menisectomy, debridement of cartilage and joint surfaces, removal of a loose body, plica excision, and lateral release. 

Patellar mobilizations and scar massage are both necessary to regain full ROM.  The stationary bike should be encouraged once the ROM is adequate (usually 110 degrees).  Some patients may be back to regular activities at 3-4 weeks while others may take significantly longer.

Following a lateral release, a slightly longer rehabilitation program is sometimes necessary.  It is common for patients to have a persistent, large hemarthrosis at the lateral-superior knee due to the fact that the lateral geniculate artery is often cut during surgery.  It is imperative to keep the IT band stretched out post-operatively.  Patella glides and tilting is very important and must be encouraged daily.  Passive medial patellar glides are beneficial to prevent excessive scarring at the ITB. 

A step-wise program should be followed which is individually based.  The following are some general issues that Dr. Mora feels are important.  Deviation from this outline is usually reasonable.

 Early Goals

  • Gain full knee extension so patient can ambulate with normal gait
  • Neuro-muscular quad control – use biofeedback on VMO
  • Control swelling: Swelling inhibits quad firing and limits ROM; as long as there is a flexed knee gait, the more the patient ambulates, the more swelling will increase; therefore, limit activities and ambulation early in rehab.
  • Normal gait: patients will ambulate with flexed knee gait secondary to no quad control; have patient focus on quad contraction and full knee extension during stance phase of gait.

Exercises (should be done daily at home)

  • Quad sets (10 X 10sec)– the more the better – at least 100/day.
  • SLR – 4 way
  • Single limb stance
  • ROM Goal during this phase is 0-90°
  • Manual patella mobs – especially superior/inferior.  Very important if patient having problems achieving full ROM.
  • Seated heel slides using towel
  • Prone hangs if needed to gain full extension
  • Manual ROM exercises if arthrofibrosis developing

Modalities

  • Minimize the use of Estim and TENS.  Use ice after work-outs.

Midway Goals ( 4-6 weeks)

  • Patient should ambulate with Normal gait, have normal patella glide, have good quad control, no swelling, and be able to ascend/descend stairs.
  • Initiate all sporting activity. 
  • Full ROM (equal to opposite side, including full hyperextension)
  • Work comp patients should start work specific exercises.

Exercises

  • SLR (4 way) add ankle weights when ready
  • Quad sets continued until quad atrophy minimal
  • Closed chain terminal knee extension (TKE)
  • Leg Press
  • Mini-squats – focus on even distribution of weight
  • Hamstring curls
  • Bicycle – do not perform until 110° of flexion is achieved.  Perform daily and increase resistance in step wise fashion.
  • Jogging/Plyos:  Based on quad tone and no swelling.  The patient can begin to jog at a slow to normal pace focusing on achieving normal stride length and frequency.  This is a step wise process.  It is normal for the patient to have increased swelling as well as some soreness but this should not persist beyond one day or the patient did too much.

Late Goals (beyond 6 weeks)

  • Goals for this phase are full quad control and good quad tone; patient should be able to perform normal ADLs without difficulty.
  • Patella mobility restored.
  • Sports with minimal swelling or discomfort
  • Focus should be on quality, NOT quantity
  • Work comp patients should be able to return to all work type activities after this phase

Exercises

  • Initiate lateral movements and sports cord: lunges, forward, backward, or side-step with sports cord, lat step-ups with sports cord, step over hurdles.
  • Cycle – increase intensity; single leg cycle maintaining 80 RPM