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Knee arthroscopy rehab protocol

General post-surgical guidelines

Weeks 1 - 2

  • Nurse appt day 2 for dressing change and review of home program.
  • Ice/elevation every 2 hours for 15 minute to minimize edema and promote healing (please refer to Icing - Recommendations handout).
  • Avoid impact or twisting for 4 weeks.

Manual

  • Soft tissue treatment to quads, posterior musculature, suprapatellar pouch, popliteal fossa, iliotibial band and Hoffa’s fat pad.
  • Patellar mobilization as needed.
  • No direct scar mobilization (Avoid direct palpation and mobilization on incisions/portals for 4 weeks).

Exercises

  • Strength training specifics: quad sets/straight leg raises, hip abduction, calf presses/heel raises, Gluteus sets, and core conditioning.
  • Upper body conditioning, well-leg stationary cycling or Upper Body Ergometer (arm bike).
  • Gait training progression towards minimizing assistive devices (walker, crutches, etc).

Goals

  • Range of motion 0 to 90 degrees.
  • Pain < 3/10, minimal Edema.
  • Gait weight-bearing as tolerated; Good quality gait with least amount of assistive device.

Weeks 2 - 4

  • Nurse appt for suture removal day 14.
  • Ice and elevation daily.
  • Walking for 15 -20 mins daily.
  • Avoid impact and twisting of the knee for 4 weeks.

Manual

  • Soft tissue treatment to quads, posterior musculature, suprapatellar pouch, popliteal fossa, iliotibial band and Hoffa’s fat pad.
  • Patellar mobilization as needed.
  • No direct scar mobilization on incisions/portals for 4 weeks.

Exercises

  • Functional strengthening exercises including squats/leg Press, bridges/hamstring curls, 2” step Down.
  • Intense core training, aerobic exercises as tolerated (bilateral stationary bike, Elliptical, arm bike).

Goals

  • Active Range Of Motion: equal extension to uninvolved side and flexion to 120 degrees. No edema.
  • Full weight-bearing; normal gait without assistive device.
  • Single Leg Balance 60 sec on level surface.

Weeks 4+

  • MD appt at 4 weeks.
  • Walk up to 1 hour for exercise.

Manual

  • Continue with soft tissue mobilization.
  • Apply direct scar tissue mobilization; can use instruments/tools.

Exercises

  • Emphasize self stretching to both lower extremities.
  • Increase intensity of resistance exercises (i.e. standing resisted squats, lunges, etc).
  • Introduce lateral and eccentric exercises (4-6” steps).
  • Introduce controlled pivoting and twisting of lower extremity.
  • Initiate impact training with water or trampoline.
  • Greater emphasis on single leg strength, increase challenge of proprioceptive training.

Goals

  • Activities should be pain-free.
  • Bike with minimal resistance, Elliptical, Swimming-flutter kick all tolerated.
  • Progress back to sport training.

***MD appt and PT appt at 3 months for Sports Test I and clearance for sport

NOTE: All progressions are approximations and should be used as a guideline only. Progression will be based on individual patient presentation, which is assessed throughout the treatment process.

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