What will my recovery be like?
Rehabilitation after knee arthroscopy should begin as soon as possible at Momentum Spine & Sport Physiotherapy once you are discharged from the hospital. There are a few cases where your surgeon may delay a start in your therapy because they want the tissues to heal with rest before any further stress is placed on the joint. Each surgeon will set his own specific restrictions regarding when to begin treatment at Momentum Spine & Sport Physiotherapy based on what was done during the surgical procedure, their personal experience, and whether your tissues are healing as expected. In regards to overall recovery time, generally speaking, the more complex the surgery, the more involved and prolonged your rehabilitation program will be.
If you are still using crutches by the time we first see you at Momentum Spine & Sport Physiotherapy, your physiotherapist will ensure you are using the crutches safely, properly, and confidently and that you are abiding by your weight bearing restrictions if you have been given any. We will also ensure that you can safely use your crutches on stairs. If you are no longer using crutches, or once you no longer need them, your physiotherapist will focus on normal gait re-education so you are putting only the necessary forces through the surgical side with each step, and are not compensating in any way. Until you are able to walk without a significant limp, we recommend that you continue to use your crutches, or at least one crutch or a cane/walking stick. Improper gait can lead to a host of other pains in the knee, hip and back so it is prudent to use a walking aid until near normal walking can be achieved. Your Momentum Spine & Sport Physiotherapy physiotherapist will advise you regarding the appropriate time for you to be walking without any walking aid at all.
During your first few appointments at Momentum Spine & Sport Physiotherapy your physiotherapist will focus on relieving any pain and inflammation that you may still have from the surgical procedure itself. We may use modalities such as ice, heat, ultrasound, or electrical current to assist with decreasing any pain or swelling you have around the surgical site or anywhere down the leg. In addition, your physiotherapist may massage your leg and ankle to improve circulation and help decrease your pain.
The next part of our treatment will focus on regaining the range of motion in your knee. Your physiotherapist at Momentum Spine & Sport Physiotherapy will prescribe a series of exercises that you will practice in the clinic and also learn to do as part of a home exercise program. Range of motion in the knee generally comes back very quickly after an arthroscopic surgery, but it still depends on what your surgeon has done inside your joint, how much swelling is present, and how controlled your discomfort is. More complicated reconstructive surgeries will take longer to regain range of motion. During the exercises you may experience a small amount of discomfort at the end ranges of motion initially. Despite this discomfort it is still important to perform the range of motion exercises prescribed because moving the joint also helps to move the swelling, get fresh blood to the healing area, and provide nutrition to the surface of the joint. Only mild discomfort, however, is permissible. Any sharp or moderate discomfort should be heeded. An exercise bike at this stage of your rehabilitation is very useful to assist in gaining back the knee range of motion. Even if you are unable to fully rotate the pedals of the bike using it is still encouraged. Performing the simple back and forth motion forces fluid through the joint, which helps to move the swelling and bring fresh blood to the healing tissues.
One goal after an arthroscopic surgery is to regain full bending and straightening of your knee joint. Without this full range of motion, areas of the joint surface cartilage can become weak and start to wear down. In addition, without full range of motion the biomechanics of the knee do not function as they have been designed to, and this contributes to early wearing down of the joint. Often prior to arthroscopic surgery fully extending or bending the knee is not possible and the goal of the surgery in the first place is to deal with any issues inside the joint that are limiting this motion. For this reason, your physiotherapist at Momentum Spine & Sport Physiotherapy will be strict in encouraging you to regain both the full bending and straightening of the knee joint. There are a few limited instances where the knee joint will not regain its full range of motion even after an arthroscopic surgery and this limited range of motion in these few cases is accepted.
These instances, however, are rare and your surgeon will inform you if your knee is one of these exceptions. In all other cases, it is crucial that you regain the full bending and straightening of your knee in order to maximize the functioning of your knee and avoid further problems in the future.
In addition to you yourself doing range of motion exercises your physiotherapist may mobilize your knee joint to assist in regaining motion. This hands-on technique encourages the knee to move gradually into its normal range of motion. Mobilization of the knee may be combined with therapist-assisted stretching of any tight muscles around the surgical site.
As soon as possible your therapist will also prescribe strengthening exercises for your knee and lower extremity. These exercises will focus on the muscles on the top of your thigh, called the quadriceps, and will also focus on the muscles of the hip. Hip exercises are particularly important, as the hip is the main controller of the position of the knee. The muscles at the back of your thigh, the hamstrings, as well as your calf muscles, will also require strengthening post surgically.
After a knee surgery the quadriceps muscle becomes very low in tone and difficult to activate voluntarily, despite no injury to the muscle itself or the nerve that innervates it. This phenomena is termed reflexive inhibition, and it is said to occur in response to several factors including the initial injury itself, the swelling in the joint, the reaction of receptors in the knee joint, pain, joint immobilization, and the surgical intervention itself. Reflexive inhibition of the quadriceps muscle after surgery occurs even if you had highly defined thigh muscle tone prior to the surgery. This decrease in tone if prolonged will contribute to poor recovery after a knee surgery; therefore exercises to get the quadriceps muscles activated are crucial. It is often noted that the more tone you had prior to the surgery, the quicker the tone returns post surgically. For this reason doing a pre-operative exercise program is highly recommended!
The initial strengthening exercises that your physiotherapist prescribes after an arthroscopic surgery might be as simple sitting and tightening the quadriceps or buttocks muscles without moving the joint (these exercises are termed isometric.) Your therapist may use an electrical muscle stimulator to assist you in contracting the muscles. It is important, however, for you to perform weight bearing exercises and those involving motion of the joint as soon as you are able to in order to build up the muscles of the leg in a functional position, such as standing or squatting. Exercises that work the muscles while in standing most effectively assist with daily activities such as walking and stair climbing. Exercises such as squatting, or slowly stepping up or down a step are excellent exercises to encourage the activation of both the quadriceps and hamstrings muscles, as well as the muscles of the hip. Again, your therapist may use an electrical muscle stimulator to assist your muscles to contract while you perform these functional exercises as well. Exercises may also include the use of Theraband, exercise machines, or free weights to provide some added resistance for your thigh and hip. As soon as you are able, and your knee will safely tolerate it, your therapist will advance your exercises to include quicker movements, such as hopping. They will also encourage more repetitions of each exercise in order to help regain muscle endurance. If you have access to a pool, your therapist may suggest you go to the pool to do your exercises. The buoyancy of the water along with the warmth of the water (provided it is a heated pool) can assist greatly in providing comfort to the knee joint and often allows you to exercise through greater ranges of motion.
As a result of any injury, the receptors in your joints and ligaments that assist with balance and proprioception (the ability to know where your body is without looking at it) decline in function. A period of immobility and reduced weight bearing will add to this decline. If your balance and proprioception has declined, your joints and your limb as a whole will not be as efficient in their functioning and the decline may also contribute to further injury in the future. As a final component of our treatment your physiotherapist at Momentum Spine & Sport Physiotherapy will prescribe exercises for you to regain this balance and proprioception. These exercises might include activities such as standing on one foot or balancing on an unstable surface such as a wobbly board or a soft plastic disc. Advanced exercises will include agility type exercises such as hopping on one foot or moving side to side.
As your range of motion, strength, and proprioception improve, your therapist will advance your exercises to ensure your rehabilitation is progressing as quickly as your body allows. As soon as it is safe to do so, your therapist will add more aggressive exercises such as running, jumping to or from a height, or exercises that mimic the sports and recreational activities that you enjoy participating in. During all of your exercises your therapist will pay particular attention to your technique to ensure that you are not using any compensatory patterns or are developing bad habits in regards to how you use your knee and lower extremity. If you do not pay close attention to how you use your joint and limb post-surgically these patterns often continue to occur even once the source of your pain has been eliminated by the arthroscopic surgery. The advice from your physiotherapist at Momentum Spine & Sport Physiotherapy is crucial regarding correcting these patterns and developing new, efficient patterns during your daily activities.
Aside from directly rehabilitating the knee after surgery, at Momentum Spine & Sport Physiotherapy we also highly recommend maintaining the rest of your body’s fitness with regular exercise while your knee is recovering. Cardiovascular exercise can begin very early post-surgically. If you are not yet able to use a normal stationary cycle an upper body bike can be used instead, or your surgeon may approve of you doing gentle aerobic exercises in a pool as an alternative. A stationary bike, however, is often the best cardiovascular activity once your ranges of motion and pain levels allow it. Weights for the upper extremities and your other leg are also strongly encouraged. Advanced exercises such as the stepper or elliptical machines may be used once your knee has recovered to an acceptable level. Your physiotherapist at Momentum Spine & Sport Physiotherapy can provide a program and advice for you to maintain your general fitness while you recover from your surgery.
Today, the arthroscope is used to perform quite complicated major reconstructive surgery using very small incisions. Remember, however, that just because you have small incisions on the outside, there may be a great deal of healing tissue on the inside of the knee joint. Recovery may still take several months despite the small surgical incisions healing fairly rapidly.
When you are well under way, regular visits to Momentum Spine & Sport Physiotherapy will end. Your therapist will continue to be a resource for you as your recovery continues, but you will be in charge of doing your exercises as part of an ongoing home program.
Generally the rehabilitation after arthroscopic knee surgery responds very well to the physiotherapy we provide at Momentum Spine & Sport Physiotherapy. If for some reason, however, your pain continues longer than it should, your range of motion is slow to return, or your general therapy is not progressing as your physiotherapist would expect, we will ask you to follow-up with your surgeon to confirm that the knee is tolerating the rehabilitation well and to ensure that there are no complications that may be impeding your recovery.
Momentum Spine & Sport Physiotherapy provides services for physiotherapy in Edmonton and St Albert.
Portions of this document copyright MMG, LLC.
The use of arthroscopy has revolutionized many different types of orthopedic surgery. During arthroscopy, a small video camera attached to a fiber-optic lens is inserted into the body to allow a physician or surgeon to see inside without making a large incision (arthro means joint, scopy means look). The knee was the first joint in which the arthroscope was commonly used to both diagnose problems and to perform surgical procedures inside a joint.
The knee joint is formed where the femur (lower end of the thighbone) connects with the tibia (upper end of the main lower leg bone). On the front of the joint is the patella (kneecap). The patella is what is called a sesamoid bone that is a part of the extensor mechanism of the knee joint. The extensor mechanism connects the large muscles of the thigh to the tibia such that contracting the thigh muscles pulls on the tibia and allows us to straighten the knee. The parts of the extensor mechanism include the thigh muscles, the quadriceps tendon, the patella and the patellar tendon.
There is one meniscus on each side of the knee joint. The C-shaped medial meniscus is on the inside part of the knee, closest to your other knee (medial means closer to the middle of the body.) The U-shaped lateral meniscus is on the outer half of the knee joint (lateral means further out from the center of the body.)
The menisci (plural for meniscus) protect the articular cartilage on the surfaces of the thighbone (femur) and the shinbone (tibia) and help to create a deeper joint surface, which aids in joint stability. Articular cartilage is the smooth, slippery material that covers the ends of the bones that make up the knee joint, as well as most other joints. The articular cartilage allows the joint surfaces to slide against one another without damage to either surface.
The surgeon begins the operation by making two or three small openings into the knee, called portals. These portals are where the arthroscope and surgical instruments are placed inside the knee. Care is taken to protect the nearby nerves and blood vessels. A small metal or plastic tube (or cannula) will be placed through one of the portals to inflate the knee with sterile saline, which allows the tissues inside the joint to be more easily visible.
Once the surgical procedure is complete, the arthroscopic portals and surgical incisions will be closed with sutures or surgical staples. Small pieces of surgical tape are also applied to assist the skin to heal as smoothly as possible. Often a large bandage is applied from mid thigh to the toes. Wrapping the entire leg with a compressive bandage reduces swelling and helps prevent blood clots in the leg. Once the bandage has been placed, you will be taken to the recovery room.
As mentioned above, the portals are covered with surgical strips. The larger incisions may have been repaired with either surgical staples or sutures and the knee may be wrapped in an elastic bandage. Crutches are commonly used after knee arthroscopy even though they may only be needed for one to two days after a simple procedure.