More than 600,000 arthroscopic surgeries are performed annually in the U.S. and 85 percent of them are for knee surgery, according to the Encyclopedia of Surgery. In arthroscopy, flexible tubes, one of which includes a camera, are inserted through tiny incisions. The surgeon views the inside of the joint on a monitor in the room, while performing the surgery using instruments inserted through other tubes. Some common knee surgeries done using this procedure are cartilage repairs, smoothing roughened surfaces of the knee joint and removing loose debris in the joint.
Protocols for rehabilitation after arthroscopic knee surgery depend on the surgeon and the surgery. Patients are rarely required to remain overnight in the hospital. In general, a patient goes home using crutches, though he can put as much weight as he's comfortable with on the operated leg. Doctors usually prescribe rest, icing and elevation of the leg, and physical therapy. Physical therapists may choose a two- or four-phase protocol for rehabilitation after knee arthroscopy.
Phase One: First Two Weeks Post-op
Rehab for a knee after arthroscopy can be pursued aggressively, according to Dr. Matthew Crawford of the Austin Diagnostic Clinic. Exercises during this first phase of rehab focus on keeping swelling under control while gaining full knee extension, meaning getting the knee as straight as possible. Until patients can get full knee extension, they will have more swelling and more pain while walking. This is why crutches and limited walking time are usually recommended during this phase.
Phase Two: The Next Four Weeks
Once full knee extension is achieved, patients need to work on walking with a normal gait pattern. This means step lengths are equal and the same amount of weight is placed on each leg for the same length of time when each alternating foot is on the ground. This requires good control of the thigh muscle, called the quadriceps or quad, so lots of exercises are done to strengthen this muscle. Good quad control is also necessary for going up and down stairs, also a focus during this phase, along with continued monitoring to keep swelling down.
According to the Massachusetts General Hospital rehab guidelines, patients may gradually resume their usual pre-op activities if they have "full range-of-motion, full strength and no swelling." Therefore, some people will have completed their formal PT program at this point, though they will be encouraged to continue their exercises at home.
Phase Three: Six Weeks to Three Months Post-op
Exercises during this phase focus on developing muscle tone in the quads. According to Crawford's protocol, "a patient who continues to have poor quad tone must not be advanced to activities that require high quad strength such as squats and lunges." By the end of this phase, patients are expected to have achieved good quad control and returned to carrying out their usual daily activities, such as moving around their home and place of work and going shopping.
Phase Four: Three to Six Months Post-op
This phase focuses on stretching, strengthening and high intensity exercise, which especially benefits athletes or those who work in certain physically demanding jobs. It is during this phase that programs such as Sportsmetrics™, which focuses on ACL rehab and knee injury prevention, can be initiated.
References
- Encyclopedia of Surgery: Knee arthroscopic surgery
- American Academy of Orthopaedic Surgeons: Knee Arthroscopy
- Johns Hopkins Medicine: Patient Guide to Knee Arthroscopy
- Austin Diagnostic Clinic: Knee Arthroscopy Rehab Protocol
- Massachusetts General Hospital Orthopedics: Rehabilitation After Arthroscopic Knee Surgery
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