Your kneecap, or patella, is surrounded by a hard, dense shell of cortical bone. A rehabilitation protocol for cortical knee surgery -- which involves the kneecap -- focuses on pain reduction; ambulation, or walking; and exercises to strengthen your muscles and increase range-of-motion in your knee joint. Conditions that may warrant surgery in your kneecap include arthritis, patella misalignment and fractures. Perform a rehabilitation protocol only under the supervision of your doctor.
Contributing Factors
Several conditions can lead to surgery that involves the cortical bone covering your kneecap. For instance, surgery may occur due to a fracture of the patella -- which primarily results from a direct blow to your kneecap, according to Cedars-Sinai Medical Center. Surgery to repair a fracture can entail the insertion of metal wires, pins, screws or the complete removal of the knee cap. Arthritis, which can affect any of the three compartments in your knee, including your kneecap, may also lead to cortical knee surgery. In some cases, a surgical procedure is performed that entirely removes the cortical bone -- exposing the spongy bone, or cancellous bone, inside your kneecap. In addition, your patella can become partially or completely dislocated from injuries, which may warrant realignment surgery.
Rehabilitation Protocol Goals
The rehabilitation protocol seeks to decrease pain and enhance healing, strength and mobility in your knee following cortical surgery. Exercises, activities and pain-control methods play key roles in restoring normal knee function. A physical therapist guides you through an exercise regimen, and an occupational therapist may instruct you in activities of day-to-day living. Your rehabilitation protocol includes various specific goals for each stage of the recovery process. For instance, first-week goals can include controlling pain and swelling, initiating knee motion and activating the quadriceps muscles in your legs. Two- to six-week goals may include protecting the knee, promoting wound healing, maintaining full-knee extension and initiating knee exercises. Rehabilitation goals from six to 12 weeks can consist of normal walking and regaining full motion and muscle strength in your affected knee, according to Massachusetts General Hospital.
Safety and Pain Protocol
Although hospital protocols may vary, the first week at home following kneecap surgery generally involves the use of crutches and a knee brace -- unless directed otherwise by your doctor. Massachusetts General Hospital recommends wrapping ice in a towel and placing it over your knee for on-and-off periods of 20 minutes each. The healing protocol also involves wrapping an elastic bandage around your knee and performing 10 ankle pumps every hour to help reduce swelling and prevent blood clots. Activities for the two- to six-week period include using a knee brace when walking and, depending on your progress, using one crutch on the opposite side of the affected knee. The six- to 12-week protocol involves discontinuing use of the knee brace and slow, normal walking. After 12 weeks, you may perform activities, such as climbing stairs without the use of a crutch or brace.
Exercise Protocol
Kneecap-surgery patients generally follow an exercise rehabilitation protocol that involves range-of-motion, strengthening and proprioceptive exercises, which promote balance. Postoperative week-one exercises can include exercises to strengthen the quadriceps muscles in your thigh, such as quadriceps settings, and exercises to improve flexibility, such as assisted knee flexions and ankle pumps. You may perform active knee flexions, side leg lifts and toe raises, two to six weeks after surgery. Depending on the pace of your progress, strength training may begin before or during weeks six to 12 and can include progressive leg lifts and the use of ankle weights. From weeks six to 24, you can progressively return to a normal sports regimen that begins with walking, followed by jogging and running, according to Massachusetts General Hospital. Your physical therapist or doctor will instruct you in exercise routines, frequencies and durations.
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