Following Keyhole Surgery
Arthroscopic knee surgery is most commonly performed for cartilage tears although a number of other knee conditions can also be treated in this way.
Rehabilitation is an important part of the healing process regardless of diagnosis and preferably should be done under the supervision of a chartered physiotherapist. Physio is not essential but is recommended as it will speed up the recovery process.
Aims of Rehabilitation Post operatively
- 1. decrease pain and swelling
- 2. restore normal range of movement (ROM)
- 3. restore normal muscle tone and strength
- 4. progress to a return to normal daily activities
Most arthroscopies are carried out as day case surgery. You will usually be able to fully weight bear without the use of crutches.
It is common to experience some pain, usually quite minor, depending on the exact procedure.
Swelling causes pressure on the surrounding structures which can impair muscle function and restrict ROM. Early mobilisation of the knee helps to activate the muscles thus helping to increase the circulation to the knee. Exercises performed with the leg raised will also aid in the reduction of swelling whilst you begin to move the joint and strengthen the knee muscles.
The exercises below should be used as a guideline to aid in your recovery remembering there is no recipe for rehabilitation as every case is different. It is important to follow the advice of your physiotherapist in this early phase and be guided by them.
1. Knee Flexion using a sling
Sit with your legs out in front of you, preferably resting your heels on a sliding surface. Put a sling (towel, sheet etc.) around your foot then bend your knee using the sling, as far as it will comfortably go.
Hold it there for a few seconds before straightening the leg. Repeat 20 times.
2. Static Quadriceps Contraction (Thigh Squeeze)
Sit with your legs straight out in front of you and pull you toes upwards. Tense the thigh muscles to try and push the back of your knee against the underlying surface.
Hold for 10 seconds and repeat 10 times.
If you find this difficult try it first on the other leg as often a reminder of the feeling prompts a better response when you try it again on the injured leg.
3. Co-contractions of the quadriceps and hamstrings.
Sitting with your legs out in front of you place a rolled up towel under your knee.
Push your knee down onto the towel whilst digging your heel into the surface below. You should feel the muscles at the front and back of the thigh working together.
Hold that position for 10 seconds and repeat 10 times.
To progress this, repeat the whole process over two, then three rolls to increase the degree of bend at the knee.
4. Knee Extensions in sitting
Sit on a chair and straighten the injured knee pulling your toes up towards you.
Tense your thigh holding that position for 10 seconds and repeat 10 times.
5. Straight Leg Raise
Sit with your legs straight out in front of you and tense the thigh muscle. Turn your foot out slightly and then lift the straight leg up about 3 inches off the bed.
Hold for a few seconds before lowering – repeating the exercise 10 times.
As this gets easier to do you should not need to rest the leg down in between repetitions. If you are unable to keep the knee straight during the whole of the exercise it means you are not ready to do this one yet.
All of these exercises should be done in moderation (little and often) in the first few days after knee cartilage surgery.
Where possible, elevate the limb when sitting or when applying ice. Ice is used to help minimise swelling in your knee and is often good for pain relief (your physiotherapist will be able to give you all the correct information for this regarding application and timing).
After this initial stage, your exercise programme will be devised according to your individual needs. The aims are to encourage normal walking and to progress to a more functional strengthening programme. This may include exercises such as ski squats, lunges, knee dips, balance exercises and progression onto mini trampoline, mat work, weights etc..
Full recovery after simple knee arthroscopy can take from 2 to 6 weeks.
These rehabilitation guidelines have been prepared with the help of Gill Cannon and Rachel Galley (Physio Action Ltd.) – at David Lloyd Centre, Leeds and Harrogate Gymnastics, Hornbeam Park, Harrogate).