Knee Rehabilitation Post-Operation

Rehabilitation in the Post-Operative Period of Knee Fractures and Arthritis

• Rehabilitation of the knee is a major area of intervention for physical therapists
• High incidence of sports and work injuries, increasing rates of osteoarthritis and joint replacement surgeries due to population aging contribute to the need for rehabilitation
• High costs associated with revision surgeries due to complications
• Patients want to regain their functional level after injury or surgery
• Current scientific evidence shows effective rehabilitation programs enabling restoration of healthy functional levels

Biomechanical Factors in Knee Rehabilitation

• Understanding joint surface movement and compressive forces is crucial for manual therapies and exercise in knee fracture patients
• Most of the information won't be applicable to patients with total knee arthroplasty (TKA) or partial knee arthroplasty (UKA), except for patients without patellar coverage, who need to consider patellofemoral forces
• Forces on the tibiofemoral and patellofemoral joints and ligaments and menisci should be considered during exercise prescription
• Ligament injuries affect motion and can lead to early cartilage or meniscus damage

Neurophysiological Factors in Knee Rehabilitation

• The knee is a highly complex system with interconnected components
• Intra-articular components sense and transmit signals to the spinal cord and brain
• The knee has sensory receptors that are sensitive to stretching and pressure, essential for conscious perception
• Sensory feedback plays a role in knee function and pain
• Arthrokinase (AMI) is common in patients with knee injuries and surgery
• Edema, inflammation, and instability affect sensory input and can lead to reduced activation in the quadriceps

Knee Joint Rehabilitation Methods

• Open-chain and closed-chain exercise are used in knee rehabilitation
• Knee extension using an open-chain mechanism isolates the quadriceps
• Knee flexion using a closed-chain mechanism involves multiple joint activation
• Exercise prescription for specific conditions must account for different amounts of stress on different parts of the knee
• The position of the feet can also influence the loading on the knee, with narrow stance (feet closer together) producing less compression compared to wide stance.
• The squat exercise is often discussed and reviewed to determine optimal joint load distribution and minimize injury risk

Evaluation of Patients Post-Knee Surgery

• Objective, functional assessments (e.g., timed tasks like sit-to-stand and timed walk tests, gait analysis etc.) are crucial beyond patient-reported outcomes (e.g., questionnaires)
• Pre-operative strength, ROM, and pain can predict functional results at 1 and 2 years post-surgery.
• Lower BMI scores are associated with better functional outcomes.
• Post-operative quadriceps strength can be monitored with methods such as electromyography for long-term success
• Continuous passive motion (CPM) devices have limited effect, particularly for long-term results
• Neuromuscular electrical stimulation (NMES) might enhance recovery, although more research is needed

Progressive Strength Training

• High-intensity progressive strength training programs can yield better long-term results compared to standard care programs for TKA patients
• This approach includes exercises for the quadriceps, other muscle groups, and joint mobility
• The intensity of exercises needs to be monitored to prevent issues or injuries
• The programs typically show significant improvement in strength and function over time

Hydrotherapy

• Hydrotherapy is a widely used technique for post-operative rehabilitation in knee conditions
• Reduced weight-bearing, improved joint mobility, and pain reduction are major benefits of water-based exercise
• Evidence is mixed, and additional studies are needed to quantify the benefits over other types of exercises.

This quiz explores the essential aspects of rehabilitation following knee fractures and arthritis. It covers the importance of effective rehabilitation programs, the biomechanical factors involved, and the impact of joint injuries on recovery. Ideal for physical therapy professionals looking to enhance their understanding and skills in knee rehabilitation.