Rehabilitation program after surgery on the anterior cruciate ligament of the knee joint. ACL plastic surgery: after surgery

Arthroscopy is the most modern surgical treatment for the knee joint. Unlike traditional intervention, rehabilitation after such an operation is much faster.

However, during this period it is extremely important to take all necessary precautions. This will help protect the operated joint as much as possible from damage.

With this treatment, the length of hospital stay varies. On average, hospitalization usually lasts 15-30 hours. In most cases, meniscus treatment lasts several hours, and rehabilitation after cruciate joint arthroplasty takes from 1 to 3 days.

Recovery after surgery is fairly quick and painless. After 2-3 days the wound heals, but the patient becomes completely healthy only after 3 months.

Rehabilitation measures in a hospital setting

After the procedure, the patient must remain in hospital. At this time, he will be offered special treatments. First of all, a single (if necessary, double) administration of a broad-spectrum antibiotic is indicated. To prevent thrombosis, the patient should wear:

1. elastic bandage;
2. compression knitted underwear (at least 3 days after arthroscopy).

Also at this time, anticoagulants in tablets and low molecular weight heparin preparations are taken.

Recovery after knee arthroscopy involves complete rest. To do this, you should fix the operated joint with an orthosis (special bandage). The leg should always be in a straight position. After cruciate ligament surgery, treatment requires the mandatory use of a hinged orthosis with a flexion angle of 20 degrees.

As a rule, after surgical treatment, analgesic therapy and non-steroidal anti-inflammatory drugs are required. Next, you should relieve swelling using hardware lymphatic drainage or manual lymphatic drainage massage.

Physical therapy treatment will be no less useful. Exercise therapy on the first day after arthroscopy requires isometric tension of the thigh muscles and movements of the ankle joint. The next day, when the drainage is removed, passive smooth movements of the knee are added.

Activation is also performed, providing additional support in the form of a cane or crutches.

Rehabilitation at home

In an outpatient setting, for a quick and successful recovery, it is important to follow certain rules. Immediately after returning from the hospital, it is necessary to follow the orthopedist’s instructions as accurately as possible. So, to eliminate swelling, the patient needs to hold the operated legs as high as possible for the first day.

In addition, the patient must:

• keep the incisions clean and dry;
• carry out water procedures strictly according to the doctor’s instructions;
• on days 3-4 and 7-12, undergo an examination by a traumatologist and have a dressing done.

During dressing, the patient is replaced with aseptic dressings and, if necessary, the affected joint is punctured and the exudate is evacuated. Sutures are usually removed 7-12 days after arthroscopy.

Rehabilitation of the knee joint occurs on an outpatient basis with the mandatory use of vascular and anti-inflammatory drugs. Over the course of 7 days, an elastic bandage is applied to the operated limb.

Physical activity, local cold therapy and lymphatic drainage are provided. The duration of the procedures depends entirely on the type of surgery performed and the condition of the patient.

After meniscectomy, from the first days it is recommended to walk with moderate load on the joint. It is important to use a special crutch supported by the elbow or a cane for at least a week. If an arthroscopic suture of the meniscus was performed, then it will take another month to move with support.

When a patient has undergone anterior cruciate ligament surgery, rehabilitation after the procedure involves the use of crutches with support for at least 3 weeks. During the first days, the patient moves without putting weight on the limb, and soon, while walking, the entire foot is placed on the floor, but without transferring weight to the operated leg.

During the recovery period after meniscus surgery, a person should:

1. wear a soft or hard knee brace to fix the knee joint;
2. Apply an elastic bandage to the surface of the joint.

When plastic surgery of the cruciate ligament, the knee is fixed with a special postoperative hinged orthosis. At the same time, after the operation, if there are medical indications, the following is necessary:

• mobilization of the patella;
• light thigh massage;
• physiotherapy;
• electrical stimulation of muscles.

Physical therapy treatment by period

Almost everyone who has undergone plastic surgery of the knee joint is shown isometric tension of the gluteal muscles, hip extensors and flexors, and foot movements.

In addition, during the rehabilitation process, active movements of the knee are added, which are performed along a closed contour, that is, during the exercise the heel should always be in close contact with the surface.

Over time, exercises are added to strengthen the leg muscles. In a lying position, slowly raise your straight leg and hold it suspended for at least 5-7 seconds (a similar exercise is performed while standing). Swimming and gymnastics with a tourniquet (exercises to restore the calf muscles) have proven themselves well.

4-6 week

The patient is allowed to walk in an orthosis with full support on the limb, move with the help of one crutch or without any additional support at all (it all depends on the patient’s condition).

By 4-6 weeks after surgery, a person should already be able to bend and straighten the knee joint to an angle of 90 degrees without pain.

During this period, it is necessary to walk slowly, without limping the operated limb.

Physical education treatment at this time should be aimed at maximizing the strengthening of the thigh muscles, usually this is:

1. slow spring squats;
2. swimming in the pool;
3. low-impact exercise bike;
4. exercises with light resistance.

If after exercise therapy the affected joint begins to swell and the pain intensifies, then the exercises should be stopped and consult a doctor.

6-8 week

Now the patient will be shown strength exercises, walking in a functional orthosis, training aimed at restoring coordination of movements, swimming, and exercise on block simulators.

During classes, you cannot be too zealous, because the knee joint is being rehabilitated and reconstructed. The strength of ligaments and articular joints is reduced and they need protection. Therefore, you should exercise without sudden bending, swinging, overloading or straightening the operated leg.

8-12 week

All exercises at this stage should be aimed at strengthening the muscles of the limb and coordination. The list of permitted physical activities is expanding significantly, and the exercises familiar to the patient are being improved:

• swimming;
• exercise on an exercise bike;
• maintaining balance on an inflatable cushion;
• gentle lunges;
• side steps;
• platform exercises.

Treatment by week 8 involves walking without any restrictions on time and speed.

Every person who has had to undergo knee surgery must understand that properly and competently organized rehabilitation will prevent the development of complications.

We also must not forget that after surgery using an arthroscope, in rare cases, infection occurs and the active development of arthritis of the knee joint, hemarthrosis (bleeding into the joint cavity). For this reason, it is necessary to monitor the cleanliness of the operated leg and the condition of the bandage.

If physical therapy treatment is too active, then such rash actions often provoke leakage of joint fluid, further infiltration into the joint and a number of other rather unpleasant complications.

Rehabilitation after knee arthroscopy will be successful if all recommendations are strictly followed. As a result, the patient will be able to return to a full and active life without pain.

To understand the danger of injury and choose the right treatment, you need to know the structure of the knee joint. It is connected by the tibia and femur. On the upper surface of the knee joint is the patella, held in place by ligaments. The ligamentous system of the knee joint includes the patellar ligament, lateral and medial ligaments. With their help, the joint is strengthened laterally. In the inner surface of the joint there are cruciate ligaments, thanks to which the tibia does not move. Articular cartilage covers the surface of joints. Their cavity contains synovial fluid. Thanks to the presence of such a liquid, the friction of surfaces is noticeably softened. Between the tibia and femur there is a medial and literal meniscus. It is a crescent-shaped cartilage. The bursa covers the knee joint.

Causes, types and symptoms of knee injuries

The knee joint is considered very large in the human body. It has a very complex structure, but despite this, it is easy to damage. It is very difficult for a specialist to investigate complications of injury.

The knee joint can be damaged in several ways:

• Bruises
• Ligament rupture, severe sprains. This type of injury is called a tear. It appears after serious falls, during sports, after road accidents. During a breakup, physical activity should be limited.
• Meniscus injuries are divided into internal and lateral. Rupture can occur in older people and athletes.
• Dislocation is one of the rarest types of injuries. Appears after road accidents, violent collisions in hockey and football.
• Fractures inside the joints occur during falls and in older people.
• Various cartilage injuries - include severe bruises, dislocations, fractures.

Resection is performed for the most dangerous injuries. Symptoms include severe pain in the knee, limited mobility, and severe hyperactivity of the knee joint. The knees may also become swollen and swollen.

Diagnostics

• Clinical testing may be included in the diagnosis. This includes patient opinions, preventive examinations, and palpation of the damaged area.
• Instrumental methods include radiography. Using this method, you can calculate severe fractures, sprains and injuries to the meniscus.
• Using an ultrasound examination, damage to the meniscus can be seen.
• In controversial situations, nuclear magnetic or computed tomography is additionally performed.

Healing phases after injury

After physical therapy, surgery and surgery, rehabilitation is divided into four main phases:

• I – postoperative. This may include fresh wounds, acute pain in the knee area, and atony of the quadriceps femoris muscle.
• II – initial healing. This includes subsided pain, reactive effusion, and atony when the knee is flexed to 90°.
• III – final healing. This phase includes a complete absence of pain, muscle atony, and knee flexion up to 120°. In most cases there is a mild effusion.
• IV – rehabilitation. In this phase, there is unlimited movement, partial or complete muscle recovery. In this case, there is no effusion, but there are restrictions in sports activities.

Treatment of knee injuries

During a rupture, sprain, impact of the meniscus, removal and other injuries, it is necessary to urgently consult a specialist. The patient must receive medical care. You should take medications, undergo physical therapy and devote more time to rest. Treatment methods depend on the severity of the disease, the patient's age and physical characteristics.

General information about rehabilitation

Absolutely all sick people who have suffered knee injuries or surgery need quiet rest. With any injury or surgery, the human body will react with identical symptoms: spasms in the knee area, swelling of both legs, severe pain in the feet and ligaments, and limitation of movement. In the future, such diseases lead to weakening of the body. This may cause loss of motor control. This leads to increased stress on ligaments and joints. Effusion occurs. Such injuries lead to abnormal positioning of the limbs. In order for recovery to occur during rehabilitation, it is necessary to perform exercises. They are carried out both in specialized clinics and at home.

Rehabilitation after injury

This method of recovery after surgery is divided into passive and active rehabilitation.

• Passive recovery includes physiotherapy, exercises, and meniscus massage.
• Active recovery should be aimed at continuing the fight against muscle atrophy. There should be a reduction in the influence of negative loads. The goal of treatment is stabilization.

Recovery time depends on the severity of the injury. Treatment is also influenced by the type of disease and the person’s age. The operation, which was performed on elderly people, leaves a strong imprint on health. Young patients cope with difficulties much easier and faster. Therefore, only a specialist can tell the recovery time.

Rehabilitation after a fracture

Rehabilitation can begin only after permission from a specialist. At the initial stages of recovery, it is recommended to use mechanotherapy using special devices. Physical activity plays an important role. During rehabilitation, physical therapy classes are aimed at strengthening the ligaments and muscles of the legs. During such exercises, cyclic movements should be performed.

In this case it is necessary to carry out:

• Manual therapy;
• Acupuncture;
• Physiotherapy;
• Gymnastics;
• Exercises;
• Physical therapy;
• Massage;
• SRM therapy;

Of the proposed methods, the most effective method is CRM therapy. Using this method, passive exercises are performed thanks to a special device. After performing the technique, patients do not feel fatigue or severe pain. Ligaments and muscles relax. The main advantage of the therapy is the possibility of using the method on the second day after surgery. CPM therapy is an excellent prevention of postoperative complications.

Rehabilitation after knee replacement

Recovery time after a complex operation is considered an important process that promotes healing of the injury. During rehabilitation it is recommended:

• Follow the recommendations of a specialist. Following the instructions leads to a speedy recovery;
• Periodically perform gymnastics and various exercises on which the recovery of the knee joint depends;
• Be active, do not give up sports, do not give up entertainment. Physical ability should not affect the replaced knee joint;
• Spend more time in nature, breathe fresh air. The flow of air into the lungs stabilizes the flow of oxygen into the blood. This helps heal injured tissue. After surgery, it is necessary to monitor your health and exercise your lungs. Otherwise, the person may develop pneumonia;
• To refuse from bad habits. Do not smoke tobacco or hookah, do not drink alcohol, do not take drugs;
• Control acute pain. To do this, experts recommend taking painkillers;
• Swelling of the knee joint should be monitored. After surgery, the soft tissue may swell. This phenomenon is considered stable. But it causes sharp pain and restricts movement. To get rid of swelling, you can apply ice to your knee. Experts also advise raising your legs, placing them on a hill;
• Give more time to rest. Overexertion has a negative impact on human health;

Forbidden:

• Carry weights. Excess weight can damage the prosthesis;
• Twist the knee joint. Experienced specialists recommend turning the entire body when turning necessary;
• Some sports are prohibited: high jumping, running, gymnastics, skiing, weightlifting, tennis;

Rehabilitation after knee replacement lasts differently for each person. Several factors influence recovery:

• Rest;
• Age;
• Complications;
• Lifestyle;

Rehabilitation after arthroscopy

1.Stretching the injured knee.

You need to sit up straight. The operated leg should be placed in a horizontal position under soft material. The socks will be pulled on themselves painlessly. Along with this exercise, the thigh muscles are tensed. The popliteal fossa is pressed against the lining.

You need to sit up straight. The operated leg is placed on a smooth surface. You should carefully slide your foot towards you. There is no need to apply axial loading.

The exercise is repeated three times a day. Fifteen repetitions are done in one approach. A total of three approaches are carried out.

Both legs must be kept elevated. Socks are pulled away from and towards themselves.

The exercise is repeated three times a day. Fifteen repetitions are done in one approach. A total of three approaches are carried out.

4. Exercises with a gymnastic ball.

They improve coordination. Position: lying on your back. Place your feet on the ball and gradually bend your knee. Then the ball is pressed with the heels.

The exercise is repeated three times a day. Fifteen repetitions are done in one approach. A total of three approaches are carried out.

Position: standing.
You need to rise up and then lower yourself onto your toes.

The exercise is repeated once a day. Fifteen repetitions are done in one approach. A total of three approaches are carried out.

Position: standing. The knees are periodically bent and straightened. Allowed to stand on support.

The exercise is repeated three times a day. Fifteen repetitions are done in one approach. A total of three approaches are carried out.

Position: sitting. The leg is extended forward and extended at the knee. The foot gently turns to the side. For 3-4 seconds. the position is fixed. Then the leg bends and lowers.

Position: standing. You need to stand on a horizontal, shaky surface. You can stand on either two or one leg, changing them periodically.

The exercise is repeated three times a day. Twenty repetitions are done in one approach. A total of three approaches are carried out.

Position: lying down. The toes are raised, and the muscles are tensed. Without moving the pelvis, the leg moves forward.

The exercise is repeated three times a day. Fifteen repetitions are done in one approach. A total of three approaches are carried out.

Rehabilitation after ACL plastic surgery

In most cases, an ACL rupture occurs along with other injuries - sprains, meniscus impacts, displacements, and tears. After surgery, all your energy must be directed toward treatment. ACL plastic allows you to keep the lower leg from moving. A drainage tube will be placed during surgery. It is designed to remove blood from the joint cavity. Rehabilitation lasts at least 12 weeks.

The following activities must be carried out:

• Immobilize with a plaster cast;
• Take antibiotics and anti-inflammatory drugs;
• Dress injuries with bandages soaked in antiseptic;
• Apply ice to the rupture site;
• Create a cozy and calm environment at home. Nervous breakdowns negatively affect health;
• Perform supporting loads, walking;
• Carry out breathing exercises;

ACL plastic surgery and proper rehabilitation helps to return to previous physical and sports activity.

Rehabilitation after a sprain

During recovery, a specialist may recommend physical therapy. Special exercises and procedures are carried out. Thanks to them, mobility improves. They prevent stiffness and swelling. The procedures are carried out in special clinics. But some of them can be done at home. Such exercises are performed only after pain has decreased. During the rehabilitation process, on the recommendation of a specialist, new procedures can be added. They will strengthen the knee joint and reduce sprains. The use of exercise bikes and treadmills is permitted. After recovery is complete, you can continue to actively engage in sports.

• When a puncture is detected, specialists use acupuncture. This procedure will remove excess liquid;
• If a ligament ruptures, surgery may be required. Sometimes grafts are used to replace torn tissue;

In this article we will talk about the symptoms that appear after a hip dislocation.
What pain on the inner side of the thigh may mean, read here

Criteria for assessing recovery of knee joint function

To restore functional activity, you must perform the following actions:

• Squats;
• Walking;
• A short jog for half an hour;
• Squats on the operated leg. Experienced experts recommend performing 75% of the number of squats on the healthy leg;
• Performing possible and simulation exercises;

Possible post-operative results:

• The best result can be considered when the patient is able to perform absolutely any duties. The knee joint should be stable and not restrict movement.
• An excellent result includes: a stable knee joint, unrestricted movement, and slight pain. Such patients are allowed to return to their jobs and exercise.
• A good result includes: a stable joint, limited movement by 15-20°, sharp pain. Such patients are strictly forbidden to exercise their legs.
• A bad result is considered to be an unstable joint, continuous pain, severe swelling, and limited movement.

Damage to the ligaments of the knee joint: causes and symptoms, treatment

In the process of life, a person’s knee joints are exposed to a variety of influences, which can lead to partial or complete rupture of the ligaments. In most cases, getting such an injury is not difficult, provided that the patient does not immediately seek qualified medical help. People do not always understand how serious such injuries are and are in no hurry to go to the hospital.

• Symptoms of injury
• Diagnosis of ligamentous apparatus damage
• Treatment of knee ligament rupture
• • Types of surgical interventions
  • How to change your lifestyle after suffering a ligament injury
• Preventive measures

In order to avoid making such a mistake, it would not hurt to become familiar with the causes of knee ligament rupture, the symptoms of this injury, and also learn how such injuries should be treated so that a person can return to their normal lifestyle.

Experts identify a number of different reasons that can cause knee ligament rupture. The most common of them are the following:

There are many cases where a person receives several types of tendon injuries at the same time. This, in turn, leads to blood entering the joint, and this significantly increases the time required to restore motor function.

Symptoms of injury

Damage to the knee ligaments can be determined by the following symptoms:

If any of the listed symptoms appear, we can talk about a tear or rupture of the knee ligaments. This means that it is necessary to seek medical help as quickly as possible, otherwise there is a danger of permanently losing the damaged ligaments.

Diagnosis of ligamentous apparatus damage

During the visit, the traumatologist should first examine and feel the sore knee. If the situation requires it, the doctor can use additional instrumental methods to clarify the diagnosis:

• X-ray examination;
• Magnetic resonance imaging;
• ultrasonography.

After carrying out the necessary diagnostic procedures, it is possible to more accurately say whether soft tissues are damaged, whether there are bone fractures, and also what condition the ligaments are in.

Treatment of knee ligament rupture

Ligaments are very susceptible to injury, so if pain appears in this area, it is necessary to carry out a diagnosis as soon as possible. When the diagnosis is confirmed, the doctor needs to make a difficult decision - to choose the optimal treatment for the patient.

In each case, the duration of treatment may vary, as well as the rehabilitation period. This is primarily influenced by how soon the patient sought help from the moment of injury. It is advisable to do this as soon as possible and then the patient will not have to spend a lot of time recovering from the injury.

In most cases, the treatment program for ligament rupture includes the following measures:

1. To eliminate signs of swelling and pain in the area of ​​tendon rupture, the patient must observe strict bed rest for two to three days after the injury.
2. You can help restore the previous state of blood vessels, remove swelling and hemorrhage in the tissue with the help of cold compresses: they are kept on the damaged area for the first day after injury.
3. As part of the treatment, the use of elastic bandages, bandages and bandages is indicated. They help prevent the recurrence of swelling, provide stability to the knee joint, and also reduce its pathological movement.
4. The injured leg must be positioned so that it lies on an elevation above the level of the heart.
5. Non-steroidal anti-inflammatory drugs may be prescribed to relieve acute placental pain. These can be tablets for internal use or special creams, ointments or lotions.
6. As part of the treatment, it is allowed to use heat compresses, however, this method of treatment is allowed only 3-4 days after the ligament injury and in the absence of bleeding. All this should help ease the pain.
7. You can speed up the regeneration of damaged tissues with the help of physiotherapy - paraffin baths, UHF, dynamic currents, electrophoresis.
8. For a speedy recovery, it is useful to combine drug treatment with exercise.

An effective method for eliminating swelling and pain is massage. However, the expected therapeutic effect will only be achieved if it is performed by an experienced specialist.

If there is a complete rupture of the tendons, the joints remain unstable, or conservative treatment methods are not able to alleviate the patient’s condition, then the doctor may decide to perform surgery. During it, two incisions are made, and then the ligaments are restored using special tools.

Provided that the patient seeks medical help in a timely manner, one can expect that the ligaments will return to their function quite quickly.

Traditional medicine for ligament rupture

To enhance the therapeutic effect, it is useful to combine drug treatment with folk remedies that effectively relieve swelling and pain when the ligaments in the knee joint are damaged.

However, before using one or another method to treat a torn ligament, you need to discuss this issue with your doctor. The following folk recipes have proven themselves well in the treatment of ligament rupture:

• Compresses made from grated raw potatoes. They are placed on the sore knee, tied with a thin cloth. You need to keep such compresses for 15 minutes.
• For pronounced swelling, you can use the following remedy. It is necessary to take bodyagu and white clay in equal quantities, mix everything well. Then you need to add warm water to this mixture so that it becomes homogeneous in composition. Lubricate the sore knee with this paste, and put a bag on top and tie it with a warm cloth. This compress must be kept for 30 minutes.
• To eliminate pain and swelling of tissues, compresses with aloe and Kalanchoe leaves are recommended.
• Effective in the treatment of ligament rupture is a remedy based on grated horseradish root. To do this, you need to grind 1 kg of prepared horseradish root, then let it boil for 3 minutes in 4 liters of water.

Next, the broth should cool. Then you need to put 0.5 kg of honey in the decoction. The mixture is put in the refrigerator and kept there for 24 hours. After this, the broth is filtered and taken 3 times a day, 15 grams. This remedy is good for restoring tissue of damaged ligaments.

Types of surgical interventions

If the examination results reveal a complete rupture of the ligaments in the knee, then the only way to treat this condition is surgery. While waiting for her, the patient will have to walk with a splint on his knee.

The moment you arrive at the surgical department, doctors begin performing the operation. Based on current practice, several types of ligament surgeries can be distinguished:

1. Arthroscopic ligament reconstruction. It involves making small incisions in the knee. Using a microcamera and special instruments, the doctor will have to perform complex manipulations. As a result of this type of intervention, the ligaments will be stitched, and if this is necessary, the doctor can remove all cartilage or bones that show signs of severe damage.
2. Autografts. This treatment method is indicated for ligament dislocation. In most cases, this operation is performed using material taken from the hamstrings.
3. Allografts. This method of therapy is chosen by the doctor when several tendons are damaged. The essence of the treatment is the use of donor tissue, which binds ligaments or tendons. However, such an operation must be carried out very carefully, since there is a risk of tissue rejection or suppuration.

Regardless of the treatment method chosen by the doctor, the patient must strictly follow all of his recommendations. The rehabilitation period is especially important, during which the patient must perform special exercises to maintain the necessary activity of the joint.

How to change your lifestyle after suffering a ligament injury

Whatever method the doctor chooses to treat ligament damage, upon completion, the patient must perform restorative exercise. It is worth saying that rehabilitation after a partial ligament rupture is a rather lengthy process and can take up to 8 weeks.

The exercises recommended by the doctor are designed to return the knee to its previous level of mobility and make the muscles of the limbs stronger. In addition, massage is recommended for this condition, as well as the use of knee pads and special bandages.

If surgery is performed, recovery may take up to six months. At the initial stage, you need to take measures to avoid muscle atrophy and learn to walk without the help of crutches. In the future, the patient is recommended to perform therapeutic exercises so that he can normally control the actions of his knee, restore muscle elasticity and the function of the limb as a whole.

Preventive measures

To prevent re-rupture of the knee ligaments in the future, the following rules must be observed:

Injury to the ligaments of the knee joint is not only unpleasant in its sensations, but also dangerous to health, since the knee joint may completely lose its motor ability. To prevent this from happening, you must immediately seek qualified medical help after receiving an injury.

This moment often turns out to be decisive and largely determines how long and successful the treatment of the injury will be. However, the prognosis for recovery is not always encouraging. In some cases, it is necessary to consider an extreme measure - surgery.

In this case, the patient must clearly understand that surgery alone will not help him return to his usual lifestyle. And he himself must make a lot of effort, performing special physical exercises to restore the previous function of the knee joint.

To avoid the recurrence of such unpleasant situations, you must be very careful when performing various activities in which the knee joint is involved. People who play sports especially need to be attentive, since an active lifestyle increases the likelihood of receiving dangerous injuries to the ligaments of the knee joints.

On the eve of surgery, the injured knee joint must be kept at rest. For this purpose, fixing orthopedic products (brace, splint) are used. Chronic use of immobilization braces should be limited to avoid atrophy of the quadriceps femoris muscle.

It is also extremely important to reduce the swelling of the injured knee joint, and, if possible, restore the range of motion in the joint. By the time of surgery, the patient needs to develop the correct gait.

It is allowed to transfer body weight to the injured leg if it does not cause pain. It is recommended to take non-steroidal anti-inflammatory drugs (Nurofen, Ibuprofen, Nais). Duration of use: 7 - 10 days after injury.

It is necessary to achieve full extension in the knee joint by performing the following exercises:

1) Passive extension of the knee joint.

• While sitting on a chair, place your foot on the edge of a stool or chair. Relax your thigh muscles. Allow the knee joint to extend under its own weight.

2) Heel support:

• Place your foot on a rolled up towel.
• Allow your leg to relax into an extension position.
• 3 - 4 times a day for 10 - 15 minutes. See Figure 1

Figure 1. Heel support using a rolled towel.

3) Passive leg extension.

• Lie face down with your feet at the edge of the table. Allow your legs to fully extend.

Figure 2. Passive leg extension. The knee should be outside the edge of the table.

Flexion movements in the knee joint:

1) Passive flexion of the knee joints:

• Sit on the edge of a table and allow your knee joint to bend under the influence of gravity.

2) Use a wall slide to increase the degree of bending.

• Lie on your back, place your injured leg on the wall and allow your leg to crawl down the wall while bending your knee. Use your other leg to apply downward pressure.

Figure 3. Wall sliding

3) Sliding the heel on the table; used to obtain final flexion in the knee joint.

Restoring muscle strength

As soon as the angle of flexion in the knee joint is 100 degrees, you can begin work on restoring muscle strength:

1) Exercise bike.

• Use the exercise bike twice a day for 10 - 20 minutes. See Figure 6

Figure 6. An exercise bike helps restore muscle strength.

2) Swimming is also a very valuable procedure that can be useful in this phase of treatment to restore muscle strength and to maintain range of motion in the joint.

3) Low-impact simulators can also be used for preoperative preparation

This preoperative rehabilitation program should continue until you have achieved full range of motion in the joint and regained muscle strength in the lower extremities (you should not walk with a limp).

Prepare yourself mentally

• You need to decide what you expect from the operation.
• Discuss postoperative rehabilitation methods with your doctor in advance.
• Arrange with family and/or friends to help during post-operative treatment
• Read and work through all the stages of post-operative rehabilitation

After operation:

In the operating room, your knee joint will be immobilized with a brace or plaster splint to rest in the knee extension position.

In the ward, an ice pack is placed on the knee joint, which will subsequently reduce pain and swelling in the postoperative period.

Postoperative immobilization of the knee joint is very important to help control pain and swelling in the joint area.

Extract:

It is performed from 4 to 12 days after surgery. Arrange in advance for transportation to your home. Driving is not permitted at this stage.

Postoperative rehabilitation (Day 1 – 14)

1) Watch for swelling. Place the limb in an elevated position. It is possible to apply cold to the knee joint. You are allowed to get up and walk, but the rest of the time you must remain in bed.

2) Do not sit for long periods of time with your leg down as this will cause significant swelling of the knee joint and the entire limb. If you have to sit for a long time, you need to elevate the operated limb (put it in front of you on a chair)

3) It is necessary to take anti-inflammatory and analgesic drugs to relieve pain.

4) As soon as the pain and swelling decrease, you can begin to walk on crutches.

The brace must be worn for up to 6 weeks from the date of surgery. Angle of flexion in the orthosis for this period: 0-10°

Early development of movements and extension at the joint

1) Passive knee extension using a rolled towel. The towel should be large enough to lift your shin and thigh off the table. See Figure 1.

• Remove the knee brace every 2 to 3 hours to perform activities
• Allow the knee to passively fully extend for 10 to 15 minutes. In this case, it is necessary to completely relax the muscles of the thigh and lower leg.

This exercise can also be done while sitting on a chair. While holding your heel with your healthy leg, you should try to fully straighten the knee joint.

2) Active extension can be done using the healthy leg. Excessive hyperextension of the joint must be avoided. See Figure 7:

Figure 7. Use your unaffected leg to extend your knee joint.

Exercises targeting the quadriceps femoris muscle

1) Isometric contractions of the thigh muscles should begin as early as possible

• Do 10 exercises 3 times a day.
• Each contraction should last about 6 seconds.

This exercise helps prevent atrophy and contracture of the quadriceps muscle, reduce swelling and the amount of fluid in the knee joint.

2) Start straight leg raises in a brace (10 exercises 3 times a day). Do these exercises while lying down.

• This exercise is performed sequentially by first contracting the quadriceps femoris muscle while the knee is fully extended. Contraction of the quadriceps “locks” the knee joint and prevents excessive stress on the installed graft.
• The leg remains in an extended position and is raised at an angle of approximately 45-60 degrees and held for about 6 seconds.
• The leg is then slowly lowered back onto the bed. The muscles relax.

REMEMBER TO RELAX YOUR MUSCLES EACH TIME YOU LOW YOUR LEG

This exercise can be performed without a brace when the patient is able to lift the operated leg. Once you feel confident, this exercise can be performed in a sitting position. See Figure 9

Figure 9. Straight leg raise (left in a lying position), in a sitting position (right)

For patients who have had ACL reconstruction using inner thigh tendons, it is very important to avoid overstretching the hamstrings for the first 6 weeks after surgery.

• The hamstrings take approximately 6 weeks to recover; excessive tension during this period can lead to persistent pain in this area in the long term.
• Unintentional muscle strain usually occurs when bending excessively forward, putting on socks or shoes, or picking up objects from the floor.

Postoperative rehabilitation (3-4 weeks)

Full extension at the joint

1) Continue the exercises with full, passive extension of the joint. Active flexion, active extension, isometric quadriceps exercises, and straight leg raises are also necessary.

2) Flexion at the knee joint up to 60 degrees

Restoring muscle strength:

1) Partial squatting.

• Feet shoulder-width apart with feet slightly turned outward
• Use a table for support and gradually squat and stand up slowly.
• Hold in extreme positions for 6 seconds.
• Do the exercise 3 times a day for 10 squats.

Figure 10. Partial squats using a support table.

2) Lifting on your toes.

• Using a table for support, slowly lift your heel off the floor.
• Hold for 6 seconds, then slowly lower back onto your heels.
• Do the exercise 3 times a day for 10 lifts.

Figure 11. Toe raise

3) Continue to use the orthosis while walking, even if you have developed sufficient muscle strength. This will protect your graft.

4) Walk with crutches, placing your full body weight on your leg. It is necessary to practice a normal gait with a roll of the foot.

5) You can continue to use the exercise bike, which is an excellent tool for restoring quadriceps strength. See Figure 6

• The distance to the pedal should be such that the knee joint is in a position of slight flexion.
• There should be no resistance. Maintain good posture throughout the exercise.
• Once your pedaling ability improves, you can begin to increase the resistance (about 5-6 weeks).
• Your goal is to slowly increase the time spent on the machine (starting at 5 minutes, gradually increasing the time to 20 minutes)
• The resistance should increase so that by the time you finish the exercise you feel tired in your muscles.

THE BIKE IS ONE OF THE SAFEST EXERCISES YOU CAN USE TO REHABILITATE YOUR KNEE. THERE IS NO LIMITATION ON ITS USE.

Postoperative rehabilitation (5-6 weeks)

1) Passive flexion of the knee joint up to 90 degrees. (See Figure 8 below)

• Sit on the edge of a bed or table and allow the knee joint to flex passively, using the opposite leg to measure the amount of flexion in the joint.
• This exercise should be performed 4 to 6 times a day for 10 minutes. It is very important to achieve at least 90 degrees of passive flexion 35 to 40 days after surgery.

Figure 8. Passive flexion under gravity allows knee flexion to 90 degrees.

2) It is necessary to add an exercise - “sliding along the wall” (see Figure 3) and pulling up the heels with the help of your hands in a lying position to increase your range of motion in the joint.

3) Continue with isometric quadriceps exercises and straight leg raises (see Figure 9).

4) Squatting, toe raises (see Figure 10 and Figure 11).

5) If you are assigned to a sports and fitness center or gym, you can start working on the following equipment:

Postoperative rehabilitation (7-8 weeks)

1) Expected range of motion should be from full extension to 125 degrees. Begin curling with a load.

2) Continue doing all the previously described exercises.

3) Exercises to maintain body balance (helps restore spatial sensitivity of the knee joint)

Postoperative rehabilitation (9-12)

By 9-12 weeks, the range of motion in the knee joint should be full.

1) Continue doing all the previously described exercises.

2) Exercises on a simulator for the muscles of the posterior thigh. Correlate the load with the pain. If pain occurs, reduce the load.

3) Continue exercises to restore body balance.

4) Continue exercising in the swimming pool.

5) Start exercising on the treadmill.

MOUNTAIN BIKE RIDING OR ROCK CLIMBING IS PROHIBITED!

Postoperative rehabilitation (week 12-20)

1) From week 12, increase the intensity of exercise.

2) Start running, gradually increase the duration and distance

Postoperative rehabilitation (6 months)

This is the earliest time you can return to full sports activities.

To resume sports activities, you need:

• Restore quadriceps muscle strength to at least 80% of the healthy leg
• Restore hamstring muscle strength to at least 80% of the healthy leg
• Restore full range of motion in the joint
• No swelling
• Satisfactory stability in the joint
• Complete the rehabilitation program

Visual rehabilitation program. A complete rehabilitation program and recovery course after anterior cruciate ligament surgery.

1st week

Immobilization	Permanent fixation of the knee joint with an orthosis in the extension position.
Movement	Walking with crutches.
It is allowed to place the operated leg on the floor and maintain a sense of support.
Treatment	During the first 24 hours, a thin drain (tube) may be placed in the cavity of the knee joint to drain fluid. Removed when dressing. Next, joint punctures are possible to remove excess fluid.
Medicines	Pain relief – Ketonal IM as needed. Antibiotic prophylaxis – Amoxiclav 1000 mg 2 times a day orally.
Physiotherapy	Topical application of cryotherapy or ice pack for 20 minutes up to 5 times a day.
Exercises

2nd week

Immobilization	The knee joint orthosis is in extension at night; flexion up to 15 degrees is allowed during the day.
Movement	Walking up stairs with crutches.
It is allowed to place the operated leg on the floor, the feeling of support is 20 - 30 percent.
Treatment	Surgeon's check-up. Joint punctures are possible to remove excess fluid. Removal of sutures 8-10 days after surgery. Dressings. Prevention of thromboembolic complications - elastic stockings on the legs at all times.
Medicines	Prevention of thromboembolic complications - Xarelto 10 mg tablets once a day or Prodaxa 150 mg once a day. Pain relief – Ketonal tablets as needed.
Physiotherapy	Topical application of cryotherapy or an ice pack for 20 minutes after exercise. Magnetotherapy.
Exercises	Movements in the hip joint. Movements in the ankle joint. Active flexion and passive extension of the knee joint up to 30 degrees with the heel resting on the surface of the bed. Mobilization of the kneecap - move the patella with your hands to the right and left and up and down, a series of 10 - 20 repetitions 3 - 4 times a day.

3-4th week

Immobilization	The knee joint orthosis is in extension at night; flexion up to 30 degrees is allowed during the day.
Movement	Walking with the help of crutches or a cane with an armrest.
It is allowed to place the operated leg on the floor, with a load of 50% of body weight.
Treatment	Possible punctures joint to remove excess liquid. Swelling and pain in the joint decrease significantly in the morning. If the pain and swelling are quite severe, then it is necessary to reduce the load on the joint. Use non-steroidal anti-inflammatory drugs. Prevention of thromboembolic complications - elastic stockings on the legs at all times.
Medicines	Prevention of thromboembolic complications - Xarelto 10 mg tablets once a day or Prodaxa 150 mg once a day. Venotonics – Lyoton gel locally.
Physiotherapy	Magnetotherapy. Lymphatic drainage massage.
Exercises	Movements in the hip joint. Movements in the ankle joint. Active flexion and passive extension in knee joint up to 60 degrees with your heel resting on the surface of the bed. Mobilization of the kneecap - move the patella with your hands to the right and left and up and down, a series of 10-20 repetitions 3-4 times a day.

5-6th week

Immobilization	Knee brace while walking, bending up to 30 degrees is allowed.
Movement	Walking with the help of the 1st Canadian cane with an armrest.
It is allowed to place the operated leg under body weight.
Treatment	With excessive load in joint Pain and swelling may occur. In this case, it is necessary to reduce the load. Use non-steroidal anti-inflammatory drugs. It is possible to conduct a course of intra-articular administration of hyaluronic acid preparations (lubricants).
Medicines	Venotonics - Lyoton gel topically if swelling of the legs persists.
Physiotherapy	Topical application of an ice pack for 20 minutes after exercise. Lymphatic drainage massage. Electrical stimulation of the muscles of the thigh and lower leg, the use of portable myostimulators is possible.
Exercises	Mechanotherapy using the ARTROMOT® device with an amplitude of up to 60 degrees. Half squats up to 30 degrees.

7-8th week

Immobilization	Orthosis for the knee joint while walking, flexion up to 60 degrees is allowed.
Movement	Walking without additional support for limited distances.
Full. Periodic rest.
Treatment	Control inspection. If there is excessive stress in the joint, pain and swelling may occur. In this case, it is necessary to reduce the load. Use non-steroidal anti-inflammatory drugs. It is possible to conduct a course of intra-articular administration of hyaluronic acid preparations.
Medicines	The use of chondroprotectors according to individual indications.
Physiotherapy	Local application of cryotherapy or an ice pack for 20 minutes after exercise. Firming and toning massage. Electrical stimulation of the muscles of the thigh and lower leg, the use of portable myostimulators is possible.
Exercises	Mechanotherapy using the ARTROMOT® device with an amplitude of up to 90 degrees or more. Movements in the hip joint with an elastic bandage. Movements in the ankle joint with an elastic bandage. Active flexion and extension of the knee joint up to 60 degrees with the heel resting on the surface of the bed. Half squats up to 60 degrees.

9-12th week

Immobilization	Lightweight knee orthosis for walking.
Movement	Walking without additional support.
Full. Periodic rest.
Treatment
Medicines
Physiotherapy	Local application of cryotherapy or an ice pack for 20 minutes after exercise. Firming and toning massage. Electrical stimulation of the muscles of the thigh and lower leg, the use of portable myostimulators is possible.
Exercises	Mechanotherapy using the ARTROMOT® device with full range of motion. Movements in the hip joint with an elastic bandage. Movements in the ankle joint with an elastic bandage. Classes on an exercise bike 20 - 40 watts, step machine. Half squats up to 90 degrees without additional weighting. Exercises to stabilize joints and restore proprioception, i.e. "joint feeling" on inflatable and rubber hemispheres with caution. Classes in a swimming pool with a closed circuit of motion of the knee joint.

3-6 months

Immobilization	Lightweight orthosis for the knee joint during high loads.
Movement	Anything except shuttle running, cross-country running, outdoor and team games.
Full. Periodic rest and relaxation of the muscles of the limb.
Treatment	If there is excessive stress in the joint, pain and swelling may occur. In this case, it is necessary to reduce the load. Use non-steroidal anti-inflammatory drugs.
Medicines	Continued use of chondroprotectors according to individual indications.
Physiotherapy	Local application of cryotherapy or an ice pack for 20 minutes after exercise. Firming, toning, sports massage.
Exercises	Movements in the hip joint with an elastic bandage. Movements in the ankle joint with an elastic bandage. Classes on an exercise bike 40-60 watts, step machine. Half squats up to 90 degrees with additional load. Joint stabilization exercises and restoration of proprioception i.e. " joint feeling» on inflatable and rubber hemispheres. Complex coordination exercises. Classes in the pool with an open circuit of motion of the knee joint. Treadmill.

After 6 months

Immobilization	Special sports orthosis for the knee joint during professional activity.
Movement	No limits.
Start of sports training according to an individual program under the supervision of a specialist.
Treatment	Depends on a situation.
Medicines	Depends on a situation.
Physiotherapy	Firming, toning, sports massage.
Exercises	Classes on an exercise bike 60-100 watts, step machine. Restoration of complex coordination movements. Classes in the pool with an open circuit of motion of the knee joint. Treadmill.

1st stage of rehabilitation

So, after achieving certain results, restoration procedures move to the next “level”. On average, the process takes about six months (24 weeks).

During the first stage, which lasts for four weeks, the main goal is to minimize the patient's pain, as well as swelling in the joint. In addition, thanks to the procedures performed, it is possible to restore control over the hip muscles, and then improve proprioception of the joint, increasing the passive range of its movements.

Usually, after completing this stage, the patient can already move without crutches.

It is worth noting that after surgical intervention in the ACL, the process of “switching on” the inner part of the quadriceps femoris muscle is extremely difficult. This is a logical result of the atrophy that took place before the reconstruction. We should not forget that surgical trauma and, accordingly, subsequent immobilization have a negative impact.

To restore optimal sensitivity of the medial head of this femoral muscle, specialists prescribe electrical stimulation and massage. It has a positive effect on peripheral blood circulation and increases muscle contractility.

To achieve the best results, almost all patients are prescribed a course of general strengthening physical exercises.

2nd stage of rehabilitation

The decision to move to the second stage rehabilitation accepted on the basis of the results achieved during the first 4 weeks, and only if the goals set by the doctor were successfully implemented.

Starting approximately from the fourth week, a set of measures is taken to completely eliminate swelling, as well as restore the full range of motion. At the same time, no less important tasks are:

• improving thigh muscle strength;
• improving proprioception of the joint, as well as its balance;
• achieving stability, i.e. control, while walking.

It is necessary to understand the fact that the most difficult and at the same time important period is the period associated with the restoration of normal functions of the operated limbs, which takes about 4 months. And in this case, the fact that the following must be restored is taken into account:

• range of motion;
• endurance and muscle strength;
• support of the injured leg.

The most significant at this stage is therapeutic exercises, which includes traditional and aquatic exercise, or more precisely, exercises that improve mobility knee joint, stability of the extensor apparatus, etc.

In addition, patients are prescribed a course of massage (manual and underwater) and intense electrical stimulation.

3-4th stage of rehabilitation

Third stage recovery is to increase strength, endurance and muscle power without the patient experiencing pain. The decisive criterion is also the complete restoration of functional activity, including the ability to jog.

In progress rehabilitation the patient is recommended to perform self-help exercises, including lunges, squats, etc. Gradually, there is a transition to dynamic loads using various modern exercise machines: rowing machines, treadmills and many others.

At the next stage, the patient’s main task becomes recovery full range of active movements. At the same time, in the process of performing physical activity, swelling should not occur in the leg, pain should not be acceptable, and the maximum degree of endurance and strength should be demonstrated.

Experts pay special attention to the state of neuromuscular coordination.

As a rule, the pre-training period takes about six months, during which measures are taken aimed at restoring muscle strength and endurance, both under prolonged static and dynamic loads.

Patients during this period rehabilitation apply exercises with a vertical load on the injured leg, while gradually complicating locomotion, including:

• lunges;
• running at a slow pace in a straight line;
• walking on toes;
• cycling, etc.

5th stage of rehabilitation

If the fourth stage gave appropriate results, then the patient moves on to the fifth, i.e. final stage recovery.

In this case, it is necessary to “add” functional testing of concentric, isokinetic, as well as eccentric, peak and average torque in relation to the quadriceps and hamstring muscles to the already achieved goals.

The optimal result is one in which this parameter corresponds at least 90% to the parameters of the other, healthy leg.

This recovery stage involves drawing up an individual training program aimed at restoring the patient’s technical and tactical sports skills.

During the recovery process, the patient’s agility, endurance, as well as strength and speed are tested, which makes it possible to determine his readiness to return to his usual rhythm of life.

Specialists evaluate how successful the treatment was by monitoring the stability of the injured person. knee joint during jumping and running, as well as the ability to withstand functional loads. The doctor diagnoses the presence or absence of synovitis, pain in the damaged joint, as well as the condition of the quadriceps femoris muscle.

To confirm the conclusions made by a specialist, biomechanical, radiographic and electrophysiological studies are carried out.

Every year, millions of patients around the world undergo reconstruction of anterior cruciate ligament injuries. The surgical technique of anterior cruciate ligament reconstruction is a standard procedure in most cases. With adequate technical equipment, sufficient qualifications and conscientiousness of the surgeon, performing such an operation does not pose a big problem. However, surgery is only one of the “three pillars” that ensure a good outcome of the entire recovery process after an anterior cruciate ligament rupture. The other two are preparation for surgery and post-operative rehabilitation.

One of the important stages of recovery after anterior cruciate ligament injury is the preoperative period.

One of the complications of surgical treatment of anterior cruciate ligament ruptures is the limitation of the range of motion (contracture) of the joint, especially extension. Loss of extension results in quadriceps muscle wasting and constant pain in the anterior knee joint. Scientific studies have shown that the development of such complications is highly dependent on the preoperative condition of the knee joint. The greatest risk of developing such complications occurs if surgery is performed on an inflamed knee joint.

Therapeutic massage of the knee joint demonstration video

Start from the second week after surgery.

What is important is not the timing after the injury, but the condition of the knee joint at the time of surgery.

Therefore, to properly prepare for surgery, the following steps must be taken.

Immobilization of the knee (immobilization)

After an injury, it is necessary to put an immobilizer (brace) on the knee joint. The load on the leg should be limited. This is achieved with the help of crutches. It is necessary to step on the foot with such force that it does not cause pain.

Anti-inflammatory treatment.

To reduce pain and swelling, apply ice compresses to the knee joint for 10 to 15 minutes 4 times a day. You can use a bag of frozen fruits or vegetables purchased at the supermarket from “improvised” means.

As for medications, the use of anti-inflammatory drugs is indicated, for example arcoxia 90 mg x 1 time per day in the absence of contraindications to taking these medications (see excerpts from the instructions given below). When taking other anti-inflammatory drugs, you must read the instructions.

Restoring the range of motion in the joint.

These exercises should be performed immediately after an injury, if general health allows.

Restoration of extension.

1) Passive extension of the knee joint.

Sit on a chair or chair, place the heel of the injured leg on the edge of the chair or chair opposite (Fig. 1).

Relax your leg muscles.

Allow the knee to sag under its own weight to its maximum possible extension. It is necessary to ensure that the knee does not hyperextend.

Rice. 1. Sagging knee on a chair.

2) Bends at the knee using a folded towel (Fig. 2).

Rice. 2. Sagging of the knee on the bolster.

3) Knee extensions on the edge of the bed while lying on your stomach (Fig. 3).

Rice. 3. Knee extension while lying on your stomach.

Restoring flexion:

1) Passive knee flexion.

Sit on a high chair or bed. Relax your leg muscles. Allow your knee to bend under its own weight (Figure 4).

Rice. 4. Bend the knee under its own weight.

2) Sliding along the wall (Fig. 5).

Lie on your back. Place the foot of your injured leg on the wall in front of you. Bend your knee as you slide your foot along the wall. Apply pressure from the healthy leg to increase flexion

Rice. 5. Sliding along the wall surface.

3) Sliding the foot along the surface.

Bend your knee, sliding your heel along the surface (floor or bed). Upon reaching the maximum As you bend, hold the position for 5 seconds. Sliding your heel along the surface, straighten your leg at the knee to the maximum possible position, hold for five seconds (Fig. 6).

Rice. 6. Sliding on a horizontal surface.

4) Bend your leg at the knee, as written in exercise 3. When you reach maximum bending, grab your shin with your hand and further bend your knee. Hold for 5 seconds (Fig. 7).

Rice. 7. Help with your hand to increase knee flexion.

Criteria for sufficient preparation for surgery.

1) Complete pain control (no pain at rest and within the limits of permitted loads).

2) Restoring muscle control of the leg (the ability to perform recommended exercises in the recommended volume)

3) No significant swelling.

4) Restoration of full extension and flexion within 120 degrees.

Solving organizational issues.

Each patient needs to resolve a number of organizational issues before undergoing surgery.

1) Familiarize yourself with the plan for the upcoming treatment and its prognosis.

2) Based on the recovery plan and the nature of professional activity, agree on the terms of incapacity at work. Find out about the need to obtain a certificate of incapacity for work (sick leave).

3) Educate family members and/or friends about the amount of assistance that may be required during treatment.

Day of surgery – day 2.

Immediately after the operation, the leg is placed in a splint (brace). The knee joint is covered with ice packs. Ice is applied for 30 minutes with a break of 30 minutes. Before and at the end of the operation, an anesthetic (marcaine or bupivacaine) is injected into the knee joint. These non-toxic drugs block pain receptors and can significantly reduce the amount of medications needed for pain relief. However, pain sensitivity varies from person to person. Therefore, if pain in the knee joint increases, medical personnel should be informed.

After removing anesthesia drugs from the body, stabilizing the general condition and reducing pain, the patient can be discharged from the hospital. This usually happens on the second day after surgery. It should be remembered that after such an operation, patients cannot drive a car independently. Therefore, you should arrange transportation in advance.

After discharge.

3 – 14 days after surgery.

Prevent swelling and pain.

1) After discharge from the hospital, you should remain in bed for 2 days. At this time, you need to be in a splint with your leg elevated (your leg should be above chest level). You can move around as needed (for meals or hygiene procedures), but the rest of the time your leg should be kept in an elevated position.

2) Don't lower your leg unless necessary. This leads to swelling of the knee joint and lower leg. If it is necessary to sit to perform any work, the leg should be placed on a chair or stand, giving it an elevated position.

3) To relieve pain and reduce swelling, you must take the medications recommended upon discharge. If they are not enough, you should contact your doctor.

4) As pain and swelling decrease, you can increase your activity and spend more time sitting.

5) The most effective way to prevent swelling of the knee joint is to unload the knee joint. Therefore, if pain or swelling in a joint increases, you should transfer most of your body weight to crutches.

Exercise regimen, dressings and hygiene procedures.

1) If you have the opportunity to exercise on an exercise bike, this can be done by adjusting the position of the seat to adapt it to the amount of bending at the knee (raise it higher first). The minimum load should be applied, the main effort to pedal should be made with the healthy leg, the operated leg should only “follow” the pedal.

2) Upon discharge, skin wounds are sealed with a special plaster in which you can shower. However, its protection is not enough for taking a bath. Therefore, if necessary, the leg should be placed in a plastic bag. The wound is not allowed to get wet until the sutures are removed (usually on the 14th day after surgery). To shower safely, do the following:

Place a towel on the bathroom floor to prevent crutches from slipping on wet tiles

Enter the shower stall in a tire

Unfasten the tire

Take a shower

Wipe your foot dry

Put on the tire

Get out of the cabin.

3) Typically, patients who live in the Kyiv region should come for examination a week after surgery, and for suture removal - after 2 weeks. Nonresident patients can have sutures removed at their place of residence and appear for a follow-up examination 1 month after surgery.

Recovery program after anterior cruciate ligament surgery.

Early restoration of range of motion.

1) Restoration of extension.

Passive extension of the knee joint (Fig. 1).

Sit on a chair or armchair, place the heel of the injured leg on the edge of the chair or armchair opposite

Relax your leg muscles

Allow the knee to sag under its own weight to its maximum possible extension.

Carry out the exercise 3 – 4 times a day for 10 – 15 minutes

Alternatively you can do:

bending the knee using a folded towel (Fig. 2).

2) Passive knee flexion up to 90 degrees (Fig. 4).

Sit on the edge of a bed or table and allow your knee to gently bend to a 90-degree angle.

The unaffected leg can be used to support and control the amount of flexion. Unlike the previously described exercise, it is necessary to straighten the leg by contracting the muscles of the operated and healthy leg.

This exercise should be performed 4 to 6 times a day for 10 minutes. It is important to achieve 90 degrees of flexion in the first 7 days after surgery.

Strengthening the quadriceps muscle.

1) Tension of the quadriceps muscle without movement in the knee joint (isometric contraction) must be started immediately after surgery, as soon as physically possible (Fig. 8).

You need to do 3 sets of 10 contractions 3 times a day. Each muscle contraction should be held for a count of 6.

Rice. 8. Isometric tension of the quadriceps muscle.

2) Raising the leg in the splint. While lying on your back, tighten your quadriceps muscle, raise your leg to an angle of 45 - 60 degrees, hold for a count of 6. Smoothly lower your leg, be sure to relax your muscles. Repeat from the beginning. Perform 8 repetitions 3 times a day (Fig. 9).

Rice. 9. Straight leg raise.

As soon as muscle strength allows, the exercise can be performed sitting or standing.

Exercises for the back groupmuscle mass

Patients who have undergone anterior cruciate ligament repair of the gracilis and semitendinosus tendons should avoid excessive stretching of the hamstrings for 6 weeks after surgery. This period is required for their final healing.

Uncontrolled stretching of these muscles occurs when bending forward and trying to pick something up from the floor (or put on socks or shoes). Therefore, caution should be used when performing such movements.

13 - 15 days after surgery (suture removal)

1) Control examination for suture removal (in the office or at your place of residence).

After the stitches are removed, you can shower and bathe without protecting your wounds with a bandage or bag. To improve the condition of skin scars, it is recommended to use an oil solution of vitamin E 3 weeks after surgery. Postoperative scars must also be protected from direct sunlight for a year after surgery.

Return to work

If your job is of an office type, which requires you to be primarily at a desk, you can return to it 7 to 10 days after surgery, provided you can confidently move on crutches and have a safe route to your place of work.

Patients whose work involves physical activity (builders, workers, security guards, etc.) should not begin performing their duties earlier than 8 weeks (decided individually in each case).

Third week after surgery

Therapeutic massage of the knee joint with mobilization demonstration video.

Continue isometric contractions of the quadriceps muscle, raising the leg in the splint, passive flexion with active extension as described above. It is necessary to achieve 90 - 100 degrees of flexion.

Development of muscle strength.

1) Mini squats.

Place your feet shoulder-width apart and place a stable chair behind you for belay.

Holding onto a table or wall, perform squats as if you were trying to sit down on a chair.

Perform squats until pain occurs in your knee, without touching the chair, hold for 6 seconds, straighten up and repeat again.

Do 3 sets of 10 repetitions daily (Fig. 10).

Rice. 10. Mini squats.

2) Calf raises.

Holding onto the edge of the table or wall, carefully stand on your toes. Hold on your toes for 6 seconds, then smoothly place your heels on the floor. Do 3 sets of 10 repetitions daily (Fig. 11).

Rice. 11. Raises on toes.

3) Continue to use the splint while walking.

4) You can refuse crutches if you return to normal walking without lameness.

5) Continue exercising on the exercise bike.

WITHgoeshould be installed in such a way thatsin the lowest position of the pedal the stop is completelywas in contact with her, and the knee was slightly bent.

Use level 1 load, maintain correct posture when performingexercises.

5–6 weeks after surgery, the load on the exercise machine can be gradually increased as tolerated. The degree of increase in load can be controlled by the condition of the quadriceps femoris muscle at the end of the session. When properly loaded, a “burning” sensation occurs in the muscle.

The duration of exercises on an exercise bike should be gradually increased from 5 to 20 minutes.

4 weeks after surgery

During this period, the range of motion in the knee should be achieved from full extension to 100 - 120 degrees of flexion. Flexion should be developed with the exercise “sliding along the wall” (Fig. 5) and/or bending with the hand (Fig. 7).

Continue isometric contractions of the quadriceps muscle (Fig. 8) and straight leg raise (Fig. 9).

Continue mini-squats and calf raises (Fig. 10, Fig. 11).

If you visit a fitness club, you can exercise on the following machines:

Exercise bike. The saddle position should be such that the knee does not extend or bend excessively.Load - as tolerated. You should exercise 15 – 20 minutes a day.

Elliptical trainer (orbitrack)15 — 20 minutes a day.

Trainer forleg pressin a sitting position.

Exercise machine for the posterior thigh muscles in a sitting position. Attention. If the anterior cruciate ligament reconstruction was performed using a graft from the tendons of the gracilis and semitendinosus muscles,DannsExercises should begin no earlier than 8 to 10 weeks after surgery.

Lovese training apparatus s for the upper part of the bodywith a starting position sitting. The use of free weights is prohibited until 8 weeks after surgery.

Swimming: walking in the pool, jogging in the water, straight leg swings. Don't dive off the side swimming without using your legs until 6 weeks after surgery.

5 – 6 weeks after surgery

1) The range of motion should be achieved from full extension to 125 degrees of flexion.

2) Continue with mini squats, calf raises, straight leg raises, stationary bike or elliptical machine, seated leg press, seated knee curls.

3) Coordination exercises. Performed on a balancing board or balancing platform.

6 – 12 weeks after surgery

By 6 weeks after surgery, the range of motion in the knee joint should be from full extension to at least 135 degrees of flexion.

1) Continue with mini squats, calf raises, straight leg raises, stationary bike or elliptical machine, seated leg press, seated knee curls.

2) Continue coordination exercises. Performed on a balancing board or balancing platform.

3) Patients who have undergone ACL reconstruction using the gracilis and/or semitendinosus tendons can begin performing leg curl exercises in a seated position. The load should be chosen so that after exercise you do not feel pain in the back of the thigh.

Such patients are prohibited from using leg curl machines while lying on their stomach, since they apply increased stress and excessive stretching to the muscles of the posterior thigh, which can lead to their tearing.

4) Continue with the swimming program. You can swim using your legs.

5) Start fast walking on level ground (stadium).

6) Riding a bicycle on a flat road. Driving on rough terrain is prohibited.

12 – 20 week after surgery.

1) Continue all exercises for 6 – 12 weeks.

2) Start jogging and move on to fast running as tolerated.

3) You can start accelerating, zigzag, running with side steps.

6 months after surgery.

The period of time when you can return to sports activities.

Criteria for returning to sport

Quadriceps strength: at least 80% of the healthy leg

Knee flexor strength of at least 80% of the healthy leg

Full range of motion

No swelling

Good stability

Ability to work in a general group

“The best operation is the one that was avoided” - Nikolai Pirogov. But it happens that either you “ran” for too long, or in principle you couldn’t “run”/“escape”. This is exactly the situation I found myself in a little over a year ago, when, in the literal sense of the word, I crawled to the surgeon with a request to get rid of constant pain in my knee. For almost 12 years I was treated conservatively. Successfully, I limited myself to almost nothing - you can get used to everything. But the old sore took me by surprise and did not give me any more chance to choose. Surgery in 3 days and...

Next, I must make an obligatory remark. Everything written below is subjectively my personal opinion and my situation. In medicine, almost no cases are the same. All, even the most standard, diseases are purely individual. That is why I will often use the words: “almost”, “probably”, “most likely”, “often”, “happens”, etc. Then why am I writing about this? I had no choice, but what if I had one? Based on my experience, the stories of friends and those who went through this journey with me in clinics, I made a clear conclusion for myself - there are almost no operations without complications. Probably, it cannot be in principle. The only problem is that doctors (surgeons) don’t talk about it, and if they do, it’s in passing. Yes, they can talk for hours about the methods of performing the operation, about history, about statistics, about details. But at least about complications and side effects, and if they say anything, then only about the main or mandatory ones, or about those that occur in more than 60% of patients. But there is also another 40%. All this against the backdrop of terrible stress and pain, which has an even stronger impact on the understanding of what is happening. As one geektimes article rightly noted, quote: “Like most surgeons, they lost interest immediately after the operation was declared a success.” As a result, the patient often encounters complications not only immediately after surgery, but often later, having already forgotten about the illness.

Surgical intervention itself, as it turns out, is not such a large percentage of the success of recovery. No, of course, everything depends 99% on the hands of the surgeon. But there is also anesthesia/anesthesia, rehabilitation, medication courses, exercise therapy, physiotherapy, diet/daily regimen and much more. Do you have any complaints about the buttons? No - then it’s not really a matter for the surgeon. This article is not about surgery or even about medicine in the scientific sense of the word. And about the fact that I want doctors to open their mouths more often and explain to the patient all the possible risks and complications. This may not be particularly important for them, the masters of this jewelry business. This is important for us, patients, because we want to know what awaits us not only during the operation, but also before and after. And there will be various problems: I repeat - there are practically no operations without complications. But first things first.

I have never been a professional athlete, but my entire childhood was spent at the stadium, where the whole neighborhood kicked the ball into a makeshift goal made from briefcases. During my school years, as a student, I couldn’t live without playing. He played several times a week: for the student team in football, for the amateur team in hockey. Despite the old equipment or even partial lack of it, I managed to get away with bruises or minor microtraumas. Until he reached his sharply swollen right knee. In those days, MRI diagnostics, which we are now accustomed to, were not yet widespread. Maximum x-ray, examination and the words of the regional traumatologist like “he will heal before the wedding.” Next was a partially homemade orthosis on hinges. I played actively for another 2.5 years. Then the orthosis stopped helping. Thanks to good people, I was able to arrange a consultation with a doctor at a professional club, where I was diagnosed with an ACL rupture, and they were wide-eyed and amazed at how I was able to play all this time. In Russia at that time they did not do artoroscopy, but only full opening of the joint, and naturally, as a student, I did not have money for Germany. Then the solution was conservative treatment. Yes, I had to stop with sports, but I lived a normal life for a long time until one rainy evening the problem returned. Repeated conservative treatment (which I insisted on) did not help, and as it turned out later, it could not help.

Now, in 2016, arthroscopy is the gold standard for meniscal surgery or knee ligament surgery. Not at all what it was in 2003. Now this is a minimally invasive procedure, with a minimum of stitches. And the prices are not particularly steep. I will not dwell on the issue of choosing a clinic and surgeon - this is not so important in this story and is purely individual. Everyone I met said about the same thing - everything would be relatively easy, I’d go home in 3-4 days, and in 3-4 weeks I’d be walking, albeit with crutches. After 3-4 months - swim and run. In six months I’ll be as good as new, and in a year, “I’ll be able to play the piano, although I couldn’t before.” Important! Now a year has passed since the 1st operation. In fact, I actually already run, play ping-pong and even swim. I go to the fitness club. But then I had no idea and did not understand how thorny this path was. How often will you have to go through pain and fear, experience complications and get side effects? This is exactly what I was not particularly warned about (or emphasized). As it turns out, there are many little things that I would like to know about BEFORE, and not AFTER.

It all starts with collecting tests for admission to the hospital. Depending on what is required, the complications here concern mostly the wallet. If you don’t use a free clinic (and they don’t do all the tests and procedures), then the total amount can turn out to be decent. This is important because before taking the tests, the cost of the operation and hospital stay is already known, but these additional costs came as an unpleasant surprise. The night before the operation and preparation for it are also not the most pleasant procedures, but clearly not the worst.

But then comes the first thing you need to think about - anesthesia/anesthesia. A conversation with the anesthesiologist the day before the operation is mostly information for him (type of anesthesia, choice of drugs, doses, etc.) so that everything goes safely. Yes, he will tell you about what will happen and how it will happen, what “could go wrong.” But again, not in full. They won’t always tell you what you can and can’t do that day or the next day. Figuratively speaking, 99% of operations with this type of anesthesia (in my case, spinal injection) go well. But somehow I don’t want to fall into this negative 1%. The same spinal injection gives complications (and not even at the injection site) immediately after the procedure or long after. And it is not always clear that the illness that appears after 3-4 months is a consequence of anesthesia, how to react to it and how to deal with it. I was lucky, both operations went almost well from the point of anesthesia. Although I still remember with a shudder how difficult it was to breathe on the operating table during the 2nd operation (the anesthesia in the back was lower the 1st time, and higher the second time). But in fact, for another month or two there were slight dizziness and neurological pain for no apparent reason. And after 6 months, vision problems appeared. Is there a connection with anesthesia - no doctor can answer either yes or no, but the fact that after 2 spinal anesthesia there is a drop in immunity and an imbalance in body functions is a fact, even if I cannot prove it.

The second is the pain after. The ACL plastic surgery itself was successful. The process took about 1.5 hours. In theory, the worst is over. In theory. In fact, when the spinal cord came off, the pain came. But not “bad” pain, but “good” pain is a sign that this is the first step towards recovery. But the fact that she was “good” did not change the fact that her knee was bursting and it ached for several days in a row, 24 hours a day. Yes, the hospital nurses did an excellent job: they did all the necessary procedures and injections. I am very grateful to them for this. And from the third day, when the bandages were removed and a special orthosis was put on (also an expensive pleasure), it was necessary to ALREADY start doing some light exercises. In addition to the pain inside the knee, pain from the stitches was added (the orthosis was attached next to the stitch and put pressure on it). On the 5th day I was already at home. But at home, of course, there are no drugs that are injected in the hospital under the supervision of doctors. You say - how could you want without pain? I will answer - I understood that it would happen and that I had to go through it. But, I wanted to know or hear about this from pre-doctors.

Third - compensatory. This is a very important point that is often forgotten. But it was because of this that I ended up having a second arthroscopic surgery on the other leg. It's funny, but few people think about such things BEFORE. And I don't mean household inconveniences. In fact, I was on crutches for a month. Accordingly, the functions of the right leg were distributed between two arms and a healthy left leg. But again, this did not always work out and the load on the healthy leg increased several times. No, the knee where the ACL plastic surgery was done is healing and in perfect order, but the lifestyle that changed while I was on crutches took a toll on my then healthy leg, arms, and back. As a result, I suffered a torn meniscus on my healthy leg with not the most complex movements. Most likely, I tore through the trauma of my youth. But if I had not had to live on one leg, perhaps this would not have happened. In fact, compensation is not only a problem in traumatology. Based on the stories of my friends, I can say that those who have had operations, for example, on the eyes or undergone chemotherapy courses, have an essentially similar problem. No, compensation is again not a contraindication against surgery and is not the main factor in decision-making. You will say that this is all clear and logical, that I’m stupid. Agree. But! I was lucky that I had never walked on crutches before and had no idea about these problems. And this is logical if this problem is “based on someone else’s experience.” But when everything is upside down, it hurts and your brain is still dull, then such problems creep to the fore and really interfere. The worldview even changes a little. For example, I realized how inconvenient cities are for people with disabilities...

Fourth - rehabilitation (post-operative courses of pills, etc.). I was warned in advance about rehabilitation. Yes, this is often necessary, and in my case even critical. Accordingly, these periods were included in sick leave and vacation. But I only found out what will be included in this course after the fact. Yes, during this time they put me on my feet, in fact, they taught me to walk again. But as time has shown, this was not enough. A second course of rehabilitation was required. And this again means money, nerves, sick leave... Yes, this point is not directly related to what was left unsaid, but in fact, I’m not the first who was unable to recover within the standard time frame. And if so, then when planning time and money, I would also like to take this into account BEFORE. And another important point. In my case, the knees are being operated on, but the muscles are flying. In the sense that we treat one thing, and treat the other. Yes, this side effect is always present with ACL, but during other operations other organs, for example, those located nearby, may suffer.

Fifth, there are no easy operations. Yes, after the 1st course of rehabilitation, a torn meniscus on the other leg “resurfaced”. Having already gone a certain way, it was decided not to suffer and to operate on the second leg. Moreover, at that time I considered the experience rather positive. After talking with the same surgeon (the details don’t matter), for some reason I got the idea in my head that after ACL plastic surgery, arthroscopy on the meniscus is a trifle. And the conversation with the doctor took not 2 hours, but 30 minutes. A lot was already clear, and it seems like there won’t be much digging and drilling. And home on the third day, and without an orthosis, and without complications - like treating a tooth. This was my key mistake. I emphasize - mine. I didn't ask the right questions. For some reason I thought that the meniscus was a small thing after ACL. And my doctor, who has already performed a thousand operations on the meniscus, did not consider this something terrible. If I had known BEFORE what I know now, I would still have had the second surgery, but later. I would give the body more time to recover and compensate. But what happened was what happened. The operation was again successful. Yes, everything went much easier. I walked on the 2nd day and nothing hurt. But on the 4-5th day side effects began. Not critical, but given the surgical intervention, they almost caused panic. It seems like we went through this circle of hell again, and at the end, if not better, then even worse. No, I have no complaints about the doctor - on the 5th day I asked all these questions and received answers to them. After some time, almost everything went away. The key word is almost. And now it has become clear that this is “almost” - for the entire remainder. Although I am making every effort to make this pass too.

Sixth - relapse or delayed complication. A year has passed. I would estimate my knee condition to be 70-75% of normal. I make up for the rest in the gym. The funny thing is that now the knees are the healthiest part of the body. I mean the joints themselves. Yes, you need to continue to pump up your muscles, continue to do yoga, stretching, etc. But recently a complication emerged after ACL plastic surgery. Not fatal, the likelihood of surgery is very low. So far only injections and physiotherapy. I don’t want to go into details, according to the surgeon, such complications have occurred in the history of modern medicine (arthroscopy) in 3 cases (1 was re-operated). I am 4th. Of course, this is difficult to predict BEFORE, given how many such operations are now performed daily. But from the moment this side effect emerged until the consultation, a couple of days passed, which added more gray hair to me. The problem has been resolved for now. I hope it won’t happen again... I also read that my knees will ache in bad weather, that the crunch will remain, and problems with full bending will not go away either. A whole pot and a glued one are still two different pots. This is important to understand, since miraculous 100% healing or complete disappearance of the problem is still very difficult to achieve. The main thing is that it does not hurt and practically does not interfere with leading a normal lifestyle.

Once again I want to emphasize. The story is private. I was very lucky to have excellent doctors and excellent hospital staff working with me. But even their magical hands and care cannot help given the peculiarities of the body. Yes, I had no choice: I could not help but have surgery. But, if someone has a question about surgery, try to collect more information about it. Information, not even about the procedure itself (they will tell you about it inside and out), but about what is hidden and what doctors so often talk about. There are almost always complications and side effects. They may be more or less pronounced, but they will be there. And it’s better to be prepared for them in advance. If not physically, then at least psychologically. This will help you not only make a decision, but calmly deal with unexpected situations after surgery and, possibly, return to your normal lifestyle faster.