The surgical procedure on the knee joint damages tissue structures. These structures as well as the muscles surrounding the joint are subject to a certain recovery process during post-operative treatment. Medical Training Therapy is the last healing phase of the aftercare but also the longest. Equipment is used here and a progressive increase in load characterizes this therapy.
Aftercare
The inflammatory phase extends from day 1 to day 5 postoperatively and consists of 2 phases. Vascular phase: A number of leukocytes and macrophages enter the tissue. Leukocytes and macrophages are part of the immune system.
Cells in the tissue begin to heal from the injured vascular system in this phase, which causes oxygen-rich blood to enter the tissue, thus increasing the PH level. This triggers the stimulus for further wound healing. Macrophages are responsible for the division of fibroblasts into myofibroblasts, which are necessary for the formation of new cells.
Likewise, the collagen synthesis for collagen type 3 begins, a process that only takes place in the inflammatory phase. Collagen 3 is necessary for wound closure. In these first hours of wound healing, there is hardly any targeted therapy for the operated knee.
The patient is mobilized out of bed, thrombosis prophylaxis and circulation stimulating measures are the most important contents. Cellular phase: Further myofibroblasts are formed and type 3 collagen continues to close the wound. The tissue still has a low load-bearing capacity.
Many sensitive nociceptors are found at the site of the injury, which are particularly sensitive during the course of wound healing. This can prevent overloading of the tissue. Pain is an important warning signal of the body and should be seen as a warning.
For this reason, pain should be adapted in this phase and treated in a tension-free area. The patient may move his knee as far as he can. In addition, it is used to practice standing up and walking on the supports.
As an exercise, the patient is given the opportunity to stretch the hollow of the knee as the first tension of the quadriceps and to bend in the supine position. In the seat, the patient can train the flexion with the help of a cloth on the floor, which facilitates flexion.
- Vascular phase (first 48h)
- Cellular phase (day 2-5)
5th – 21st day.
The actual inflammation should be completed by the end of the inflammatory phase on the 5th day. The number of leukocytes, macrophages and lymphocytes thus decreases again. From approx.
day 14 onwards, only myofibroblasts remain in the new tissue. Decisive in this phase is collagen synthesis and myofibroblast activity to further stabilize the wound. The loading should also take place in the proliferation phase in the painless and tension-free area.
Too early stretching and too intensive mobilisation should still be avoided. The patient will always be able to increase the movement and initial strengthening exercises such as getting up and sitting down from the chair can be included. In addition, a quilting board can be used to train the patient to climb and descend stairs.
It is also important to develop a proper gait pattern already in the healing phase. It is important to make sure that you roll over the entire foot to avoid an unphysiological gait pattern. 21st -360th day.
The fibroblasts multiply and begin to synthesize the basic substance, thus improving the elasticity of the tissue. The newly formed collagen is stabilized and increasingly organized. The collagen fibers become thicker and thus more resilient.
Type 3 collagen fibers are slowly converted into type 1 collagen fibers. Myofibroblasts are no longer needed and disappear from the tissue. Up to the 120th day, collagen synthesis remains highly active and on about the 150th day, 85% of the collagen type 3 has been converted into collagen type 1.
Movements are finally allowed and the load can be increased. The therapy is only complete when the tissue can withstand the stresses of everyday life. Medical Training Therapy is crucial in this phase.
This is where devices are now included. Devices have the advantage that muscles are trained in a targeted and isolated manner and the weight can be reduced or increased depending on the performance level. An adjustable bicycle can be used as a warm-up so that the patient can adjust the possible knee mobility on the bicycle.
The treadmill can be used for gait training as well as for warming up.A trainer should be used on the equipment from the very beginning to avoid incorrect movement sequences. The leg press is one of the most important and unproblematic devices after a knee TEP surgery. It trains the back and front leg muscles.
The weight should be increased slowly and the execution should be axis-compatible. Knee bending machines are also very effective and suitable for everyday use. It is important to pay attention to a proper execution of the knee bend.
The knees remain behind the toes, the buttocks push far back. The costs of medical training therapy are covered by private insurance companies for a certain number of sessions. It is best to ask your treating physician for an estimate of the costs.
Exercises on the stepper to develop a proper gait pattern on the stairs are very important. Exercises can be chosen specifically for the supporting leg by placing the affected leg on top of the stepper and slowly moving the other leg down the step. The eccentric training improves the muscle activity.
Alternating steps up and down ensure strength endurance in the entire leg musculature. The abductor and adductor machines provide stability in the muscles surrounding the knee. Lunges and knee bends can be included in the training plan under supervision.
Exercises on uneven surfaces are very useful for improving the stability of the knee joint when the machine is fully loaded. This includes one-leg stands and coordinative movements of arms and legs. Sports involving jumping and impact loads should be avoided. Sports such as cross-country skiing, swimming and cycling, on the other hand, have a positive effect on the affected knee joint.
