Medical Training Therapy is part of the follow-up treatment for recovery of the knee joint after meniscus surgery. It is characterized by a steady increase in load and a concomitant hypertrophy of the muscle. However, before this load and the associated mobility is reached, the knee joint first goes through several healing phases. This article describes a follow-up treatment for the knee joint after meniscus surgery. More information about Medical Training Therapy can be found in the article MTT Medical Training Therapy.
Aftercare
In the first 5 days postoperatively the inflammatory phase takes place. This is divided into 2 phases. The first 48 hours (vascular phase) are characterized by an invasion of leukocytes and macrophages into the tissue.
Leukocytes and macrophages are part of the immune system. During this period of wound healing, the cells in the tissue begin to damage the vascular system, causing oxygen-rich blood to enter the tissue. This increases the PH level, which in turn 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. During this time, collagen synthesis also begins for collagen type 3, which is only found in the inflammatory phase. Collagen type 3 is primarily required for wound closure and forms the basis for further collagen synthesis.
In the vascular phase there is hardly any targeted therapy. Instead, the patient should be mobilized out of bed and undergo thrombosis prophylaxis and circulation stimulating measures. 2nd – 5th day postoperatively (cellular phase).
At this time, further myofibroblasts are formed and type 3 collagen continues to close the wound. The tissue is still slightly resilient. Due to the many sensitive nociceptors on the wound, overloading on the tissue is avoided.
Since pain is an important warning signal of the body, pain should be adapted and the tension-free area moved in this phase to avoid overloading the tissue. 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 extension of the hollow of the knee as the first tension of the M. Quadriceps and the bending 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 in the first 48h
- Cellular phase from day 2 – 5
>The actual inflammation should be largely complete from 6 days postoperatively.
In the proliferation phase (6th day -21st day), the number of leukocytes, macrophages and lymphocytes decreases. From day 14 onwards, only the myofibroblasts are still present in the new tissue. Decisive in this phase is collagen synthesis and myofibroblast activity.
Thus the wound is further stabilized. Too early stretching and too intensive mobilization should be avoided. Initial strengthening exercises such as getting up and sitting down from the chair can be performed.
In addition, the ascending and descending of stairs can be trained on a quilting board. It is also important to develop a good gait pattern already during the time of wound healing. Special attention should be paid to rolling over the entire foot to avoid an unphysiological gait pattern.
Depending on how fit the patient is, exercises such as careful knee bends on the knee bending machine can be included. The article “Physiotherapy gait training” might be of interest to you. Day 21 – 360th day.
The fibroblasts multiply and begin to synthesize the basic substance, thus improving the elasticity of the tissue. The newly formed collagen is thus more strongly stabilized and increasingly organized. The collagen fibers become thicker and more resilient and slowly change from type 3 to type 1.
Myofibroblasts are no longer needed and thus disappear from the tissue. Up to the 120th day, collagen synthesis remains highly active and on approximately the 150th day, 85% of the collagen type 3 is converted into collagen type 1. Movements are finally allowed after consultation with the doctor and the load can thus be increased.
In movement therapy, therapy is now increasingly carried out with devices. The leg press is one of the most important and unproblematic devices for muscle building in the knee joint. It trains the rear as well as the front leg muscles.The weight should be increased slowly and the execution should be carried out axially.
Squatting 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 are pushed far back.
Do not relieve tension in the abdomen and back. Exercises on the stepper to work out 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.
In general, mobilization should not be forgotten. In the meantime, a physiotherapist can make a new assessment of the mobility and, if the values are worse, a therapeutic session can be included. Sports with jumps and impact loads should be avoided for the time being.
