Physiotherapy after knee surgery

The knee joint is one of the joints that is operated on most often. Our knee joint is often heavily strained due to accidents, injuries during sports, but also due to a wrong gait pattern or axial misalignment of the legs. It tends to wear out and is prone to injuries.

After an operation, the focus is on restoring the function of the joint. On the one hand, this includes restoring the full mobility of the knee joint, on the other hand it is important to strengthen the surrounding musculature and make it resilient. Frequent operations are arthroscopy, e.g. after a meniscus injury, open meniscus surgery, cruciate ligament surgery, a joint toilet at the arthrotically modified knee to restore the joint surfaces, or of course the use of endoprostheses. After all these operations, early functional therapy is started more or less immediately (depending on the surgical technique and the doctor’s instructions) to restore the physiological functionality of the joint. This article Knie-TEP might be of interest to you in this regard.

Contents of physiotherapy/recovery

The rehabilitation of knee joint function after knee joint surgery includes several objectives, which are focused to varying degrees on the individual stages of wound healing. Objectives are: In the first days (approx. 5) after the operation, the knee is still in the so-called inflammatory phase.

During this period, therapy is limited to pain-relieving and wound healing-promoting techniques. Light, mostly rather passive, i.e. movements performed by the therapist in the pain-free area can be part of the therapy in addition to lymph drainage, gentle massage grips or cold/heat applications. In the acute phase, the knee is not yet able to bear weight, the knee shows all signs of a predominant inflammation, is reddened, warmed, swollen, and its function is usually painful and limited.

In this phase, the knee must be relieved and the inflammation allowed to subside. In the following days (until about day 21) the knee joint is in the proliferation phase. Now healing begins, new tender tissue is formed and wounds slowly close.

The knee is still not able to bear weight well. Although it is important to provide functional stimuli now, overloading the joint should be avoided in any case. Functional stimuli are gentle movements to a slightly greater extent than in the acute phase, which should be painless!

Many repetitions can be performed without heavy strain. This improves blood circulation and promotes wound healing. At the same time, the newly formed tissue is stimulated in the way it is to be moved later, the newly formed fibers can align themselves correctly.

Soft tissue techniques can also be applied in this phase, heat and cold treatments are still part of the therapy. It is important to make sure that the reduced mobility of the joint does not cause the surrounding structures to stick together. Slight friction (selective massage techniques) on the insertions and tendons can prevent this.

In the following phase, the consolidation phase (until the 60th day), the tissue begins to become increasingly resilient. Now the knee joint can be exposed to stronger stimuli up to the pain threshold. Of course, more caution is required at the beginning of the consolidation phase than towards the end.

The resilience is gently increased. The range of movement is now increased until the knee joint regains its full mobility, if possible. Muscles can be stretched and targeted strengthening also begins.

Here it is important to observe the load specifications of the doctor. It may be that the knee must not yet be loaded with full body weight, or the use of resistors is still prohibited. Adapted exercises should be chosen to strengthen the muscles in a targeted manner.

Less repetitions are performed for strengthening than for improving mobility. 10-15 repetitions of an exercise should be performed in 3-5 sets with a break of approx. 60 seconds.

Resistance and difficulty of the exercises are slowly increased. As the consolidation phase progresses, the proportion of coordinative exercises also increases. The interplay of endurance and strength as well as the perception of the joint position and posture is trained so that the patient can use his knee safely in everyday life.

It should be stable and reactive. There is a variety of exercises, which can also be slowly increased in difficulty over time. In the consolidation phase, active training is very important in physiotherapy after knee surgery.Passive techniques performed by the therapist are now rarely used, e.g. for stubborn adhesions.

  • Alleviate pain
  • Promoting wound healing
  • Restore mobility
  • Strengthen/stretch the surrounding musculature
  • Improve coordination
  • Restoring everyday stress

Once the consolidation phase is complete, the organization phase begins (from the 60th day to the 360th day). During this phase it is particularly important to expose the tissue to the stimuli to which it will later be exposed. Strength training increases in intensity up to maximum strength training.

Mobility is further improved, long stretching positions and passive stretching techniques can also be used. Coordination training is very important, jumps, fast changes of direction or start-stop-strain can be practiced. Sore muscles are allowed to occur. The knee should be brought up to its everyday load.