Optimizing Knee Injury Recovery: Modern Rehabilitation Protocols After Surgery

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• Personalized Rehabilitation Plan
• Early Mobilization and CPM
• Controlled Motion Restrictions
• Managing Inflammation with PRP
• Phased Recovery Timeline
• Return to Sport
• Full Transcript

Personalized Rehabilitation Plan

Dr. Matthias Steinwachs, MD, emphasizes that a personalized treatment concept is essential for successful knee injury rehabilitation. This principle applies to both the initial surgical intervention and the subsequent physiotherapy plan. Every patient presents a unique combination of injury type, surgical procedure, and personal goals. Dr. Steinwachs, MD, explains that tailoring the program to the individual ensures optimal healing and functional recovery.

Early Mobilization and CPM

Modern knee rehabilitation protocols prioritize early mobilization, often starting on the first day after surgery. Dr. Matthias Steinwachs, MD, states that this early movement is vital for metabolic processes, healing capacity, and joint nutrition. A continuous passive motion (CPM) machine is frequently used to provide passive joint mobilization. This helps prevent adhesions and is a critical factor for cartilage healing, as movement significantly increases metabolic activity in the repaired tissue.

Controlled Motion Restrictions

Despite advocating for movement, Dr. Steinwachs also advises specific restrictions in the range of motion to protect healing tissues. For injuries involving the patella or trochlea, avoiding deep knee bending is necessary initially. A common protocol involves a graduated increase in motion. The patient might be restricted to 30 degrees for two weeks, then 60 degrees for another two weeks, before progressing to 90 degrees. A key strategy is differentiating between active and passive movement, allowing a physiotherapist to gently push the joint slightly further to improve flexibility safely.

Managing Inflammation with PRP

Controlling inflammation is a primary goal in the first phase of knee rehab. Methods include joint cooling and anti-inflammatory medications. Dr. Matthias Steinwachs, MD, frequently utilizes Platelet-rich plasma (PRP) injections directly into the knee joint. He finds that PRP effectively balances the inflammatory response, reduces patient pain, and initiates a beneficial biological healing process. This biological therapy is a cornerstone of his modern approach to post-operative care.

Phased Recovery Timeline

Rehabilitation after knee surgery follows a structured, phased timeline. The initial six weeks are a protection phase, involving partial weight-bearing on crutches and the use of a CPM machine at home. Thrombosis prophylaxis is also standard during this period. After these six weeks, patients begin to load the joint normally. The next phase involves medical training therapy to restore the knee's full range of motion, load-bearing capacity, and sensorimotor function.

Return to Sport

The time required to return to sports depends entirely on the type and severity of the knee damage. Dr. Steinwachs provides clear timelines: an athlete with a ligament injury typically requires six to eight months of rehabilitation. For cartilage repair procedures, a minimum of six months is standard before a return to sports activity is considered. Dr. Matthias Steinwachs, MD, concludes that the characteristics of the restored cartilage area and the patient's individual situation must be fully integrated into the final return-to-play program.

Full Transcript

Dr. Matthias Steinwachs, MD: Rehabilitation is crucial after surgical treatment of knee ligament injury and meniscus injury. Rehabilitation is important after cartilage repair and treatment.

Dr. Anton Titov, MD: What is the modern approach to rehabilitation after knee injury treatment? How do you combine pharmacological and physiotherapeutic methods of rehabilitation after knee injury?

Dr. Matthias Steinwachs, MD: We have to personalize the treatment concept for each patient. It is true for knee trauma surgery and also for a plan for rehabilitation.

We mostly start with the mobilization of the patient on the first day after the surgery. I think early mobilization after surgery is very important for metabolic processes, healing capacity, nutrition, and so on.

We also use a so-called CPM machine for passive mobilization of joints to avoid adhesions in the joint and help cartilage with nutrition. Movements of a joint are very important factors for cartilage healing.

You need movement in the joint. Otherwise, the metabolic activity in the cartilage is low. The metabolic activity in the repaired cartilage is also very low.

We also advise some restrictions in the range of motion after the rehabilitation. For example, if you have a defect on the kneecap or trochlea, you have to avoid bending the knee for some time as the tissue is starting to restore itself.

Normally, I have a six-week window for using partial weight-bearing. I advise a restriction in range of motion initially for two weeks, mostly at 30 degrees.

After an additional two weeks of rehabilitation, we increase range of motion to 60 degrees, and then we come up to 90 degrees. In a 30-degree step, the patient actively goes forward, but I allow a passive range of motion by a physiotherapist to go 30 degrees further.

For example, patients start after two weeks of rehabilitation not with 60 degrees of passive range of motion, but they go up to 90 degrees of joint movement. For that reason, you can allow more bending and more function of an injured joint by differentiating between active and passive movement.

In the first step of rehabilitation, we start with therapy to stop inflammation. We use joint tissue cooling, and we also use anti-inflammatory drugs.

But I often use Platelet-rich plasma (PRP) in the area affected by the injury. The patient gets a Platelet-rich plasma (PRP) injection directly into the knee.

We see that PRP injection balances inflammation in a very good way. The patient’s joint pain also decreases under that condition of PRP injection.

It starts a biological process of injury healing. For that reason, it makes sense.

We also use thrombosis prophylaxis for the first six weeks during the use of crutches. Every patient gets a CPM machine at home on a rental system for six weeks.

This is called the protection phase. After six weeks, the patient starts joint weight loading in a normal way.

After that, we start with medical training therapy to come back to the normal function of the knee. We work to improve range of motion, load, and sensorimotor function.

The time to return to physical activity depends on the type of knee damage. In a ligament injury, we know that it will cost an athlete about six to eight months before they can go back to sport.

For cartilage repair treatment, it is often a minimum of six months of rehabilitation. Then an athlete can go back to sports activity.

Each type of restored cartilage area will have its characteristics regarding the optimal rehabilitation plan. You have to integrate each patient’s individual situation into your rehabilitation program.