Rehabilitation after knee injury therapy. Physiotherapy after cartilage repair. 8

Rehabilitation after knee injury therapy. Physiotherapy after cartilage repair. 8

Rehabilitation after knee injury therapy. Physiotherapy after cartilage repair. 8

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Rehabilitation is crucial after surgical treatment of knee ligament injury and meniscus injury. Rehabilitation is important after cartilage repair and treatment. What is the modern approach the rehabilitation after knee injury treatment? How to combine pharmacological and physiotherapeutic methods of rehabilitation after knee injury? We have to personalize the treatment concept for each patient. It is true for knee trauma surgery and also 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 a passive mobilization of joints to avoid adhesions in the joint and help cartilage with nutrition. Because movements of a joint are very important factors for cartilage healing. So you need the movement in the joint. Otherwise, the metabolic activity in the cartilage is low. The metabolic activity also in the repaired cartilage is very low. We also advise some restrictions in the range of motion after the rehabilitation. So I think, for example, if you have a defect on the kneecap [patella] or a 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 the additional two weeks of rehabilitation, we increase range of motion to 60 degrees, and then we come up to 90 degrees. So in a 30-degree step 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 the active and passive movement of the joint. 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 a field affected by the injury. The patient gets the Platelet-rich plasma (PRP) injection finally into the knee. We see that PRP injection balances inflammation in a very good way. The patient’s joint pain is also decreasing under that condition of PRP injection. And it starts a biological process of injury healing. So for that reason, it makes sense. We also use thrombosis prophylaxis for the first six weeks during the use of crutches. Every patient gets CPM machine at home on a rental system for six weeks. It is called the protection phase. After six weeks, the patient starts the 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 [weight bearing on the joint], and sensorimotor function. The time to return to physical activity depends on the type of knee damage. So in a ligament injury, we know that it will cost an athlete about six months to seven months or eight months before they can go back to the sport. For cartilage repair treatment, it is often a minimum of six months of rehabilitation. Then an athlete can go back to sports activity. So, each type of restored cartilage area will have its characteristic regarding optimal rehabilitation plan. You have to integrate each patient’s individual situation in your rehabilitation program.

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