For a long time, the leg swells after plastics
Recommendations for restorative treatment after arthroscopic surgery on the knee joint.
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Duration of hospitalization for arthroscopic treatmentpathology of the knee joint may be different. At present, there is a tendency to reduce the length of stay in the hospital. The stationary stage of treatment, with the majority of operations on meniscuses, ranges from several hours to 1 day, with arthroscopic plasty of cruciate ligaments from 1 to 3 days.
- Intraoperative antibiotic prophylaxis is a single intravenous injection of a broad-spectrum antibiotic, if necessary, repeated administration after 24 hours.
- Prevention of thromboembolic complications -compression knitwear, or elastic bandage of limbs during surgery and in the postoperative period (up to 3-5 days), administration of low-molecular-weight heparin preparations (up to 10 days), tablets anticoagulants.
- Cryotherapy in the postoperative period - cold locally, with intervals of 30-40 minutes during 1-3 days.
- Ensuring the rest of the joint in the earlypostoperative period. If necessary, the joint is fixed by an orteal bandage. Normally, the limb is in the forward position. When plastics of cruciate ligaments are used, fixing the joint with a postoperative tutor or a hinged orthosis in a closed position (fixation in the orthosis with a flexion angle of 20 degrees is possible).
- Anesthetic therapy, non-steroidal anti-inflammatory drugs (NSAIDs).
- Lymphatic drainage.
- Therapeutic physical training for the first period
1 day - isometric tension of the muscles of the thigh, movements in the ankle joint.
2 days - drainage is removed, passive movements in the knee joint are added, in a painless range, activation is carried out.
- When activated, an additional support / cane or crutches is used, depending on the degree of permitted load on the leg
Period of outpatient treatment, 1-3 weeks:
- Dressings. Usually the examination of the traumatologist and dressings are carried out on the 1st day after the operation, 3-4 days, and 7-12 days. Aseptic dressings are changed, if necessary, puncture of the joint to evacuate the fluid. Seams are removed on the 7-12 day.
- Use of anti-inflammatory and vascular drugs.
- Elastic bandage of the limb up to 3-7 days.
- Cryotherapy up to 3 -5 days.
- Lymphatic drainage.
- Depending on the type of operation performed, one or another degree of activity is allowed.
After a meniscactomy, walking fromDose load on the leg is allowed from the first day after the operation. It is recommended to limit loads, use a walking stick, or crutches with an elbow support up to 5-7 days after surgery. When performing a suture of the meniscus, walking with crutches is recommended without foot rest up to 4 weeks.
When PKC is plastic in early postoperativeperiod, walking with crutches is also recommended (using crutches with elbow support) up to 3 weeks. First, walking is done without loading the leg. Then, when walking the foot (not the sock) is put on the floor, but without transferring the weight to the operated limb. If there is no pain syndrome, a gradual increase in the axial load on the straight leg is carried out.
- Additional fixation of the knee joint.
At operations on a meniscus the elasticbandaging the joint area, or wearing a soft (or semi-rigid) knee. When PKC plastic is used, joint fixation with a postoperative articular orthosis, with a gradual increase in the allowed bending angle. Movement can be started within 3-5 days after the operation, the angle of permitted flexion gradually increases to 90 degrees within 2-3 weeks after the operation. For the night, the brace may be blocked in the extension position.
- Electrostimulation of the hip muscles (not necessary).
- Easy massage, mobilization of the patella by its passive shifting up and down and to the sides.
- Full extension in the knee joint in a supine position (without overextending the joint!).
- Passive movements in the knee joint. A good effect gives the use of the apparatus "Artromot" for the development of passive movements in the joint.
- Physiotherapy exercises for periods.
Isometric muscle tension continuesflexors and extensors of the hip, gluteus muscles, motion of the foot. Add active movements in the knee joint, flexion-extension in a painless range. The movements are carried out in a "closed loop", that is, in such a way that the heel during movement is always in contact with the surface. For example, lying on the back, bending at the knee joint is performed, so that the heel slides over the surface of the couch, you can help bend your hands, capturing the lower third of the thigh. Add exercises to gradually strengthen the muscles of the limb, but without significant loads and taking into account the pain syndrome: slow lifting of the straight leg, lying down (sock to yourself), and keeping the weight for 5-7 seconds. Raising a straight leg while standing. Exercises with a tourniquet for the calf muscle. Possible exercises in the pool. Classes are held 2-3 times a day, for 10-15 reps.
- It is possible to walk with full support on the leg (in the orthosis), walking with one crutch, or without additional support.
- Development of the volume of movements in the joint. The allowed amount of flexion is more than 90 degrees (up to the full volume of movements). By this time, a full extension must be achieved and preferably a 90 degree bend in a painless mode.
- Forming the right gait. To walk it is necessary slowly, not by the big steps, trying not to limp on the operated leg.
- Physiotherapy, aimed at strengthening the muscles of the hip. It is desirable to conduct exercises under the supervision of a physician of physiotherapy exercises and taking into account the reaction of the joint to the load.
Classes are held 2-3 times a day, 10-15repetitions. Raise and hold the straight leg (sock to yourself). Not deep slow springing squats (flexion 30-40 degrees), exercises with light resistance (rubber tourniquet), exercise bike with minimal load and a slight angle of flexion in the joint, strengthening of the leading and diverting portions of the quadriceps muscle of the thigh, exercises in the pool - walking in the water.
If the joint swells, pain in the joint increases after exercise, the joint is not restored by morning - the load needs to be reduced and consulted by the treating doctor.
- It is possible to walk and exercise in a functional orthosis, with a full range of movements.
- Continuation of strength training. Exercise bike, active flexion and extension, ghost and lead in with elastic resistance (rubber tourniquet), not deep slow sit-ups (bending up to 60 degrees), swimming lessons, walking and running in water, swimming with a style of breaststroke. Classes on block simulators are possible, without using the loader of the front group of hip muscles.
- Training aimed at coordinating movements. Swaying the body on the half-bent legs, step on the step, exercises on the platform, with insurance, holding on to the support.
It is necessary to avoid sharp extension andoverextensions of the leg, fly movements, jumps, twisting loads. Despite the reduction in pain, the ligament is in the process of adjustment at this time, its strength is reduced and the joints need to be protected.
- Walking without restrictions.
- Continuation of exercises aimed at strengthening the limb muscles, exercise bike, swimming, block simulators, exercises with a platform.
- Coaching aimed at coordinating movements- keeping the balance on an unstable platform on straight and half-bent legs, with open and closed eyes, keeping balance on the inflatable cushion, exercises on 1 foot, accurate attacks, side steps.
- Continuation of training aimed at strengthening the muscles and coordination of movements.
- Jogging is possible on a flat surface.
- The use of the knee under the loads, the danger of awkward movements (transportation, travel) and exercise exercise therapy.
It is necessary to avoid premature elevatedloads, an early return to the sport, sharp leg extensions, especially shin movements "flush", jumps, running along a hard or uneven surface, twisting loads, falls, uncontrolled movements during sports exercises.
Restriction of sports loads after performing PKC plastics is necessary up to 4-6 months.
Limitation of employment by contact or game sports up to 9-12 months.
I would also like to emphasize that the selection ofThe rehabilitation program should be carried out individually and take into account a variety of factors. This is a sufficiently long and responsible stage of treatment, without which it is unlikely to achieve good functional results of treatment.