Post operative considerations

Question 1

Operations

Answer 1

Meniscal Repair
Meniscectomy
Knee Arthroplasty (TKA and UKA)
Patellofemoral Procedures

Question 2

Meniscus Repair

Answer 2

Outer 1/3 has a good vascular supply
Limited WB progression over 8 weeks
Often prescribed fixed extension brace
No knee flexion >45 in WB for first 4 weeks
No knee flexion >90 in WB for first 8 weeks
Focus on OC quad strengthening

Question 3

Meniscal Excision

Answer 3

Inner 2/3 has poor vascular supply
No precautions post-op
Rehab driven by presence of typical impairments
Recovery time 2-6 weeks
Need for further surgery most common in lateral compartment

Question 4

Meniscal repair Goals Week 1-4

Answer 4

Regain functional ROM
Prevent patellar restrictions
Reestablish control of knee musculature
Restore postural stability
Improve strength and flexibility of hip and ankle
Maintain CP fitness

Question 5

Meniscal Repair Goals week 4-12

Answer 5

Discontinue bracing at 6-8 weeks
Restore full ROM
Improve LE flexibility, strength, endurance
Establish NM control and balance
Improve aerobic fitness

Question 6

Meniscal Repair goals weeks 12-9 months

Answer 6

Reutrn to high level physical activity
Patient education
Advanced strengthening
Simulate fuctional activity movement patterns
Improve coordination, power, and proper alignment
Transition walking to running program ~6months

Question 7

Meniscectomy Management immediate

Answer 7

Compression dressing
Cryotherapy
Elevation
WB as tolerated

Question 8

Meniscectomy Management weeks 1-2

Answer 8

• Exercises to reduce atrophy, prevent contracture
• Gradual progression of WB and non-WB activity in pain free range
• Control inflammation and pain
• Establish independent abulation
• Restore ROM

Question 9

Meniscectomy Management weeks 3-4

Answer 9

Restore full, pain free ROM
Normal Gait pattern
Resistance training
Endurance activities
Proprioceptive/balance activities
NM Retraining

Question 10

Meniscectomy Management weeks 4-8

Answer 10

Return to function tasks

Question 11

Meniscal Transplant

Answer 11

Candidates: 
-Under 40
-Minimal OA
-Not currently candidate for TKA
-Wish to remain highly active
Not applicable for:
-Patients with malalignments
-Advanced arthritic changes
-Uncontrolled knee instability

Question 12

Meniscal Transplant timeline

Answer 12

Surgeons expect full extension within first few weeks

Limited WB for 3-6 weeks progressing to FWB after 9 weeks

Question 13

Osteotomy

Answer 13

Wedge of bone is taken out to realign joint
Pts <60 y/o
May delay need for arthroplasty for 10 years
Failure rate of 10%
-Cannot use cuff weights distal to osteotomy until after 4 weeks
-Full ROM encouraged immediately

Question 14

Unilateral Knee Arthroplasty Considerations

Answer 14

DJD in one compartment
Max 10 degrees varus or 5 degrees valgus from mechanical axis
Flexion contractures <32

Question 15

Unilateral Knee arthroplasty rehab

Answer 15

Immediate WBAT
Facilitate full extension and 90 degrees flexion 1st week
Facilitate quad activity
Patellar joint mobilization

Question 16

Unilateral knee arthroplasty advantages

Answer 16

Greater bone preservation
More normal mechanics due to ligament sparing
Better ROM and proprioception

Question 17

Cemented TKA

Answer 17

Allows for immediate WBAT
Implant is cemented into the bone
High rate of loosening

Question 18

Uncemented TKA

Answer 18

WB restrictions immediate post op
Rely on rapid bone growth
High rate of loosening at the tibial interface

Question 19

Hybrid TKA

Answer 19

Uncemented femoral component

Cemented tibial component

Question 20

TKA Post op considerations

Answer 20

Monitor integrity of incision
Avoid SLR in sidelying to avoid excessive varus/valgus forces for:
2 weeks if cemented
4-6 weeks if uncemented
Joint mobilization techniques may not be appropriate depending on prosthetic components

Question 21

Complications of TKA

Answer 21

Wound healing issues
DVT <3%
Pneumonia
Myocardial infarction
nerve or vascular issues
joint instability
Knee stiffness

Question 22

Success variable of ACL operation

Answer 22

Preoperative fitness level
Healing properties
Status of knee joint at time of injury
Time from injury to surgury
Presences of concomitant injury that occurred at the same time as ACL injury

Question 23

Current guidelines focus for ACL rehab

Answer 23

Immediate WB
Immediate ROM
Early return to function and sport

Question 24

ACL rehab

Answer 24

Avoid strengthening of quads between 60-90 degrees of knee flexion due to greatest amount of anterior tibial translation here