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Flashcards in Post operative considerations Deck (24):
1

Operations

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

2

Meniscus Repair

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

3

Meniscal Excision

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

4

Meniscal repair Goals Week 1-4

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

5

Meniscal Repair Goals week 4-12

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

6

Meniscal Repair goals weeks 12-9 months

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

7

Meniscectomy Management immediate

Compression dressing
Cryotherapy
Elevation
WB as tolerated

8

Meniscectomy Management weeks 1-2

-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

9

Meniscectomy Management weeks 3-4

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

10

Meniscectomy Management weeks 4-8

Return to function tasks

11

Meniscal Transplant

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

12

Meniscal Transplant timeline

Surgeons expect full extension within first few weeks
Limited WB for 3-6 weeks progressing to FWB after 9 weeks

13

Osteotomy

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

14

Unilateral Knee Arthroplasty Considerations

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

15

Unilateral Knee arthroplasty rehab

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

16

Unilateral knee arthroplasty advantages

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

17

Cemented TKA

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

18

Uncemented TKA

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

19

Hybrid TKA

Uncemented femoral component
Cemented tibial component

20

TKA Post op considerations

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

21

Complications of TKA

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

22

Success variable of ACL operation

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

23

Current guidelines focus for ACL rehab

Immediate WB
Immediate ROM
Early return to function and sport

24

ACL rehab

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