Knee Arthroscopy Rehab Protocol - Phase 1

Patient Profile: 19 year old basketball player suffered what was initially thought to be an ACL partial tear, and combination tears in the posterior horn of the medial and lateral meniscus of his left knee. On April 2, 2010, once the Docs went in to scope his knee, they found the ACL to still be intact, also minimal damage to the meniscus; at which point they just cleaned up and any scarring that took place along the ligamentous attachment sites. Below are a few of the exercises we are working on in order to restore the patients' full range of motion, strength, and confidence in the use his knee.

1. TKE (Terminal Knee Extensions) 2 x 15 - I am actually on the opposite end providing the resistance. This can modified in a number of ways. Some like to affix the end to an attachment wall, or via pulley-system. But since I did not have those items available to me at the time, one must get creative

(START position)

(END position)

2. Cup Walking 10x - This is also another exercise that can be highly modified. Some are more comfortable with using larger cones, but for the purposes of this rehab, I use a stack of cups (again, resources available) because partially, this is only Day 2, and your patient may not be as comfortable with that much hip flexion at this point. So, a 4" obstacle vs. a 8" obstacle makes a huge difference.

3. Total Gym mini squat - Patient performs a partial squat in a limited range that is to be predetermined in your evaluation. In this particular case, the patient was able to actively flex his knee to about 45 degrees without pain. Allowing pain to be his guide, we asked the patient flex his knee to his end point, and from there, flex it slightly beyond the point of pain, but no further than that.

4. Calf raise 2 x 15 - This is a great exercise I like to do because not only does it incorporate gastroc strengthening, but it provides physical and tactile feedback to the body about its positioning in space. From the initial evaluation, the patient complained of placing as low as 35% of weight on the involved leg. So this is a great exercise to address both strengthening and confidence concerns.

(START position) Patient stands close to a stable, depending on stability, and raises up off the floor to the metatarsal heads, or the ball of the foot. For patients with patellar grafts, or any one who has undergone a procedure involving the patellar tendon, raising to their toes may provide an unwanted strain on the tendon at this point in the rehab.

(END position) Simply return to the flat-foot position

5. Quad Sets 10 x 10 secs - A standard exercise in most knee rehabs, patient actively contracts their quadriceps muscle group while playing close attention to the firing order of each muscle. Most importantly, we want to focus on the neuromuscular control of the vastus medialis oblique; allowing it to contract first, while the others follow. Having the patient place their hand over each muscle is an easy way to determine if this is being accomplished.

6. Straight Leg Raise (5 way) - The SLR is also a common exercise found in many rehab protocols. It is an excellent way to build strength and range of motion, especially during the early phases of rehab. Pictured below is the patient performing SLR's with a 2lb. weight, which he progressed to after exhibiting good technique and control with no weight attached. Many reading this already know the 4-way direction in which the hip moves, but may ask about the "5th direction?" Nope, it is not "rotation," it resembles a 90-90 hip extension that T. Solley coined the "donkey kick," which sorry to say, is not pictured. It is patent-protected ;-)

Overall, we have had good success with these rather simple exercises. They are easily progressed for difficulty and easily modified for future phases. Within one week, the patient has shown tremendous improvement, going from 11o degrees of knee flexion, to 130 degrees in essentially 5 days. His uninvolved side was last measured at 148 degrees, so there is 18 degrees to go. Although his swelling has subsided significantly, it is still noticeable, which is why every session is completed with 5-10 mins on the bike in order to flush out any remnant substances from the workout, and a cryotherapy treatment for residual swelling.