Physiotherapy in Orthopedic Knee Injuries: Rehabilitation Program Following Treatment of Posterior Cruciate Ligament Rupture
Clinical Anatomy of the Knee: An Atlas, Springer International Publishing Ag, ss.311-321, 2021
- Yayın Türü: Kitapta Bölüm / Araştırma Kitabı
- Basım Tarihi: 2021
- Doi Numarası: 10.1007/978-3-030-57578-6_19
- Yayınevi: Springer International Publishing Ag
- Sayfa Sayıları: ss.311-321
- Lokman Hekim Üniversitesi Adresli: Evet
Özet
Physical therapy starts on the first postoperative day with a posterior icepack on the postoperative dressing and a long-leg knee brace locked in full extension with bilateral axillary crutches. The postoperative bandage and dressing are changed to allow the application of thigh-high compression stockings and a Jones bandage [1-4]. Early control of postoperative effusion is important for pain management and early quadriceps re-education. In addition to compression, cryotherapy is important in this period. Throughout the first week, the patient is instructed to hold the lower extremity as tight as possible. The response to surgery and progression in the first 2 weeks determines the initial stages of the rehabilitation program. Commonly seen postoperative complications include excessive pain or swelling, quadriceps shutdown, and limited joint range of motion (ROM). Early identification and treatment of these problems are critical for a successful result. In patients with quadriceps tendon autograft, pain may increase during knee flexion and quadriceps contraction. To be sure that the rehabilitation targets are reached, care must be taken in the first four postoperative weeks [2, 3]. When the patient is doing ROM exercises, an electrode is placed in the center of the hamstring muscle. Cryotherapy is started postoperatively in the recovery room. There are several different modalities for use both in the clinic and at home. For most patients, a bag of ice or a commercial cold pack is applied, and patients can have a commercial cold unit to be used at home, 4-8 times per day. Of the cold therapy units which can be purchased, there are mobile cold units that provide fixed hot and cold water circulation along a pad providing excellent pain control [1, 2, 4-6]. Gravity-flow units also provide effective pain management, although it is harder to maintain a fixed temperature with these devices. The temperature can be controlled by releasing the water and using reverse flow gravity, and when necessary the sleeve can be filled with fresh iced water. Standard treatment is applied for 30 min five times a day depending on the degree of pain and swelling. In some cases, the treatment time can be extended depending on the thickness of the buffer used between the skin and the device. Cryotherapy is generally used when necessary for pain and swelling control or after exercise and is retained as a part of the whole postoperative rehabilitation protocol [3-5].