Table 1.
Proposed Postoperative Treatment Scheme
0-10 Days | Up to 3 Weeks | 3-6 Weeks | 7-12 Weeks | 4-6 Months | From 7 Months | |
---|---|---|---|---|---|---|
Pain treatment | Analgesia Ice application | Analgesia Lymph drainage Muscle stimulation Thermotherapy | Lymph drainage Electrotherapy Muscle stimulation | Electrotherapy Muscle stimulation | ||
Weight bearing | Foot sole contact 3 point walk with crutches | Foot sole contact 3 point walk with crutches | Foot sole contact Walking with crutches | Building up full weight bearing Full weight bearing from 8th week | Full weight bearing | |
Mobilization | Orthesis: 0/0/60° femoral condyle, 0/0/30° patella and trochlea Patella mobilization in all directions | Active motion in pain-free region Patella mobilization in all directions Orthesis/CPM*/CAM*: 0/0/90° femoral condyle and patella and trochlea from week 4 Increase time interval | Active motion Patella mobilization in all directions Weaning off orthesis Orthesis/CPM*/CAM*: 0/0/90° femoral condyle, patella and trochlea from week 4 Increase time interval | Active motion 0/0/90° for all defect locations from 6th week Full flexion allowed when full weight bearing achieved | Patella guidance 0/0/120° | Patella guidance Release motion |
Electrotherapy | Quadriceps Isometrics Muscle stimulation | Quadriceps isometrics Movement of leg in extension Muscle stimulation | Leg press | Leg press | Leg press | |
Proprioception | Manual therapy of foot joints Rubbing/brushing sole of foot PNF pattern with other leg | Foot resting on ball Different foot sole contact while sitting in many different knee positions | PNF* pattern with operated leg with knee extended Foot resting on ball | PNF* pattern with operated leg including knee flexion Trampoline Soft floor mats Equilibrium training | PNF* pattern with operated leg including knee flexion Trampoline Soft floor mats Equilibrium training | |
Walking | Mobilization 3 point walk | Walking in water Walking stairs with crutches | Walking in front of mirror | Weaning off crutches Stepper Walking long distances on different ground Increase velocity | Walking on soft ground | Jogging |
Sport | Aquatraining | Aquatraining Swimming Ergometry | Aquajogging Biking | Swimming Biking Ergometry 0/0/120° | Jogging, skiing after 9-12 months Skating after 12 months Biking Contact sport after 18 months |
CPM: Continuous passive motion; CAM: Continuous active motion; PNF: Proprioceptive neuromuscular facilitation.