Repair on the femoral condyle of the knee

General guidelines

art_joint1. Joint circulation exercises

Joint circulation exercises are necessary for nourishment and stimulation of the transplanted cells. If the cells receive daily nourishment, they can properly develop and become optimally integrated.
It is suggested that these exercises are:

  • Repetitive with a large ROM
  • Painless, performed daily and for a longer period of time, for example 30 minutes per day
  • Easy to perform, safe and preferably active
  • Without substantial load

 

art_rom

Joint circulation exercises are necessary during each rehabilitation phase; without nourishment, cell and tissue adaptation is not possible.

art_rom22. Progressive increase of ROM

The exact location of the implantation must be known
For an increase in ROM, the exercises must be performed:

  • After an active circulation exercise
  • Paying attention to the joint kinematics
  • Long, static and with minimal stress
  • No opposite muscle strain is allowed
  • Only local pain during stretching in the region is normal

 

art_rom3To maintain ROM, use full range circulation exercises.
Bicycle ergometry can be started if active flexion of 100° is achieved.

art_strain13. Progression of resistance to strain

To start progression of resistance to strain, use:

  • Short periods of stress with functional stress positions
  • Perform many short sets with many repetitions
  • Objective feedback of stress during various exercises


art_strain2Stress with slow movements can induce shearing forces leading to plastic deformations of the repaired surface and, thus, damage to the transplant. Thus, avoid slow, static moments of stress in certain angles depending on the size and location of the transplant. (See table below.)

Follow guidelines regarding progression to ensure continued joint homeostasis. The use of 2 crutches is recommended until the patient can readily achieve the defined goals of the second stage of rehabilitation. It is normal to experience some local swelling and pain during the first month after surgery, but clinical intervention should be considered if deemed excessive. In order that patients not over exert themselves during the exercises, it is important to instruct the patient that pain and swelling should not occur during and after exercises.

 

Location on femur Repair size (cm²)
and borders
Avoid shear-stress
between
Intermittent controlled
loading in CKC between
Anterior
art_anterior
< 2.5 0 to 30º flexion 0-40°flexion
> 2.5, contained 0 to 60° flexion 0-70° flexion
> 2.5, uncontained 0° to 110° flexion 0-120°flexion
Central
art_central
< 2.5 20º - 80º flexion 10º - 90º flexion
> 2.5, contained 20º - 110º flexion 10º - 120º flexion
> 2.5, uncontained 10º - 120º flexion 0º - 130º flexion
Posterior
art_posterior
< 2.5 45º - 130º flexion 35º - 140° flexion
> 2.5, contained 45º - 130º flexion 35º - 140º flexion
> 2.5, uncontained 45º - full flexion 35º - full flexion

4. Strength and function

art_strenght1Each new exercise is a proprioceptive exercise
  • Sense of position (in relation to contact surface or body part) and
  • Sense of movement (direction, speed and force) should be stressed
  • Control over an isolated muscle (isometric, concentric, eccentric) is required for development and automatic correct coordination.
  • Perform straight leg raisings (multidirectional) in full extensionto prevent shear forces

 

art_strenght2Position balance is optimised in a safe load or load position.
The following adjustments can be made with respect to the progression:

  • From a stable to a less stable exercise surface (within the patient’s limits)
  • First condition the patient with eyes opened, then repeat with eyes closed
  • Equally distributed bipedal balance to partially or shifted bipedal balance and
  • Bipodal to unipodal balance

 

art_strenght3Strength training is functional training, as much as possible. Isolated muscle training specifically for strength is not a primary goal. Normalisation of open chain function is necessary, without the use of external force. External force can induce shearing forces on the repaired tissue and can, thus, cause damage.

Closed chain exercises are preferable to train stability in functional load positions.

art_strenght4An example is added to achieve specific maximum power output. (1 MR = 1 maximum repetition, set = repetitions of an exercise without pause)

  • Start with endurance > 25 MR, rest 3 min. between different sets, 5 repetitions
  • Low intensity > 20 MR, rest 2 min. between different sets, 3 repetitions
  • High intensity 10 - 15 MR, rest 1 min. between different sets, 2 repetitions
  • Strength / maximum power 3 – 8 MR, rest 30 sec., 1 to 2 repetitions

art_strenght5The number of sessions per week depends on the patient’s recovery time and the exercises performed. This varies from one individual to another. Generally, when possible, 3 sessions per week is recommended, especially during the early phases.

Speed of the movement during exercises should be functional. It is easier and safer to learn a movement at slow speed. To prevent shearing forces to the repaired tissue, gradual adaptation of the load may be necessary.

 

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