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Via Amadeo 24, 20133 Milano
Tel: 02-7610310 – Fax: 02-70124931
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Via Vivaio 22, 20122 Milano
Tel: 02-76009310 – Fax: 02-76009152
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Patient: _________________________


Surgery: ________Knee arthroscopy and partial meniscectomy and debridement

During the immediate post-operative phase (1-5 days):

characterized by bleeding, swelling, pain and quadriceps inhibition, ROM and isometric quadriceps (SLR and inner range quadriceps (IRQ)) may be started. Other exercises include prone quadriceps stretches, ankle pumps, ankle ROM, passive knee extension in the seated position with the knee unsupported, knee flexion on a bed or in a chair and balance/proprioception exercises.
Patients are encouraged to FWB without a brace with as normal a gait as possible. Prescribed analgesia should be taken as required or just prior to exercising in addition to rest, ice, elevation and compression. Cryotherapy leads to significant improvement in knee pain and swelling, analgesic consumption, compliance, and weight bearing, and may be beneficial for up to 14 days post-operatively.

During the early healing/progressive phase (days 5-14)
an effusion is still present, there is ongoing quadriceps weakness and reduced ROM, but less pain. Strengthening may commence with isometric exercises (SLR) and progress to isotonic exercises (free weights, gym, theratube) once sufficient strength has returned. Though pain has usually resolved by the late healing/functional exercise phase (2-3 weeks), there is some residual quadriceps weakness and reduced end-range flexion. Patients increase their isokinetic and resistance activities, and are started with the minitramp, wobbleboard, swimming, running in the pool and bike work. Pilates may also be used to maintain ROM and increase strength.
There may be some persisting weakness during the conditioning phase (3-5 weeks), and patients continue with CKC, OKC and isokinetic training. Running (initially straight line, followed by cutting and lateral movements), jumping, balance and sports-specific agility drills are also included. Isokinetic testing can be useful in determining any residual strength imbalance prior to RTS.

In summary:
Week 1
– Encourage normal unsupported gait
– General advice for control of swelling (ice, elevation, compression)
– Activation of VMO with isometric exercises
– Passive and active knee exercises
– ROM 0-120

Week 2
– Full ROM
– Soft tissue mobilization and reduction of scar tissue
– Isokinetic, resistance and Pilates based exercises to maintain ROM and strengthen quadriceps, hamstring and gluteal muscles
– Stretching programme for quadriceps, hamstring, ITB, calf, hip rotators

Week 3-4
– CKC exercises (Wall squats, lunges, steps)
– Isokinetic CKC and OKC quadriceps and hamstring rehabilitation
– CKC and OKC resisted exercises in the gym using treadmill, bike and leg press
– Balance, strength and stability exercises on the gym ball

Week 5
– One might consider performing isokinetic open chain quadriceps and hamstring tests on the KIN-COM, and initiate strength and stability training to overcome any residual deficits.

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Via Amadeo G.A., 24 – 20133 Milano (MI) Tel. + 39 02-7610310 Fax + 39 02-70124931
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