Post-Arthroscopy Rehabilitation

Post-Arthroscopy Rehab: Principles - Healing Blueprint

• Goals:
  • Pain & swelling ↓
  • ROM & strength ↑
  • Proprioception restoration
  • Safe functional recovery
• Phases (Tissue Healing Guided):
  • Inflammatory (Protection): 0-2 wks. RICE, pain control, gentle passive/active-assist ROM. Goal: Minimize effusion, protect repair.
  • Proliferative (Repair): 2-6 wks. Progressive ROM, isometric & light isotonic exercises. Goal: Promote tissue healing, restore mobility.
  • Remodeling (Maturation): >6 wks. Advanced strengthening, plyometrics, sport-specific drills. Goal: Maximize strength, prepare for Return To Function (RTF).
• Key Principles:
  • Early Mobilization: Prevents adhesions, aids cartilage.
  • Criterion-Based Progression: Functional milestones, not just time.
  • Pain as Guide: Modify activity based on pain.
  • Patient Education & Adherence: Essential for success.

⭐ Early, controlled motion post-arthroscopy is crucial for synovial fluid nutrition to articular cartilage and preventing arthrofibrosis.

Post-Arthroscopy Rehab: Knee Protocols - Hinge Highlights

• Core Goals: ↓ Pain/swelling, restore ROM (esp. extension), regain strength, safe activity return.
• Phased Progression (Criteria-Based):
  • Phase 1 (Acute; 0-2 wks):
    • Protect repair, control effusion. ROM: 0° ext, 90° flex.
    • Exercises: Heel slides, quad sets, patellar glides. WBAT w/ crutches.
    • ⚠️ Signs: Infection, DVT.
  • Phase 2 (Subacute; 2-6 wks):
    • Full ROM. Closed-chain exercises (mini-squats). Gait normalization.
  • Phase 3 (Strengthening; 6-12 wks):
    • Progressive resistance, balance/proprioception.
  • Phase 4 (Return to Activity; 3-6+ mo):
    • Sport-specific drills, plyometrics. Gradual return.
    • 📌 Respect tissue healing; avoid overstressing.

⭐ Early full passive knee extension (to 0° or matching contralateral side) is paramount post-arthroscopy to prevent disabling flexion contractures and ensure normal gait mechanics later on.

Post-Arthroscopy Rehab: Shoulder Protocols - Socket Savers

• Focus: Labral repairs (Bankart, SLAP), capsular plication. Goal: Protect repair, restore motion, strength.
• Phase I (Protection: 0-6 wks)
  • Sling: 4-6 wks (abduction pillow if needed).
  • PROM: Gentle, surgeon-limited (e.g., ER @ side 0-20°, Fwd Flex to 90-120°).
  • No shoulder AROM. Pendulums, distal AROM.
• Phase II (Early Motion: 6-12 wks)
  • Wean sling. AAROM → AROM.
  • Submaximal isometrics: RC, deltoid, scapular muscles.
  • Scapular stabilization.
• Phase III (Strengthening: 12-20 wks)
  • PREs: RC, scapular stabilizers.
  • Closed-chain → open-chain exercises.
  • Avoid combined Abduction + ER.
• Phase IV (Return to Activity: 20+ wks)
  • Sport-specific drills, plyometrics.
  • Gradual return to sport.

⭐ For anterior stabilization (e.g., Bankart repair), external rotation is typically restricted for the first 6 weeks to protect the healing labrum (e.g., ER @ 0° abd: 0-15°).

Post-Arthroscopy Rehab: Complications & Adjuncts - Trouble Shooters

• Common Complications:
  • Infection (septic arthritis): Urgent antibiotics, possible washout.
  • Deep Vein Thrombosis (DVT): Risk ↑ in lower limb; consider prophylaxis (e.g., LMWH).
  • Persistent pain/swelling: Investigate; NSAIDs, cryotherapy.
  • Stiffness (arthrofibrosis): Aggressive physiotherapy; Manipulation Under Anesthesia (MUA) if severe.
  • Nerve injury (neuropraxia/axonotmesis), instrument breakage (rare).
• Helpful Adjuncts:
  • Cryotherapy & compression: Manage pain, edema.
  • Continuous Passive Motion (CPM): Early ROM, cartilage health.
  • Pharmacological: NSAIDs, targeted analgesia.
  • Blood Flow Restriction (BFR) training: ↑ strength with ↓ loads.

⭐ Septic arthritis post-arthroscopy, though rare (<1% incidence), is a devastating complication requiring immediate joint aspiration, empirical IV antibiotics, and often surgical debridement and washout to preserve joint function. Early diagnosis is critical!

High‑Yield Points - ⚡ Biggest Takeaways

• Early mobilization is crucial to prevent stiffness and Deep Vein Thrombosis (DVT).
• Rehabilitation follows a phased approach: protection, Range of Motion (ROM), strengthening, and sport-specific training.
• Pain and swelling control (e.g., RICE protocol) is vital in the initial phase.
• Weight-bearing progression (Non-Weight Bearing to Full Weight Bearing) depends on the specific surgical procedure.
• Continuous Passive Motion (CPM) may be used for certain knee procedures to improve early ROM.
• Proprioception and neuromuscular control exercises are essential for restoring joint stability.
• Return to activity/sport is criteria-based, not solely time-based, ensuring functional recovery.