Femoral Condyle Lesion – Un-contained

 

Phase 1 -  Preoperative

 

Therapeutic aim during preoperative phase

 

rehabilitation (remedial therapy), particularly neuromuscular and

proprioceptive training

(biking / rowing)

outside the home

capacities (no pain or swelling)

 

Procedures

 

 

Phase 2 - 0 to 6 weeks postoperative

 

Background

 

Wound healing, graft repair (cell attachment, inflammation and proliferation)

 

Therapeutic aims during phase 2

 

forces (neuromuscular and proprioceptive training)

 

 

Rehabilitation in hospital

 

    permitted)

 

Range of motion (ROM)

 

Weeks 0–3         0 - 90ľ active flexion

Week 4              0 - 110ľ active flexion

Week 6              0 - 130ľ active flexion

 

Procedures

 

 

Load

 

Days 0 - 3           Do not load (activities of daily living (ADL) with 2 crutches)

 

Day 3 - week 2    Continue with 2 crutches and support a maximum of 20 kg

 

Week 3 +           10 to 15 kg load during all activities using 2 crutches. 

During exercises, load within previously determined angle depending on location, size and quality of the borders of the lesion

 

 

Strength and function

 

Weeks 0 – 2   - Isometric exercises (no pain) in various knee positions

                     - Myofeedback for muscle rehabilitation

 

Weeks 2 – 4   -Closed and open chain exercises within load limitations

                     -Weight movement (isometric)

                     -Proprioceptive training and neuromotor control

                     -Improvement of general condition using exercises in     

                      swimming pool and/or cardiovascular training of upper limbs

 

Weeks 4 – 6   -Begin with biking and/or rowing ergometry for a total of 1  

                      hour per day.

                     -Bilateral closed chain exercises with limited load, such as

                      rowing, ‘leg press’, ‘squats’ with objective balance 

                      measurement.

                     -Depending on the size and location of the defect, unilateral 

                      closed chain exercises can be started within limited angles 

                     

 

 

 

Criteria for passage to phase 3

 

 

 

Phase 3 -       4 to 12 weeks postoperative

 

Background

 

Acquisition of strength in repaired tissue (cell differentiation and maturation phase)

 

 

Therapeutic aims during phase 3

 

 

 

Range of motion

 

From week 7 Progressive extension to full ROM

 

Procedures

 

􀀁 Maintain complete passive extension

􀀁 Patella mobilisation

􀀁 Daily stretching program, paying attention to joint kinematics

􀀁 Extend active knee flexion, paying attention to the repaired zone

 

Load

 

Weeks 6 – 10   - If walking pattern and propriocepsis are normal and

                         swelling and pain are minimal, the use of crutches can be 

                         gradually reduced (starting in the morning for a few days,

                         with gradual extension to full days)

         - Starting in week 6, begin control exercises without brace     

                         within load bearing range (week 4 load-bearing guidelines 

                         to progress, see table)

 

Starting in week 10  - Full load

 

 

Strength and function

 

Weeks 4 – 6   - Begin with biking and/or rowing ergometry for a total of 1 

                       hour per day

                     - Bilateral closed chain exercises with limited load, such as 

                       rowing, ‘leg press’, ‘squats’ with objective balance 

                       measurement

                       unilateral closed chain exercises can be started within 

                       limited angles

 

Weeks 6 – 12  - Progression of proprioceptive exercises within the load

                        limitations

                      - Prevent or correct ‘knee in-in’ position by relieving the

                        medial compartment

        - Increase of knee load during functional activities by means

          of biking and/or rowing ergometry for a total of 1 hour per 

          day

 

Criteria for passage to phase 4

 

􀀁 Completion of phase 3

􀀁 Minimal pain and swelling

􀀁 Full active ROM

􀀁 No reactive knee (increase of pain and swelling) after strength

    exercises

􀀁 Able to walk 1.6 – 3.2 km or bike and/or row 30 minutes on an

    ergometer

 

 

Phase 4 10 to 26 weeks postoperative

 

Background

 

Continued remodelling of the tissue into a more organised structure

 

Therapeutic aims during phase 4

 

􀀁 Improve muscle strength within safety margin

􀀁 Improve endurance through ‘low impact’ activities or exercises in

    upper limbs

􀀁 Extend functional activities

 

Range of motion

 

Patient must be able to perform his/her full active ROM

 

Procedure

 

Active ROM exercises with mild resistance within the safety zones

 

Load

 

Patient should be fully loaded

 

Strength and function

 

3 – 6 months          -Steps within range of motion

                             -Biking and/or rowing with mild resistance (max. peak 

                             load 1x body weight)

                             -Cardiovascular training in upper limbs

                             -Few repetitions with bipedal landing on a “soft” surface    

                              (e.g. minitrampoline or mattress)

                             -Build up specific strength within safe zone (e.g. through    

                              triple repetitions)

 

Criteria for passage to phase 5

􀀁 Completion of phase 4

􀀁 No pain or swelling during ‘low impact’ exercises

􀀁 Full active, painless ROM

􀀁 Strength within 75-80% of contra lateral leg

􀀁 Balance and stability within 75 - 80% of contra lateral leg

 

Phase 5 -  5 to 9 months postoperative

 

Background

 

Tissue reaches full formation, maturation starts

 

Therapeutic aims during phase 5

 

􀀁 Muscle control within loaded zone

􀀁 Extend functional activities

􀀁 The moments of force and functionality can be evaluated at around

the 9th month, provided such evaluation is clinically justified (patient

experiences no pain or swelling)

 

Range of motion

 

Full active and passive ROM

 

Load

 

Full load

 

Strength and function

 

6 - 9 months            -Gradual increase of resistance through increased  

                               repetitions and decrease of number of sets

                              -Start more intensive jogging, meaning low average 

                               speed, rapid movement frequency for short distances, 

                               more sets (namely, dynamic, ensure that the landing 

                               of the front of the foot is secure when beginning

                               jogging)

                              -Muscle control in loaded zone, with ‘high load’ 

                               isometric control

                              -Eccentric training in legs, with full ROM during ‘low 

                               impact’ and only within safe zone for ‘high impact’

                               exercises such as skipping

 

Criteria for passage to phase 6

 

􀀁 Completion of phase 5

􀀁 No pain or swelling during or after ‘low impact’ or ‘high impact’

    exercises

 

Phase 6 9 to 12 months postoperative

 

Background

 

Tissue maturation

 

 

 

Therapeutic aims during phase 6

 

􀀁 Sport-specific training, ‘low impact’ sports

 

􀀁 The moments of force and functionality can be evaluated at around the 9th month,

    provided such evaluation is clinically justified (patient experiences no pain or

    swelling)

 

Range of motion

 

Full active and passive ROM

 

Load

 

Full load

 

Strength and function

 

Sport-specific training for ‘low impact’ sports (no pivoting sports and sports characterised by open skills)

Sport-specific training for ‘high impact’ sports not allowed, increase of strength training

 

Criteria for passage to phase 7

 

􀀁 Completion of phase 6

􀀁 No pain or swelling during ‘low impact’ sports

 

Phase 7 > 12 months postoperative

 

Background

 

Tissue reaches full maturation

 

Therapeutic aims during phase 7

 

􀀁 Sport-specific training, ‘high impact’ sports

􀀁 Return to ‘low impact’ sports

 

Range of motion

 

Full active and passive ROM

 

Load

 

Full load

 

Strength and function

 

-After month 12 Maximum muscle force exercises during complete ROM movements      and slow progression in plyometric load forms in the repaired zone

-Increase resistance training during ‘moderate impact’ activities

-Sport-specific training for ‘high impact’ sports

-‘Low impact’ sports allowed, provided joint homeostasis is maintained (no

  pain or swelling)

-Return to sport situation depending on: the type of sport, the patient’s

  level and medical guidelines

-Activities such as football, basketball, etc. can be started after 16 months

 or earlier if the patient has no pain and there is no swelling.

 

 

No return to ‘high impact’ sports without consent of treating physician