1

Volume

PHYSICAL THERAPY

Emphasizing on the Knee Post-OP

Administrati
ve Direction
Manual

T E C H N I C A L C O M M U N I C AT I O N S

University of Texas at El Paso

Joel Silva Physical Therapist

Christina Martinez Public Health
Ray Banuelos Social Worker

Miners Publisher
500 West University Ave Suite 100
El Paso, TX 79968
Phone 915.747.5000

Table of Content
Geting to know your Knee....................................................1
The anatomy of the Knee......................................................1
Bones of the Knee.................................................................2
Ligaments of the Knee..........................................................2
Causes and symptoms of Knee pain.....................................2
Knee pain symptoms.............................................................3
Surgery types.......................................................................3
Arthroscopic Meniscus repair ....................................3
Meniscus Transplant....3
Casting and Post-Op Care.....3
Cast Care.........3
Time care for healing4
Intercultural Aspect..5
Index7

D E S I G N

C U S T O M I Z AT I O N

1
Volume

Basic Post-Operation Knee Manual

Getting to Know Your Knee

our knee is one of the most important joints in your body. It is a major "weight-

bearing" jointwhich means it helps support your body's weight. It plays a role in
almost all of your movements. The way your knee bends back and forth is a lot like
a hinge on a door. Part of it also rotates whenever you bend it (this is called
"flexion") and straighten it (this is called "extension").

The anatomy
knee

of the

Your knee is made up of four

the Knee: Bones, Ligaments,
Tendons

parts: Anatomy of
Cartilage
and

Bones
Ligaments
Cartilage
Tendons

D E S I G N

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Bones of the knee

The bones of the knee are The femur (thighbone)
The tibia (shinbone)
The patella (kneecap)
The femur and tibia meet to form a hinge with the patella in front of them, which
provides protection for the joint. The patella moves in a sliding action up and down
in a groove in the femur called the femoral groove. The sliding occurs whenever
you bend or straighten your knee.

Ligaments of the knee

The job of the ligaments is to make sure all parts of the
knee are held together and kept stable. The medial
(inner) collateral ligament (MCL) and lateral (outer)
collateral ligament (LCL) limit sideways motion of the
knee The posterior and anterior cruciate ligaments
(PCL and ACL) limit forward motion of the knee The
stability provided by these ligaments is very important;
without it, you would feel that your knee is simply
giving out from under you.

Causes and symptoms of knee pain

Knee pain is very common. In fact, 33% of people in the United States over the age
of 45 report some form of knee pain.
There are many causes of knee pain: Injuries, often due to sports

D E S I G N

C U S T O M I Z AT I O N

Some medical conditions such as arthritis, gout, infection, and inflammation

Knee osteoarthritis is a major cause of knee pain

Knee pain symptoms

The symptoms and intensity of knee pain can be divided into three groups:

Starting Procedure
SURGERY TYPES:
Arthroscopic Meniscus Repair:
Is a minimally invasive method to repair torn cartilage. There are
different types of meniscus tears that either occurs in a
horizontal or vertical direction or a combination of both.
Although surgery is to preserve healthy meniscus tissue, many
types are not repairable. Most common tears are common in
active sports which require cutting and pivoting. It is estimated
that there are 850,000 surgeries performed each year in the
United States. Anti-inflammatory medications, taken by mouth or
injected into the knee reduce pain and swelling symptoms but do
not improve healing.

Meniscus Transplant:
Meniscus Transplantation is a reasonable treatment option for
some patients with specific types of knee pain. The problem is
that only a small number of patients have the option for this
procedure. This transplantation or placing cartilage from a
cadaver donor has become a possible treatment for patients with
a specific pattern of knee pain. This attempt for surgeries is to
preserve the meniscus surgically; unfortunately not all meniscus
tears are amenable to repair. In some cases the best treatment
for a damaged meniscus is to remove it entirely.

Casting and Post-Op Care:

After surgery of the knee has been completed, a leg cylinder
cast is applied from the upper thigh to the ankle. This type of
cast is used on patients for knee or lower leg fractures, knee
dislocations or after leg or knee surgery. There are two types
of casts. Plaster is white in color. Fiberglass comes in a variety
of colors, patterns and designs. Cotton and other synthetic

materials are used to line the inside of the cast to make it soft
and to provide padding around the affected area. Special
waterproof cast liners may be used under a fiberglass cast
allowing it to get wet while showering or other activities that
involve water.

Cast Care
Cast care instructions include keeping the cast clean and dry
(plaster), checking for any cracks or breaks around the cast. It
is important to never insert any objects inside the cast such as
hangers, pens, pencils or any sharp object that might break
the skin open when itching occurs or any discomfort. Avoid
putting powder or lotion inside the cast, this could cause the
cast to get soft and tear. To decrease any swelling, elevate the
cast above heart level.

Time Frame for Healing

How long will it take to recover from knee
surgery is a common question most patients
ask after their knee surgery. There are many
factors that can affect the length of time it
takes to recover but a patient in most cases
can return to a normal life within 3-6 months
after the procedure.
There are two recovery stages, Short-Term and Long-Term.
A Short-Term recovery involves stages such as the ability to get
out of the hospital bed and be discharged from the hospital. On
first two days after the knee replacement, the patients are given
a walker to stabilize them. After the third day most patients are
discharged barring any complications from the surgery and
recovery. The Short-Term recovery for a total knee replacement
is about 12 weeks.
A Long-Term recovery involves complete healing of the surgical
wounds and internal soft tissues to be able to return to daily

living activities and work or when the patient feels normal again.
There a number of contributing factors that influences recovery
such as a positive attitude, the expectation that the future is
going to be bright and having a strong support network. It is
extremely important that the patient start rehabilitation
exercises to strengthen the muscles around the knee to get as
close as a full Range-of-Motion in the joint as possible. A full
Range-of-Motion in the knee means the patient should be able to
bend the knee from 0 degrees (straight) to 130 degrees (bent)
and straighten it from 120 degrees (bent) back to 0 degrees
(straight).
Range-of-Motion exercises for the knee include Heel Slides,
Wall Slides and Seated Scoots for soft tissue structures on the
front of the knee quadriceps.
Strengthening Exercises for the knee include Quad Sets,
Hamstring Sets, Knee Extensions and Hamstring Curls.
It is important that any exercises should be done only by the
direction of your doctor or therapist. Some exercises are used to
help control pain and help with movement in the knee. The
therapist may choose tools or modalities to help control the
symptoms the patient may have from the knee surgery. Rest is
an important part of treatment, Ice makes the blood vessels in
the sore area become narrower and Heat makes blood vessels
get larger that helps flush away chemicals that are making the
patients knee hurt and it also helps bring in nutrients and oxygen
which help the area heal.

Intercultural Aspect
Cultural differences have a bearing on health and can influence
the effectiveness of treatment. It is possible to compare different
cultures using the criteria of power distance, Individualism
collectivism, masculinity-femininity and uncertainty avoidance.
Cultural differences are important because they can influence
the effectiveness of you functioning as a physical therapist in

another
country,
or
your
cooperation with nationals from
other countries. Culture influences
the expectations we have of people
in particular roles. Many expatriates
have found that out the hard way. We
may expect other people to be open
to our point of view, to understand that we don't have a ready
answer to all questions, to be motivated by a challenging task,
but we may be mistaken. Conversely, if we don't live up to the
expectations of others, relationships can quickly become very
tense, and it may be difficult to change that subsequently. Some
examples of the ways in which expectations can clash are given
later in this paper.
Often, stereotyping can lead to incorrect assumptions
which can lead to improper care. To avoid stereotyping, everyone
should be treated as an individual from the start and nothing
less. Johnette Meadows, of the American Physical Therapy
Association, some years ago voiced a strong opinion on this
issue. According to her there is no set approach to providing
culturally sensitive care, because everybody is an individual. She
said: I would never attempt to give anybody a book on how to
treat an entire race or ethnic group, because that is racist. How
do you treat an African-American? Well you treat him like a
human being, and from there you go where you need to go
(quoted in Federwisch, 1996).

Post-Operation Follow-Up
Remember, all surgical procedures have recovery time
involved. Following the patients rehabilitation protocol it is an
important investment in your patient and their future abilities.
No matter what kind of rehabilitation is prescribed, its
important to follow it exactly.

Post-Surgery Follow-up

Most surgeons will require routine follow-up visits, generally

at 2, 4, and/or 6 weeks, 3 months, and 6 months.

Leg Brace
Its recommend that a
leg brace is worn for the
first two to four weeks
even while you sleep.
Bracing the leg protects
it from movements that
might injure the knee
more, including twisting
and turning. The brace
should only be taken off
when using the CPM
(continuous passive motion) machine or during other physical
therapy.

Physical Therapy
As the doctor, you will send the patient home with specific
physical therapy exercises, as well as a list of dos and donts,
and crutches. You can also issue a CPM machine if needed,
which helps restore motion in the knee.

Pain Management
The first week after surgery is usually the most
uncomfortable; as the doctor you will discuss your patients
individual pain management in more detail. After the first
week, medication may be only necessary before physical
therapy exercises and at bedtime.

Normal Activity
While the length of your recovery depends on many factors,
most patients can perform normal activities like walking or
driving relatively quickly. How soon you can return to work or
other activities depends on how much stress those activities
place on your healing knee. Patients may return to various
sport activities as progression in rehabilitation and cartilage
healing allows.

Glossary
Arthroscopic
A thin flexible fiber optic scope which is introduced into a joint space through
a small incision in order to carry out diagnostic and treatment procedures within the
joint.
Bone
The hard connective tissue forming the substance of the skeleton of most
vertebrates composed of a collagen-rich organic matrix impregnated with calcium,
phosphate, and other minerals.
Cartilage
Firm, rubbery tissue that cushions bones at joints. A flexible kind of cartilage
makes up other parts of the body, such as the larynx and the outside of the ears. (Pg.?)
Cast
A protective shell of fiberglass, plastic, or plaster, and bandage that is molded
to protect broken or fractured limb(s) as it heals.
Knee
The knee is a joint which has three parts. The thigh bone (femur) meets the
large shin bone (tibia) to form the main knee joint. This joint has an inner (medial) and
an outer (lateral) compartment.
Kneecap
The patella, the small bone in the front of the knee. The patella is a little
(sesamoid) bone, embedded in the tendon of the quadriceps muscle.
Ligament
A band of tissue, usually white and fibrous, serving to connect bones, hold
organs in place, etc.
Meniscus
The word meniscus comes from the Greek and refers to a crescent-shaped
structure. Today a meniscus is something that is shaped like a crescent moon or a
croissant pastry.

Physical Therapy
A branch of rehabilitative health that uses specially designed exercises and
equipment to help patients regain or improve their physical abilities. Abbreviated PT.
PT is appropriate for many types of patients, from infants born with musculoskeletal
birth defects, to adults suffering from sciatica or after effects of injury or surgery, to
elderly post stroke patients.
Range-of-Motion
The full movement potential of a joint, usually its range of flexion and
extension. For example, a knee might lack 10 degrees of full extension due to injury.

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