Step-By-Step Rehab Outlined for Knee ArthrofibrosisIt's still true that an ounce of prevention is worth a pound of cure. The prevention and early treatment of arthrofibrosis is a good example. Arthrofibrosis is scar tissue in a joint that keeps it from moving. It occurs most often in the knee after anterior cruciate ligament (ACL) repairs.
Arthrofibrosis is difficult to treat. This means that early recognition of the problem is important. Modern rehabilitation techniques for arthrofibrosis are the topic of this report. Doctors, athletic trainers, and physical therapists present the most up-to-date approach to this condition.
First, how do we prevent arthrofibrosis? The authors say don't do surgery when the knee doesn't have full motion, use good surgical technique, and start early with a rehab program. The next step is to catch problems early on. Doctors should watch for loss of motion after surgery. Again, early rehab is the key.
Physical therapists assess the entire knee. This includes movement of the kneecap (patella), the patellar tendon, and the quadriceps tendon. Any of these areas can get scarred down and in more than one direction. Treatment depends on the area involved, but may include bracing, mobilization, and exercise.
Doctors may release scar tissue and adhesions with an arthroscopic operation. The doctor uses a special tool to look inside the joint, find the problem, and correct it. Besides scarring, there can be tight connective tissue and pinching of the ligaments. For mild cases, the doctor may only perform a manipulation on the knee. This means the knee is moved and bent to help regain motion while the patient is under anesthesia.
Pain control is another important part of the program. Low pain levels help the patient start rehab early and move along quickly. Early motion keeps the cartilage and the joint moving smoothly. Passive motion is used to stretch the joint capsule and soft tissues. Some examples of passive motion are wall and heel slides. Wall slides are done by resting the back and buttocks against a wall with the feet away from the wall. The patient slowly bends the hips and knees as far as possible and holds the position. Heel slides can be done in the sitting position with the feet firmly planted on the floor. The patient slowly moves the buttocks forward on the chair without moving the feet, increasing knee flexion.
The rehab program can't go too far or too fast, or the patient ends up with more swelling and pain and less motion. The authors provide specific guidelines to follow for each stage of rehab. They describe the use of continuous passive motion (CPM), bracing, aquatherapy, and physical therapy. Use of the stationary bike, treadmill, and elastic bands are also discussed.
Peter J. Millett, MD, MSc, et al. Rehabilitation of the Arthrofibrotic Knee. In The American Journal of Orthopedics. November 2003. Vol. 32. No. 11. Pp. 531-538.
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