Physiotherapy after Arthroscopy
Physiotherapy after arthroscopy is an essential part of the recovery process. The most common joints that undergo arthroscopy (i.e. a camera-based procedure of a joint) include the knee, shoulder, ankle, hip and elbow. Despite the heterogeneity of procedures within and across joints, there are key rehabilitation principles that can apply. Using knee arthroscopy as an example, important phases of physiotherapy include:
Prior to surgery, working with a physiotherapist to obtain full range of motion, minimizing swelling, and improving core and quadriceps strength are important predictors of the success of surgery. Examples of conditions where prehabilitation is not suggested is in the setting of bucket-handle meniscal tears or loose osteochondral bodies that cause locking.
- Early post-operative period
In the first few weeks following arthroscopy, the goal is to minimize inflammation, decrease swelling, regain range of motion and work on quadriceps strength. Weight-bearing status is affected by the exact procedure performed. Similarly, range of motion restrictions are influenced by procedure type. For example, after a microfracture (i.e. cartilage repair) or meniscal repair, flexion up to 90 degrees may be permitted in the first 4-6 weeks. In the setting of a partial excision of the meniscus, full weight-bearing and full motion is encouraged as soon as possible.
- Repair and Remodelling Phases
In the intermediate stages of recovery, improving gait, enhancing quadriceps strength and core strength, and gradually introducing activities is suggested. Once again, the sequence and timing of exercises and activities introduced is affected by the procedure. Simple knee arthroscopies with meniscal dedridement tend to result in resuming full activity within 4-10 weeks. After meniscal or cartilage repair, return to sports may not occur for at least six months. Despite which procedure has been performed, patients need to demonstrate full pain free range of motion, the absence of swelling, adequate quadriceps strength, and good technique and form for an sports specific endeavours before clearance for full physical activity is permitted. Working with a physiotherapist and orthopaedic surgeon for clearance is suggested prior to returning to high level activity.