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Post-operative care: Patello-femoral surface

Weight Bearing:
• FULL WEIGHT BEARING is allowed in a hinged knee brace with the hinges set to allow 0 – 20 degrees flexion only for 6 weeks.

Movement of the knee joint:

• Early movement (flexion) of the knee is encouraged immediately following surgery and a CPM (Continuous Passive Motion) machine may be used.
• Alternatively a static bike can be used without load: 500 revolutions three times a day, out of the brace.
• The aim is to obtain full passive pain free range of movement as soon as possible

Exercises during first 6 weeks:
• Physiotherapy exercises commence during the postoperative phase with static quadriceps and hamstring exercises while working on range of movement using static bike, CPM and pool exercises.
• Weight should not be put through the knee cap part of the joint, in other words by taking weight on the bent knee. This is because, rather like avoiding walking on new grass, any greater load through the joint is likely to damage the healing tissue. Even though the knee may feel comfortable the weight must be kept of it to allow the new surface to mature.
• With the brace on, then strength training is allowed but only in the 0 – 20 degree range

From 6 weeks:

• The brace is removed and normal walking should be achieved.
• Weight on the involved leg is allowed as tolerated, but it must be limited to the angles of flexion that do not compress the treated surfaces.
• It is important for the physio to know the specific angles that need to be avoided, but often the patient will have been aware of a particular position that the knee cap used to cause pain or catching.
• After six weeks a gradual increase in exercise activity is allowed building up to commencing impact type activities at 4 – 6 months.
• For the patello femoral joint specific closed chain exercises are used to strengthen the muscles controlling the patella without overloading the new surface.
• It is expected that the repair tissue will gradually mature and improve over six to nine months from surgery.

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