2 months status post chondroplasty and removal of my Right medial femoral condyle

[decadon]

I was looking for tips on starting leg training...
i have been using a recumbant bike and start bar squats and one plate leg press...i am staying away from the leg extension machine...

any tips to this rehab...physical therapy is 35 each appt and they want me there 3x a week...simply cant afford it !!!!
thanks
decadon

[archive_Killer]

What the heck did you do to need your femoral condyle removed? Any restrictions put on you by your ortho?

Let me do a little research on this. But, def start stretching right away - quads, hams, calves, hip flexor, IT band... everything.

[decadon]

i had a subchondral fracture...which presented like a meniscal tear with a locked joint....most likely a small fracture that happenned in my teens that slowly progressed to it breaking free from the rest of my femur...so he removed it and drilled holes in my femur
couldnt walk for a month....sucked...

[archive_Killer]

A little info on chondroplasy (although you are 8 weeks post op)


Sometimes during arthroscopy of joints, arthritis or surface defects are discovered. If the patient is the correct age and the lesion or problem is just right for the procedure, a "chondroplasty" is done.

In addition to the other work of removing any uneven surfaces and tears of the menisci or loose fragments from the knee joint itself, the articular surface of the joint can have significant arthritis. The operation that might be performed is to drill holes in this area of arthritis and create tiny little "microfractures" to promote healing and a scar tissue response.

The white shiny cartilage on the end of the bone is called Hylan cartilage. Hylan cartilage is the healthy, fairly normal appearing white shiny surface that allows the surfaces to meld together smoothly while at the same time creating a very low friction surface. Another important component of Hylan cartilage is to be a shock absorber for the knee. The shock absorber pads the bony surfaces so that when you jump, run or twist you have some padding that prevents injury to the bone.

In cases of arthritis or chondral surface injury, the padded surface or white shiny surface that is know as Hylan cartilage, is injured or partially absent. In order to make up for this problem, the surface can be drilled and bleeding can be made to occur. It is important to know that the white shiny cartilage does not have a blood supply so it will not heal on its own. What we do know is that if you create a bleeding "micro fractured" bone just underneath the area of injury, that an excellent healing response can occur. Scar tissue then grows in and around this region and fills in the gap a lot like a "windshield patch job".

Once the scar tissue has grown into the area of surface injury, it is important to grow some cartilage cells within the scar tissue matrix. Imagine that this surface of the bone is filled in with an interwoven fabric-like material called collagen. Some cells can grow inside this interwoven fabric and provide an even better tissue. The synovial fluid is where the cartilage gets its nutrition. The more synovial fluid that presents itself to that surface of the new tissue that is growing, the more cartilage cells will grow inside the soft tissue matrix. The formation of this new scar cartilage or fibrous cartilage as it is more formally known is important in the process of healing of your knee.

We can not change the natural outcome or arthritis, nor can we cure arthritis. What we hope to do by performing with the chondroplasty is to delay progression of arthritis significantly so that the time before you develop profound arthritis is much longer. The way that you can grow fibrocartilage best is to create as much new synovial fluid with new nutrition as possible and present it to the surface of the scar tissue that is growing from the operation that you have. How can we accomplish this?

Synovial fluid is made by the cells that make up the lining of the joint. In order for new synovial fluid to manufactured there has to be an exit of the old synovial fluid. Synovial fluid leaves the knee throughout the mechanical motion of the knee moving. Using a stationary bicycle and riding it slowly at 15 minute intervals for at least 2 hours daily is one way to "squish out" the old knee fluid and allow the new knee fluid to present itself to the scar tissue. Joint motion following injury is extremely important in the healing and rehabilitation of the injured extremity. One reason that this is so important is that the joints must move in order to remain healthy and have good nutrition to the end of the cartilage. Good nutrition to the end of the fibrous tissue is also important and new synovial fluid must be remanufactured. This is why you must ride a stationary bike for 2 hours daily at 15 or 20-minute intervals.

It is not important to ride the bike rapidly. In fact, you can ride the bike very slowly while bending and straightening the knee at an extremely slow pace while watching T.V. Just the knee motion that is important and the time of knee motion that is important, not necessarily the muscular action.

Another important thing that you can do to promote healing of your knee is to stay non-weight bearing on crutches for a period of 4 weeks at least. The post operative instructions on weight bearing may vary from patient to patient. We need to understand that the bone has been "micro fractured" and so it will take a period of months to fully negotiate a remodeled tissue complex. It is extremely important to not walk on this joint that has been treated with a chondroplasty for the initial phases because the bone is healing because it has truly been "micro fractured". To walk on this area is to commit the operation to failure so cooperation in a non-weight bearing status is extremely important.

Keeping the muscles pliable and intact by doing the Range of Motion on the bicycle is also important. It is also important to keep the quadriceps muscle strong as possible. Straight leg raising (keeping the knee straight in a sitting position and moving the leg up and down several hundred times 2 to 3 times daily) is also important to keep the muscles from becoming atrophic. Further therapies may be ordered as necessary.

What can you expect with time? What we know about this process is that it may improve your knee significantly to have cartilage fragments and loose fragments removed. It may also delay the progression of arthritis significantly to have an area of chondroplasty. In most cases, the operation is successful and helpful but it usually does not promote the complete healing of knee arthritis. In other words, there is no real cure for arthritis. Furthermore, it is important to realize that this operation of chondroplasty is really a "delay of game tactic". By having a chondroplasty we hope to put off a total knee or other more serious operations until a much later date than would naturally be present had we not done the operation.

What else can you do to improve your knee and help promote a long life of your natural before a new knee is required? It would be important to understand that arthritis is really incurable. There is some evidence to suggest that Glucosamine 1500-mg daily may be beneficial. Non steroidal anti-inflammatory medications will help with the pain and diminish the inflammation but must be monitored carefully with your physician for liver and kidney problems over the long haul. Unfortunately, nonsteroidal medicines will not cure arthritis either.

We can also administer Synvisc injections, a Hyaluronic acid derivative, which may improve your knee for some period of time.

Multiple options exist for the treatment of the articular surface damaged knee. One operation called "chondroplasty" is one of the goal standards of therapy, but it requires that you do your bicycle exercises and stay non-weight bearing for at least 4 weeks. A brace may or may not be ordered as well. Be sure and check with you doctor to check for any variability in your problem and whether this plan will be good for you.

[archive_Killer]

A good read for knee rehab. Pretty much all knee rehab is generally the same, just different exercise time frame for different injuries. Start slow with the exercises and progress as pain tolerates. Hit the stretches, cannot say that enough. Of course always ice after. I you want, you could throw on a hot wet pack beofre exercise, but it is not mandatory. Also remember to massage (roll the skin between fingers) over any scars/portals. This will help re-align the scar tissue. Obviously, you are already into the strengthening phase.


PRINCIPLES OF REHABILITATION
If you can understand what the PT is trying to achieve, then the whole rehabilitation programme becomes more challenging. Each of you will be at a different stage in the management of your knee. Walk through these principles and try and establish your own starting point. It may be necessary with re-injury to go back some steps.


EARLY

RESTORE COMFORT

R.I.C.E. (P.R.I.C.E.)
(protection, rest, ice, compression, elevation)

REDUCE INFLAMMATION

ice after injury or exercise. Remember that ice from the freezer is at -20C whereas ice from the refrigerator is not nearly as cold as this. Protect your skin with a towel if you use ice, peas or packs from the freezer.
non-steroidal anti inflammatory tablets or gel (NSAIDS)

REDUCE PAIN

rest is important in the early stage for a day or two after the first injury, after any re-injury and later after any over-exercise.
analgesic tablets (pain-killers are different from anti-inflammatories)
REDUCE SWELLING

elasticised bandage or sleeve or eoprene-type support sleeves
elevation


REFER COMPLICATIONS EARLY

LOCAL INFECTION

redness
local soreness in wound
pus or discharge
INTERNAL JOINT INFECTION

feeling unwell
shivery
high temperature
joint hot and/or red
DEEP VEIN THROMBOSIS (CLOT)

calf tenderness
swelling of calf
breathlessness


PREVENT THE QUADS WASTING

quads isometric exercises
static quads
short arc extensions

MAINTAIN PASSIVE RANGE OF MOTION TO PREVENT INTERNAL ADHESIONS & STIFFNESS

assisted passive stretches
portal massage after arthroscopy
patellar mobilisations (passive)




INTERMEDIATE

START ACTIVE MOBILISATION BUT AVOID NEGATIVE FEEDBACK LOOPS (QUADS INHIBITION)

avoid exercising 'through the pain' (painful arcs). Work in the pain-free range.
follow a graduated sequence of therapy (eg. short arc extensions graduating to straight leg raises, half squats graduating to full squats, five repetitions graduating to 10 reps, without weights graduating to with weights)
if discomfort gets much worse, go back a step with exercise, eg back to half squats from full squats, reduce reps, reduce weights etc.


ACTIVELY STRENGTHEN THE MUSCLES

ACTIVELY STRENGTHEN QUADS
straight leg raises
step ups
build up graduated sequences with more reps and with graduated weights
ACTIVELY STREGTHEN VMO (part of quads)
wall slides
cross-over scissor steps
side step-ups and step-downs
ACTIVELY STRENGTHEN HAMSTRINGS

leg curls
resisted leg curls with Theraband or assistant
leg curls with weights
more reps
ACTIVELY STRENGTHEN ADDUCTORS & ABDUCTORS
resisted abductions (leg out to side) (ask PT for Theraband - big elastic bands)
resisted adductions (leg into middle from side)


ACTIVELY INCREASE RANGE OF MOTION AND STRENGTH IN A PROGRESSIVE SEQUENCE

TWO-LEGGED FIRST

short squats progressing to
full squats progressing
assisted extensions to
non assisted extensions to
resisted extensions
PROGRESS TO ONE-LEGGED

partial lunges to
stationary lunges to
full lunges to
one-legged partial squats
assisted extensions to
non assisted extensions to
resisted extensions


RESTORE PROPRIOCEPTION (internal joint 'awareness')

wobble board
mini-trampoline
being pushed gently off axis


MINIMISE SECONDARY EFFECTS OF
A DISORDED KNEE

BE MINDFUL OF GAIT

consciously correct limp
exercise hips and back
active stretches




ADVANCED


SPORTS-SPECIFIC EXERCISE

take advice about your sport and how to prevent further injury
always warm up well and cool down slowly
active STRETCHES before exercise (esp. hamstrings, ilio-tibial band)
make the exercise regime sports specific



PREVENT FURTHER DAMAGE

UNDERSTAND YOUR INJURY

the consequences of a neglected bucket-handle tear
the consequences of a neglected ACL
UNDERSTAND ASSOCIATED CONDITIONS

chondral defects & loose bodies go together
osteochondritis dissecans and loose bodies go together
ACL tears & meniscal tears go together
baker's cysts and other internal derangements go together
chondromalacia and patellar tracking problems go together
UNDERSTAND THE CONSEQUENCES OF INAPPROPRIATE TREATMENT OR NEGLECT

neglected knee conditions nearly all end up in arthritis


BE WATCHFUL FOR UGLY LONG TERM PROBLEMS (REFER TO SURGEON)

R.S.D. (reflex sympathetic dystrophy)

persistent inappropriate pain
profound inappropriate wasting
usually a highly anxious personality
KHELOIDS

inappropriately thick and itchy scars




knee, knee, knee, knee, rehab, rehab, rehab, rehab, rehab, rehabilitation,

[archive_Killer]

Oh, I would also recommend that you take the glucosamine/chondrosin mix. Without a femoral condyle, I would think you might cause some abnormal wear and tear on your hyline cartlidge. Bone on bone is not to fun.