Patients facing knee surgery — especially knee replacement surgery as well as surgery to reconstruct the ACL (anterior cruciate ligament) will benefit from Prehabilitation.
Prehabilitation involves getting your knee... and you ready for surgery. The stronger and more flexible you are heading into surgery, the stronger and more flexible you will be after the surgery — usually.
Prehabilitation for ACL Tears or Total Knee Replacements involves:
- reduce swelling
- retain range of motion
- retain muscle size and strength
- maintain cardiovascular fitness
After an Anterior Cruciate Ligament Injury (ACL injury), your first step is to get the swelling down. During the initial 48 hours, be sure to ice your injured knee for 15–20 minutes at least two to three times a day. While you’re icing your knee, keep your knee elevated above your heart as much as possible. To decrease inflammation, provide compression for your injured knee with a knee sleeve or ACE bandage — but not too tight!
In addition to reducing swelling with ice, elevation, and compression, you’ll want to REGAIN your range of motion and minimize the risk of muscle wasting or atrophy. Prehabilitation also improves your strength and maintains your cardiovascular fitness. To do this, you’ll need to keep exercising. Physical therapists and certified athletic trainers can work with you (with certain limitations) to create an individualized exercise plan that will help you prehabilitate your knee and minimize the risk of reinjuring it.
L M de Pasian
Dr. Luks, I just returned from my family MD’s office for a visit about occasional clicking in my knee. He concluded that I should see an orthopedist and do an MRI for what is probably a torn meniscus. My family MD said that if it’s a torn meniscus, it won’t heal on its own and would require surgery.
This injury came about when I tripped and fell on my knee a few weeks ago. Since then, I have little or no pain in that knee, just the occasional clicking and at times, a sense that the knee is unstable and might give way.
I am 66 years old, in good health, not overweight, physically active, and very wary of surgery. I tolerate pain since it’s part of getting old so minor pain would not compel me to surgery. The only reason I would do a surgery is to prevent the tear from worsening. What is your observation about a situation like this? Thank you and God bless you for your work.
Having surgery to prevent the tear from worsening has not proven to be a good reason if you have very little pain. The research shows it is likely best to rehab the knee and keep it strong. The research shows that knees that are operated on generally have a higher risk of developing arthritis.
Cristina
Dr. Luks, I tripped on the side walk and tore my meniscus. As a result, I tore my meniscus–knee. I have been on a soft brace for months because i wanted to avoid surgery…. It is so much better now as I walk without the brace but sometimes I feel a click on the inner part of the right knee. The doctors want to do meniscus repair surgery.And I would appreciate your opinion.
I have a friend who had meniscus tear repair and it isn/t working that well. I have an elderly doctor who was the surgeon for these team and he offered to repair my meniscus tear. I have been trying to take off the brace and see if I and begin to go without the soft brace. I am scared of surgery.. Do you have any thoughts suggestions?
They have scheduled surgery for next week, but I am hesitant to go into that procedure. What to you suggest kind doctor? I am unsure what would be best. My knee is now flexible and only rare times it clicks. Would appreciate your thoughts. Is surgery the only way? Will wait to hear from you. Cristina
HI Cristina. The thought of surgery is scary. For most of us, whether or not we have surgery is a quality of life decision. You choose to have the surgery because the knee pain is interfering with your quality of life.
Many people go on to live happy lives with occasional pain without meniscus surgery. Some patients have significant residual meniscus related pain after rest and PT and choose to have the surgery.
I can not make the decision for you… nor can I make formal recommendations for you in this format.
Good Luck
Howard Luks
carmen from Philippines
I am so impressed with your article and it somehow helped me understand my case…complex meniscus tear. When I saw an orthopedic surgeon in Davao and when he saw the MRI result 6 years ago, he advised me to have an immediate operation. I was doubtful even If I wanted to but decided not to. So I flew to Manila and saw 2 Orthos. one who was as aggresive as my first ortho surgeon and the other one was conservative. I chose the second conservative. He said , if there is nothing to fix , then surgery is not necesarry. The second doctor did the physical check up first, He twisted my leg and asked if it hurt and I said No. He did a lot of stretching and twisting but it didnt hurt. si he just recommended sone stretching. Tho it helped but when I exercise or Run for 40 mins, I can feel my knee was swolen inside and a little bit pain but more than anything, I can feel that my left knee is weaker than my right knee and I know that there is really something wrong with my knee. I can still do a lot of exercise, climb stairs or squat . I can still basically do everything without pain but I can feel discomfort and weaker knee after ky exercise eap when its using my knee too mych like squat or some exercise that I am not comfortable thwn I can feel the pain, tho its tolerable but I am worried If no one can really determine what is wrong with my knee or what kind of therPy will I be needing. If i may ask, how much do i have to prepare If i Plan to see you and whatever therapy might be needed for my case. I would appreciate If you can help me. Thank you
Hi Carmen..
Thank you for the kind comments ! I am humbled to be able to see so many people from across the globe in my office! My assistant would be more than happy to assist you. 914-789-2735 or [email protected]
/HJL
Dr a Chishti
Excellent article on meniscal injury
I have just sustained a medial meniscal tear which is radial in nature from trivial activity
I have pondered whether I should go straight for surgery but your article together with a discussion with y surgical colleague I have opted to have physio and then electively have surgery
Good choice… and good luck. BTW… radial tears in many circumstances can be repaired or sutured back together.
Sherie Litteral
I wish all doctors were like this doctor in wanting the patient to understand about the injury. In my case a meniscus tear. I went in to orthopedic surgeon after MRI showed tear, bakers cyst, arthritis, bursitis etc. and he told me nothing but that I needed the arthroscopic surgery to clean tear. He didn’t tell me where the tear is and he also started the beginning of the visit with telling me I would need a knee replacement in the future because of the arthritis. When I told him I thought I was improving in not limping so much he just ignored that. I mentioned that a chiropractor and a natural/m.d. told me it is possible that it could heal on it own, he told me they were liars. I wish this doctor on this website was close enough that I could go to him for a second opinion. I am on a blood thinner and must have clearance from my pulmonary doctor as this is not an easy task to get him to respond.. I really would like to try healing on its own if possible.
HI Sherie… It would be wise to try and avoid an operation… and it is unlikely an arthroscopy alone will help given your arthritis. Possible treatments to discuss with your doctor includes, injections, braces, medications, glucosamine, and physical therapy.
Good Luck