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Author Topic: Patella Mobes after LOA  (Read 3706 times)

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Offline Jakem

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Patella Mobes after LOA
« on: May 12, 2005, 11:07:26 AM »
I am going to have LOA arthroscopic surgery soon.  I have been told how critical it is to do Patella Mobes 5-10 times a day after the surgery.  I have a dumb question.  How can I do them with the dressing on.  How long do you typically have the dressing on after this type of surgery?  4 days?  Do you take the dressing off and put it back on 10 times a day?

Also I am being fitted in advance of the surgery with an extension brace.  How will I be able to wear it with the swelling and dressing on, i.e. will it still fit?

Offline kmack

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Re: Patella Mobes after LOA
« Reply #1 on: May 12, 2005, 02:12:19 PM »

If you are having it by Steady, this is how it works.  After surgery, they train you on cruthes and just do a little ROM.  Next day you go down to PT. There they take all the dressings off and do mobes.  The only dressing you are left with after this day is 3 gauze and a sock to hold it in place.  As far as the brace, if it is JAS, it fastens to the leg  thigh high, mid calf, and down by the ankle.



Keith

Offline stgiles16

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Re: Patella Mobes after LOA
« Reply #2 on: May 12, 2005, 02:15:39 PM »
I did not have to do patella mobs after my LOA but I assume that is because of the location of the scar tissue. Mine was in the fat pad and under the patella. I had patella baja which was corrected by the LOA but I always had good patella mobility (even when it was lower than it was supposed to be) I was in the hsopital for a few days for pt and they took my dressing off several times a day. Will you be staying in the hospital? I am sure that your OS or pt will tell you how to go about it.
good luck
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline Jaci

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Re: Patella Mobes after LOA
« Reply #3 on: May 12, 2005, 09:12:53 PM »
Jake,

Until I came to Vail for surgery and PT, no OS ever mentioned doing patellar mobes and my former PT only spent about 2 minutes on  them. When I asked my former PT for instruction on how to do mobes, all I was told "they're really hard to do on yourself." That was the extent of the instruction I received! I learned to do mobes by reading posts on this board. If you haven't already done so, use the search feature above to find some of the posts with instructions on how to do them.

As far as doing mobes in the immediate post-op period, it is possible to do them through the dressing unless it's really thick, but it is easier if remove the dressing. After my first LOA at home in CA, I unwrapped the Ace bandage and removed the dressing several times a day to do mobes. I was careful not to press directly on the incisions and always washed my hands really well beforehand. In addition to the patella, be sure to mobilize the patellar tendon and suprapatellar pouch area (above the knee cap). Just an FYI-- the dressing should be changed at least once a day. Unfortunately, most places don't tell you that until after your surgery so you don't have a chance to buy a box of gauze pads when you're doing your pre-surgery grocery shopping. (At SH they give you a "goody bag" with gauze pads, steri-strips, and a rubber shower sock.)

If you go to orthosupersite.com there is a short video in the video library with Dr. Steadman giving a talk on his principles of rehab. It includes a section on patellar mobilization. (Note: You'll have to register with the website to access the videos. The "Video library" heading is a little hard to find. It's toward the bottom of the homepage. Click on "Video Library" then about 2/3 down on page 1 of the list of videos you'll find "Rehabilitation and Results.") I'll also add this disclaimer: On the video, Dr. S discusses his principles for rehab and applies them to recovery from ACL surgery. Therefore, the underlying principles apply to arthrofibrosis, but the protocol does not.

Good luck on your surgery and recovery.

Jaci

« Last Edit: May 12, 2005, 09:31:40 PM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Jakem

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Re: Patella Mobes after LOA
« Reply #4 on: May 13, 2005, 01:01:06 AM »
Hi Jaci,

I appreciate the advice and I will do the same.  I will unwrap the dressing several times a day to do the patella mobes.  Since that appears to be the single most important thing you can do, I don't want to delay at all with it unless someone tells me otherwise.

Offline Nick_Knack

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Re: Patella Mobes after LOA
« Reply #5 on: May 13, 2005, 01:52:45 AM »
I think patellar mobes are way over-rated and you can waste a lot of time doing this.

Much more important is maintaining any gains surgery gave your for extension.


Age: 35
1989 rt ACL (+25 degrees ext loss)
1994 rt ACL resection (+ 10 deg)
2001 rt ACL revision (+ 10 deg)
2003 rt med meniscus repair (+10 deg)
2004 rt LOA and post capsulotmy (zero degrees)
2005 rt LOA and tib bone plug removal (even w/ other leg)
2006 rt Fulkerson TTT & ACI Carticel

Offline vlz

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Re: Patella Mobes after LOA
« Reply #6 on: May 13, 2005, 02:40:06 AM »
Sorry to be dense, Jaci, but when you talk about the video of Dr. Steadman, what do you mean by:

Quote
I'll also add this disclaimer: On the video, Dr. S discusses his principles for rehab and applies them to recovery from ACL surgery. Therefore, the underlying principles apply to arthrofibrosis, but the protocol does not.

Also, what's an LOA?  vlz

Offline Heather M.

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Re: Patella Mobes after LOA
« Reply #7 on: May 13, 2005, 04:08:02 AM »
Actually, I found that the patellar mobes were the single exercise that most helped me MAINTAIN my extension.  It pushes out the fluid that wants to accumulate under the kneecap, which in my case is an extension killer.  The protocols from the SH and CSM clinics are based around patellar mobes, so I would be extremely reluctant to blow them off.  They certainly can't hurt, unless you spend hours doing them...you can do too many, just as you can overdo anything.  I think it's important to realize that no one exercise is the most beneficial for every person--i.e. some people take away different things from different parts of the protocol.  I find the mobes and wall slides and bike to be the very most effective things for me.  I work extension into my wall slides, being sure to sit for 30-60 seconds between each flexion set in full hyper-extension.  I do not find heel slides to be particularly effective, and they hurt.  So do the pelvic tilts or bridges, with the thera-ball or without.  So I don't do them.  Everyone finds different things beneficial, so I'd try them all and keep what works for you.  With Dr. S., he's pretty flexible, but the mobes and wall slides are non-negotiable...everyone has to do them.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline favouritesearcher

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Re: Patella Mobes after LOA
« Reply #8 on: May 13, 2005, 04:25:08 AM »
Patellar mobes (how to do) are 6/10 of the way down this thread (the link within the thread doesn't work any more).

LOA = Lysis of Adhesions.

I think that patellar mobes are critical for success, as is maintaining or improving extension and flexing the knee (eg wall slides, CPM) to improve flexion, lubricate the joint properly, limit stiffness in the joint and help stop scar tissue reforming.  I regret not starting them for six days after my second operation because my kneecap seemed to become harder to move even in that short time.

The principles of rehab are basically the same for ACL recontruction and for arthrofibrosis, but the timing of the stages is quite different; ACL rehab is accellerated but athrofibrosis rehab is slow.  I think in both cases the basic principle is to keep the joint moving (eg patellar mobes, flexion), not to do anything which irritates it, and to keep the ligaments and muscles in good condition (eg extension).

John
Mar 04 - Tibial spine avulsion fracture (skiing). Open surgery to fix, 1 screw.  Max passive ROM 20-75, active ROM 30-45
Aug 04 - Diag. severe arthro. Scar tissue clean up (LOA, removal of scar tissue).
Feb 05 - Discharged from surgeon's care. ROM 3-125.
Apr 05 - Discharged from physio. Same ROM

Offline Jakem

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Re: Patella Mobes after LOA
« Reply #9 on: May 13, 2005, 04:43:06 PM »
Heather,

When did you start them on your recent surgury?  The same day?  The next day?  Did you have to remove the dressing to dot them?

Offline Jaci

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Re: Patella Mobes after LOA
« Reply #10 on: May 13, 2005, 06:13:21 PM »
vlz,

John answered your question pretty well. In addition, Dr. S talks about the stages of rehab. (I'm not sure if that's the exact term the he uses. I don't have high-speed access where I'm staying in Vail, so I'm doing this from memory.) According to Dr. S the stages are motion, mobility, aerobics, strength, power, eccentric loads, and full recovery.

The early stages focus on 'motion' and 'mobility.' With arthrofibrosis early post-op motion is passive and accomplished with CPM, wall slides, heel slides (primarily for flexion), and prone hangs, sitting with heel  propped, JAS brace (for extension). Various stretches for hamstring, calf, quad and Achielles tendon also contribute to ROM. Mobility is accomplished through patellar mobes.

Loss of quad function can be a huge problem after any surgery and can seriously compromise your recovery. SLR and quad sets are used to stimulate active quad response. 

The early stages of rehab for arthrofibrosis include use of crutches to reduce pain, irritation, and swelling. The use of crutches and extent of weight-bearing varies from one person to the next. In my case, I was only allowed to feather toe touch for two weeks then went to partial weight-bearing (20-30 lbs). Weight-bearing will gradually increase based on how well it is tolerated. Dr. S stresses that there is no hurry to get off crutches if doing so causes an increase in pain and swelling. With ACL surgery patients are encouraged to ditch the crutches as soon as possible. 

On the video Dr. S states patients feel better when they have aerobic exercise.For me stationary bike was added 1 week post-op for ROM and aerobic exercise. Unfortunately, I peddle so slow that I cannot even activate the computer on the bike, so I also use an upper body exerciser, a machine where you sort of peddle with your your hands and arms. Some people do single-leg rowing on a rowing machine with surgery leg off the machine and sliding on a sheet plexi-glass (stiff plastic).

Dr. S stresses that you can't move on to the strength training stage if you have a stiff, swollen, or inflamed knee. Keep in mind that with arthrofibrosis it can take many months to get to that stage. I've not gotten there yet, but some other people have. Laurie posted her entire post-op protocol including strength training.

The next stages, power, eccentric loads, and full recovery, include the same activities that Dr. S decribes on the video for ACL recon. As John pointed out, the difference is the time frame at which they occur. We've said this many times, but it bears repeating, swelling and inflamation are the mother of scar tissue. Add new activities one at a time and go back to the basics (early stages of rehab) if you have pain, swelling, or inflammation.

I think it's also important to state that the purpose of the LOA surgery and rehab is not to completely eliminate scar tissue. That's just not going to happen. The goal is to reduce the amount of scar tissue and control where and how it grows back so that it has less impact on knee function.

Time to get back on the CPM.

Jaci




 
« Last Edit: May 13, 2005, 08:25:07 PM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Laurie

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Re: Patella Mobes after LOA
« Reply #11 on: May 13, 2005, 09:01:36 PM »
In my case the dressing came off the next day after surgery.

I began patella mobs that next day.  My big dressing came off that day.  Then they gave me something to just cover up the portal holes.  It was not complicated and I didn't have to do anything to "undress" the knee.  Maybe your dr. is different.  With Complete ACL surgery, yes, you have the dressing on for a week or so, but with arthroscopic I did not.

Laurie :)
Laurie :)

Offline kmack

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Re: Patella Mobes after LOA
« Reply #12 on: May 20, 2005, 03:05:45 AM »
Is there a video of Dr. S ACL protocol, if so, how can I find it/ download it?

Offline vlz

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Re: Patella Mobes after LOA
« Reply #13 on: May 23, 2005, 09:19:33 PM »
Here's a quote from Jaci's post earlier in this thread with directions on how to access the video:

Quote
If you go to orthosupersite.com there is a short video in the video library with Dr. Steadman giving a talk on his principles of rehab. It includes a section on patellar mobilization. (Note: You'll have to register with the website to access the videos. The "Video library" heading is a little hard to find. It's toward the bottom of the homepage. Click on "Video Library" then about 2/3 down on page 1 of the list of videos you'll find "Rehabilitation and Results.") I'll also add this disclaimer: On the video, Dr. S discusses his principles for rehab and applies them to recovery from ACL surgery. Therefore, the underlying principles apply to arthrofibrosis, but the protocol does not.