Knee surgery is one of the most demanded procedures among orthopedic operations. There are many reasons why your knee ceased functioning normally and depending on them you may need different treatment. Specialized orthopedic and trauma centers in Germany offer to their patients various interventional and non invasive methods depending on kind and degree of disease or traumatic condition.
Knee surgery is quite common and does not require any specific conditions. You need to have an operating field prepared and be ready for anesthesia.
The following types of anesthesia are used for knee surgery: endotracheal, intravenous, conduction, and spinal anesthesia. Regional anesthesia with anesthetics like Novocain or Lidocaine can also be used, but it is less common. A proper type of anesthesia is considered based on the surgery type and its extent. Minimally invasive interventions are most often performed under conduction or spinal anesthesia. But whenthe knee joint is replaced, general anesthesiawith muscle relaxants is more suitable, in order to provide easier access to the site of surgery.
Tip: Be serious about choosing the right anesthesia type to ensure minimal negative impact of medications on the body, as you need to reserve all its energy for recovering from surgery. Doctors should not just agree with those patients who often ask for general anesthesia,even with minor interventions, because medications anesthetics can dramatically weaken even a young and healthy body, not to mention the patients with chronic pathologies, and those over 60 years of age.
Arthritis is a main enemy of the joints. If you open Medical Encyclopedia you can find a few dozen of types of the disease. Osteoarthritis and rheumatic arthritis are the most common of them causing degenerative changes of the joints.
Osteoarthritis is a condition when cartilage, which is natural damper of our joints, wears out and reduces in sizes causing the bones rubbing against each other, which produces pain, swelling and stiffness. If you have knee osteoarthritis you may experience continuous pain when moving, climbing stairs and even sitting or lying. Mild osteoarthritis can be treated with conservative methods but from moderate to severe stages surgery is often recommended option.
Osteotomy is cutting and alignment of the bone that allow to balance pressure in the knee joint and get rid of pain. The procedure is normally recommended for patients from mild to moderate degree of the disease, especially for those who have the joint affected only from one side and who are too young to have total knee replacement. It helps to support natural function of knee joint and increase its lifespan. Sometimes reshaping and shifting of the bone helps delaying replacement surgery for years.
When your knee joint severe worn out, you have persistent pain and traditional treatment is not effective you may need total or partial knee replacement. Knee replacement surgery is a leader among replacement surgeries worldwide. Modern technologies allow replacing your degenerative joint with implant of your choice that gives immediate relieve and significant symptom reducing.
Some patients may need revision surgery, which as a rule require for replacing old prosthesis with new and modern one. In this case, it is necessary not only to change joint implants but also to clean everything around, especially, when patients have old metal prosthesis that gives debris.
Arthritis is not the only reason for restorative knee surgery, as many problems are caused with injuries and other damages such as permanent overloading of the joints as result of intense sportive exercises.
Torn Ligaments Surgery
Torn ligament is a problem of athletes but also they can be result of any other accident. There are four ligaments around knee joint and all of them may need reconstructive surgery. Anterior cruciate ligament (ACL) is a most often candidate for the surgery which can be done both with classic surgery and minimally invasive methods.
Microfracture Knee Surgery
Microfracture surgery is one of the modern methods to restore torn meniscus. Traditionally, damaged meniscus is cut but presently many surgeons in Germany apply a technique stimulating natural growth of cartilage. It is possible by drilling micro fractures in the bone that provoke build of new cartilage.
Knee Joint Puncture
Puncture of the knee joint is one of the simplest procedures on the knee. It is performed for arthrocentesis, or collecting a sample of synovial liquid, which is further used for diagnosis, and to administer drugs directly to the site of the problem. Puncture is performed under local anesthesia with a special needle.
A knee injection is not a difficult procedure. It is performed in a treatment roomon a couch, in a sterile environment. In any case, the procedure should only be done by a doctor who knows exactly how and where to introduce the needle for a therapeutic or diagnostic puncture.
Indications for Knee Puncture
Knee joint puncture is used to:
- Remove blood accumulated due to hemarthrosis
- Remove pus or exudate from the knee joint cavity
- Introduce an antibiotic that will help to eliminate an inflammation caused by bacteria
- Inject anestheticand painlessly fix joint dislocation;
- Introduce air into the knee, which may help to eliminate adhesion and restore motor function
- Introduce a corticosteroid to relieve arthritis.
A doctor can decide if puncture is advisable only after complete examination of the knee joint.
When puncture is contraindicated
A doctor should not do a procedure if any wounds, rashes, and plaques indicating psoriasis are present at the spot where a needle is to be introduced.
Performing jointpuncture in despite of these signs can lead to severe joint infection.
Puncture is also contraindicated in people with bleeding. If a patient with this disease has strong indications for knee puncture, he or she should receive some medications before the procedure.
Puncture for Diagnosis
In some cases, puncture helps to accurately and correctly establish a diagnosis. A doctor puts a needle into the joint and extracts fluid substance from the articular cavity. This liquid is examined to determine the nature of the inflammatory process.
Diagnostic puncture is performed in order to find:
- If any “joint mouse” or “rice bodies” are in the joint
- If the meniscus is damaged
- If any accumulation in the knee during the inflammatory process after getting an injury.
In order to diagnose meniscus damage, oxygen is injected into the joint under high pressure.
When pus, blood or exudate is discovered in the knee with the help of a knee injection, it is possible to treat it immediately. First, the discharge is removed, then, the joint capsule is washed and a medication is administered.
Puncture for Therapeutic Purposes
Puncture of the knee is used not only for diagnosis, but also for treatment. Treatment of knee joint disorderscan be much more effectiveand safe when medications are delivered into the joint. For example, in case of oral drug administration, there may be side effects of the digestive system. Topical ointments may be less effective, as they are not completely absorbed into the tissues and assimilated in the body. For treatment of knee disorders, a medication is injected with a needle directly into the affected area. If blood or pus accumulates in the knee, they can be removed with a syringe in seconds.
Therapeutic puncture is done to:
- Remove the blood accumulated in the joint cavity as a result of hemorrhage or injury
- Injectantibiotics to relieve inflammation in the joint
- Introduce anesthetics to correcta joint dislocation without pain
- Introduce oxygen into the knee to restore the motor activity of the knee joint
If puncture has not been performed timely, a hematoma will dissolve slower and itcan lead to knee inflammation with fever and overall deterioration of a patient’s health.
Joint Puncture Explained Step-by-Step
Thanks to the knee anatomy– the patellais located slightly forward – the procedure is very simple and easy. A patient lies on his back with a tight bolsterunder the knee. From the lateral side, a needle is inserted at the middle part of the patella to the depth 3cm. If a puncture is done to the lower part of the joint, the procedure will be painful. The technique of puncture has its own nuances.
Before the procedure, the knee is disinfected. Skin is treated with a solution of iodine and alcohol.
- To introduce oxygen, use a thin needle – 1 mm in diameter. To remove pus or blood you need a needle with a diameter at least2 mm.
- The skin at the injection site should be stretched aside to prevent infection from getting into the blood.
- The needle should be moved slowly until it reaches the articular capsule. After it is also punctured, the needle will move easier. In order not to damage articular cartilage,the needle should not be injected deeper than 3 cm.
- Depending on the type of procedure, medication is injected into the joint or liquid is aspirated from the articular cavity with a syringe witha volume from 10 to 20 grams.
- At the end of the procedure, the puncture site should be wiped with a sterile napkin; a tight bandage is applied on top.
Puncture is a specific procedure, so it is very dangerous for health and knee mobility if you try to perform it by yourself.
Knee Ligament Surgery
Ligament repair is required when ligaments are torn or damaged. You may need stitching with special suture materials. Ruptures can occur with dislocationsand fractures.
First aid if you got an accident: if you suspect a torn ligament, before meeting a doctor, give rest to your knee: to restrict movements in the joint is necessary to get rid an edema, reduce pain and prevent further injuring. Bandaging is also useful. It is very important to apply cold in the very first moments after an injury. This narrows the blood vessels, reducing edema and hemorrhage to the inner tissues.
Anterior Cruciate Ligament Tear
Most often, anterior cruciate ligament (ACL) is torn.
Conservative Treatment for torn ACL
With a complete tear of the ligament, this kind of treatment is not highly effective, but it can be assigned in elderly patients if the joint is relatively stable.
Usually,a treatment course includes:
- Electrotherapy (Functional Electric Stimulation (FES), InterferentialTherapy, etc.) or ultrasound therapy (Phonophoresis) for 10 days (a standard course includes 10 procedures, and it is important to receive them without gaps) to eliminate pain and swelling and prepare the joint for exercise therapy.
- Compresses with ointments(e.g., Lyoton, Voltaren).
- Massage to reduce pain and swelling.
- Physical exercises:at the beginning, withlow intensity andwithout direct pressureto the joint (for example, lying exercises), and, then,more intense exercises to build musclesaround the knee, and strengthen the thigh muscles and lower leg muscles.
The recovery time is approximately 1.5-2 months of regular workouts, but,again, everything depends on the gender and age of the patient, and individual features of the body.
Surgical Treatment for torn ACLis performed up to one week after an injury or six weeks after. This is becausea hematoma is formed within one week after an accident and a lot of blood accumulates in the joint, which complicates surgery.
In essence: a graft (a new ligament) is fixed in the knee joint with titanium screws. Tissues for transplantation can be obtained from several sources. Most often, the graft is taken from the patellar ligament that is located between the patella and tibia. The tendons of the posterior thigh also can be used for the graft.Sometimes, the tendon of the quadriceps muscle,located between the patella and femur, is used, which makes the treatment of the torn ACL somewhat more physiological.
Ligament reconstruction can be performed using open access or with an arthroscope, an endoscopic device that allows less traumatic surgical interventions.
Arthroscopy for ACL repairincludes the following:incision or puncturing tissues; introducingsurgical tools and a camera; cleaning the joint; removingthe torn ligament andcutting the meniscus; taking a graft for a new ligament;makingthenew ligament; fixing the ligament in the joint.
Here you can find a more extended description:
- For arthroscopic surgery, a spinal anesthesiais usually used.Although medication is injected into the spinal canal, this method is absolutely safe, despite myths about “the risk of spinal column damage and, as a consequence, paralysis”that have no any scientific basis.
- Cleaning the joint. When a trauma occurs inside of the joint, ligaments are torn. And when the ligaments are ruptured, the meniscus is often also damaged and has to be cut during surgery to remove torn edges. The old ligament and other unnecessary fibers are “nipped off” by a special tool, releasing a space in the joint.
- The types of the new ligament:made from the patient’s own tissues (it can be taken from the tendons of the inner thigh or from the patellar ligament); combined (made from lavsan and biological tendons or ligaments); completely artificial (from lavsan). Only a doctor can decide on the type of the ligament, and his choice depends on the weight and age of the patient, and his life activities.
- The ligament is fixed with titanium bolts, with one end of the ligament attached to the femur, and another one– to the tibia.
Surgery duration and how long you stay in a hospital: the surgery lasts no more than 1.5 hours. After this, the patient spends 2-4 hours in the intensive care unit, until the anesthesia wear off. The patient is discharged with crutches on the third day after surgery.
Torn Lateral Ligament Repair
A tear of the lateral knee ligaments is characterized by a lower intensity of clinical symptoms, but it also involves pain, swelling in the injured limb, and discomfort. What you have to be aware: there are no any possibilities of spontaneous relief if you have torn ligaments. On the contrary, with time, fibrous deposits may appear, which may lead to the risks of unpleasant sensations in the knee all over the life.
When one is diagnosedwith a torn knee ligament, treatment can be prescribed only by a doctor.
Choosing a method of treatment (conservative or operative) depends on the individual characteristics of a patient, including sex, age, andthe way of life: treatment may differ for professional athletes, people who lead the active lifestyle, and those who are far from being sportive. An opinion of the patient is also taken into consideration.
Conservative treatment is possible only with lateral ligament rupturesof the grades I and II. It is mostlyprescribed to elderly patients (over 55-60 years), as well as the patients who do not engage in sports. But, at the same,the patients are informed that if, after some time,knee pain and instability does not go away, surgery may be an option.
Immediately after an injury, Electrotherapy and ultrasoundcan be applied to alleviate pain and relieve swelling. Additionally, various ointmentsand compresses can be useful, as well as light massage. Treatment of torn ligaments does not take much time, even together with rehabilitation, thanks to modern methods.
Perhaps, the doctor will prescribe wearing an orthosis, and orthopedic device to maintain stability in the joint before and after exercising, while walking outside, etc.
Surgical treatmentis usually prescribed for isolated tears of the grade III, especially if there is a detachment of the superficial medial collateral ligament from the tibia (the ligaments may tear in different locations, and treatment also depends on it).
Surgery is an advisable option for all professional athletes who need to recover and be ready for competitionsin a limited time, and also for the patients who failed with conservative treatment, have persistent pain and apparent instability in the joint.
A method of surgery depends on the time elapsed after the injury. If it is still up to 3 weeks, then,a torn ligament is sewed. With the significant disintegration of ligament fibers, the ligament is strengthened by the fascia or tendon of the adjacent muscles. In this case, the treatment of knee ligamentrupture takes more time, and the risk of complications associated with infections also increases.
After 3 weeks, the ends of the torn ligamentscan no longer be brought together, since they contract, and now they can be repaired with the help of arthroscopy using artificial materials.
It is an endoscopic operation that is performed with a diagnostic or therapeutic purpose. With the help of a special device containing built-in camera and a miniature lamp, it is possible to perform many types of surgeries of the knee. Arthroscopy has become a good alternative to surgeries performed with conventional arthrotomy (cutting into a joint).
Arthroplasty is a surgery to replace, restore or reconstruct articular surfaces of joints. In modern traumatology and orthopedics, arthroplasty can be classified as follows:
Open reduction is used to re-align bony fragments of fractured joints if they located on the articular surface or very close to it. This procedure involves osteosynthesis, a fixing of the fragments by different devices, such as rods, screws, plates, etc., made of hypoallergenic materials. This immobilization of the joint provides the minimal negative consequences after a fracture.
Resection arthroplasty. In the course of this operation, a resection (excision) of one of the working surfaces of the joint is performed to introduce a tissue complex including ligaments and fascia. This type of operation preventsankylosis and facilitates conditions for restoring the motor activity of the joint. This also includes arthroplasty of the joint articulation, in which ceramic implants covered with bioactive glass-ceramic are used.
Resection of the knee joint is a large-scale surgery, which is indicated in case of purulent-inflammatory diseases of the knee and knee fractures. This intervention involves the removal of not only the joint itself, but also the damaged part of the bone. Most often, after this, another operation follows, such as joint replacement or an amputation of the lower third of the thigh. This is a complex and demanding surgery.
Knee cartilage repair. This intervention is performed to remove defects and ossification of cartilage. Defects are eliminated with the help of special pastes and solutions that, after hardening, have nearly the same density as hyaline cartilage. Surgery is followed by medication with drugs helping to restore the cartilage layer of the joint.
Knee Joint Cyst Removal. Removal of ganglion cysts of the knee joint does not cause any difficulties and lasts about 30-40 minutes. Baker’s cyst is a bit apart from the others.
Also, one of the types of surgery is intervention to replace the patella.
Total Knee Replacement (Arthroplasty)
Prosthesis of the knee joint is a replacement of a biological joint with an implant, which is made of special alloys and polymers. The implants are produced in a variety of sizes and materials in order to fit to the individual featuresof each patient, including sensitivity to implant components. To date, such artificial joints can almost completely restore the function of the lower limbs. In some cases, only the joint surface can be replaced.
Indications for total knee arthroplasty
Indications for knee replacement are considered by atrauma surgeon or an orthopedist, based on the examination results and the patient's complaints. The doctor should discuss with a patient everything concerning the forthcoming knee replacement in details.
The patient should be informed about all the pros and cons of the surgery, existing alternative treatments and possible complications associated with this particular type of surgical intervention.
Total knee arthroplasty: Procedure
Knee joint replacement is elective surgery, which means it scheduled and planned in advance and performed when a patient is duly prepared. After a replacement is considered, first, the patient is thoroughly examined. The results of examination allow make a conclusion onthe patient's overall health andcarry out preoperative preparations based on patient’s individual data.
After the examination and preparations, the surgery date is scheduled. The operation is performed under general or spinal anesthesia.All the nuances of anesthesia,oncoming surgery and subsequent rehabilitation are discussed with the patient in advance.
Surgery is performed by a team of orthopedic and trauma surgeons. There are several options how to perform surgery: with a tourniquet to stop bleeding during the procedure, without a tourniquet, and partiallywith a tourniquet. Each option has its own supporters and opponents.
A decision on the type of anesthesia is taken by an anesthetist together with the patient. Standard uncomplicated surgery lasts for 1.5-2 hours. In the postoperative period, intensive therapy, pain management, and wound dressings are carried out. For prevention of infectious complications, the patient receives antibacterial medications.
To prevent thrombotic complications, the patient is prescribed to takedrugs of the class of low molecular weight heparins. Elastic bandaging and foot movements immediately after surgery are also recommended.
Minimally invasive orthopedic surgery or arthroscopy can be used almost for all possible kind of knee surgery including knee replacement side by side with traditional methods. Scope surgery is used both as diagnostics tool and treatment. Surgeon gets inside the joint via small incisions in the knee. One incision is used to introduce a camera which translates images to the monitor where the doctor can observe the operating field. Surgical tools are brought into another incision.
Arthroscopic knee surgery is used to repair torn meniscus or torn ligament, to align synovium (joint lining), to repair cartilage and clean the debris in the knee, to adjust kneecap, to remove cysts inside the knee (Baker’s cysts) and for knee replacement procedure.
Arthroscopic knee surgery has the following advantages:
- Shorter recovery time (patients could discharge from a hospital after 24 hours or even have surgery on out patient base)
- Better cosmetic result (smaller incisions)
- Less bleeding
- Lower risk of infections
In the postoperative period, the patientwithout fail should bein a hospital on an inpatient basis, under medical supervision. After surgery,anticoagulant therapy can be assigned. Another important component of postoperative rehabilitation is electro- and mechano-therapy that can last from two months to six. In case if the patient strictly follows all the prescriptions of an attending doctor, at the end of the rehabilitation period, he or she can return to normal life and lead an active physical activity in the future.
In the postoperative period, due to damage to the periarticular and intraarticular structures during surgery, fluid accumulates in the knee and it is hurt. This is normal and not considered as a complication if the fluid accumulation accompanied by edema of the tissues around the patellatogether with pain doesnot last longer than expected. These symptoms should be diminished in approx. 3 days, and, by the second week, they tend to cease completely. In the early period, doctors drain the wound and give an antiseptic treatment to reduce puffiness and pain. Extra measures include:
- Limb immobilization by orthopedic means.
- Keeping the leg in an elevated position when the patient is in bed.
- Applyingdry cold.
- Anti-inflammatory drugs.
If edema does not decrease, it is a sign that inflammation is still progressing, and, perhaps, there is local infectious pathogenesis that not only prevents restoring mobility, but also can lead to more complex consequences. For example, if you have got a newly implanted joint, infection can cause the rejection and implant deformation, which may require a revision surgery (removal of the faulty implant) and prolonged antibiotic therapy. If the edema is associated with an excessive synovial fluid and blood in the joint, you will need a joint puncture to remove theexudate.
A range of movements should gradually increase and restore completely by the end of the 6th week. If the amplitude of knee flexion/ extension is not reaching the norm, then it can be qualified as a failure of physical rehabilitation due to mistaken actions of the doctors or the patient. If the leg cannot bend or is not fully straightened, it may be a result of a contracture of the joint that has developed due to the adhesions between the tendons and nearby tissues. If timely noticed, the condition can be is improved by manual stretching and a long, intensive exercise therapy, functional electric stimulation, etc. In case of severe pathology, surgery aimed muscular mobilization and excision of cicatricial fusion with subsequent rehabilitation is the only option.
It should be noted that the life of knee implants is limited. An implant can last 15-20 years, sometimes a little longer.
Mostly, total kneearthroplastyis successful and allows us to achieve quite positive results in restoring the motor function. But it is worth to mention that there are some exceptions. Negative body response to the anesthesia is one of possible complications during the operation and after the surgery. Also scars or extensive hemorrhage may appear after surgery. However, the most dangerous consequence is the infection of in the joint cavity. And with the following revision operation the risk of infection increases. In case of this complication, surgeons have to remove the infected implant.
The recovery period depends on method, kind of problem treated and patient’s health. The recovery after knee surgery is considered as quite easy, patients start working next day after total knee replacement, but in some cases of injuries it is not the same. In any case, it can take from few weeks till several months for complete rehabilitation. This time can be reduced by using minimally invasive technique.
- First days you should take simple measures to avoid complications
- You should start moving immediately after surgery (starting from moving in your bed and continuing walking)
- You will need crutches or other supporting devices for 1-10 days
- You should start exercising and increase load gradually
- You will need physiotherapy for weeks or even months after surgery
- You should observe yourself and report to your physician.
For successful and quick rehabilitation you need:
- Tailored planning of rehabilitation procedures based on a particular condition and individual features of a patient.
- Day-by-day schedule, including all the aspects of treatment, such as medication course, procedures, and physical exercises.
- Well balanced, gradual and correctly apportioned physical activities.
- Careful monitoring how the patient receives all treatment and recovery procedures.
Each patient needs an individual recovery program after knee surgery, specially developed for him by a medical team, including a surgeon, a rehabilitation doctor, a neurologist, a physiatrist, and others if needed. That means there is no single rehabilitation scheme for all patients. The main purposes of rehabilitation:
- Encouraging an early physical activity of the patient.
- Prevention of respiratory system congestion after surgery.
- Stimulation of regional blood circulation and lymph drainage in the lower limbs.
- Reduction of exudate in the knee;
- Rapid elimination of pain syndrome;
- Prevention of muscle weakness, contractures and tissue adhesion.
- Stimulation of metabolism and tissue regeneration.
- Prevention of infectious in the operated tissues.
- Recovering of limb motor functions.
A doctor will explain to you how to rehabilitate your knee after surgery. Do not try on your own! Incompetent treatmentmay be dangerous, remember this if you do not want your knee hurt and cannot move normally after surgery.
In a hospital, you will be trained how to bandage your leg correctly. First, bandaging is done by nurses, but upon returning home, you will have to do it yourself. Be attentive to everything that the medical staff teachesyou, while you are still in a clinic or rehabilitation center.
How to Improve Your Knee after Surgery
You may start exercising in the supine position from 12-24 hours after surgery and continue till 3-7 days. The frequency of repetition and the daily number of sessions is determined by a physiatrist.
- Carefully raise the operated leg, lifting it by 20 cm over the horizontal surface. The healthy leg is bent at the knee. Hold the raised leg for 5 seconds, and, then, gently return it to the original position. Both legs are slightly bent; the heels rest on the bed surface.
- Strain your thigh muscles. When counted to ten, relax. Hands are along the body; the torso is relaxed.
- Perform an isometric contraction of the gluteal muscles, keeping tension 5-8 seconds. Do until the light burning appears.
- Lying on the back with a rolled towel under the foot, try to bend your leg. The ligaments of the popliteal zone and the muscular structures of the lower leg should be strained. After 5 seconds, relax. The main thing is not to make a greater effort, but to increase the load smoothly.
- The legs rest on the bed straitened. Move your feet up and down, while keeping your heel on the bed. It is useful to alternately move your legs apart, sliding on the sheet. Doveryslowly.
Easy exercises are gradually supplemented with more difficult ones. Here are some examples.
- Stand by the wall or next to a chair to have a support. Slowly raise the straightened operated limb forward till 45 degree. Keep your leg in this position for 5 seconds, and gently return it to the original position. Do not forget to hold the support with your hands.
- Do the same exercise as the previous one, but move your foot to the side. With your hands on to the back of the chair, extend the limb aside (without jerking!) and slightly raise it up. Holdon for a few seconds and return to the initial position. Keep your balance.
- Lie down on your back; put a cushion under the operated knee. With support on the cushion, straighten the leg. Keep the straightened position for about 5 seconds, and, then slowly return the leg to its original position. Do this smoothly to prevent chance injuries.
After 2-3 weeks you can do more active exercises, as following:
- Semi-squats near the chair (do not bend your knee at an angle more than 90 degrees) Try to stand on your entire feet.
- Stretching exercises, for example, flexing the knee while holding the foot in your hand and lifting it to the buttocks. If you, at the same time, move the pelvis forward, the stretching effect will increase.
- Resistance exercises using a rehabilitation expander or a rubber tourniquet. You can come up with a lot of exercises with a tourniquet.
- Step (from the front and side) on the step-platform transferring body weight to the operated leg with its further straightening. Alternate the legs when doing this exercise.
- Riding a stationary bikewithan easy mode of pedal resistance, and, then, gradually increasing it to an average and heavy mode. This is the best simulator for rehabilitation.
- Walking on a treadmill: begin with a slow pace for 10-minute, then, gradually increase the speed and time; aqua gymnastics and swimming in the pool. We recommend practicing in the pool.
While exercising, listen to your own feelings: you must control the threshold of acceptable pain, not exceeding it. Overloading is not allowed! Unbalancedeffortscan lead to a painful edema. How long it will last, depends on how much harm you caused the knee. But what is really not good, swelling and pain will slow down the recovery of the joint.
If you have question on surgery detail or wish to design your individual treatment in Germany please call via our service to the doctor of your choice. Fully qualified specialists will give you detailed information on procedures and surgery cost. Please apply via GMG. We give you simple solutions and reasonable prices.