Ankle


Frequently Asked Questions

I had a special surgery done on my ankle to repair a big hole in the cartilage. The surgeon transferred normal, healthy cartilage from my knee to the ankle. In two more weeks, I'll be headed into therapy. What can I expect from that?

Every surgeon has his or her own postoperative and/or rehab protocol. This refers to the step-by-step process of movement during recovery. What we present here is a summary of the typical program. You may experience some differences depending on your surgeon's preferences. At first you will be shown how to use a walker and probably allowed to put partial weight on that foot. The therapist will guide you through early post-operative range-of-motion exercises. That's the extent of therapy for the first two weeks. A formal physical therapy program is usually started four to six weeks after the surgery. The program is carefully designed to match each stage of healing as the patient transitions from remodeling to maturation of the graft site. It's usually best if you only see one therapist for the entire rehab program. This should be someone who is familiar with the surgeon's protocol. The program may begin with cycling on a stationary bike without resistance. The idea is to get your full ankle motion back. Early on, the therapist will introduce you to proprioceptive exercises. These are designed to help restore the joint's own awareness of itself -- when, where, and how the joint is moving. Normal, healthy proprioceptive feedback in the ankle is especially important in avoiding future injuries. When the ankle moves even a little bit, adjustments are made to maintain stability and support. Muscle strengthening begins with isometric muscle contractions. With isometric exercises, the muscles contract without moving the joint. Muscle training continues with concentric and then eccentric muscle contractions. Concentric contractions move the joint through normal motion. Eccentric contractions are done when a fully contracted muscle is slowly lengthened back to its normal resting position. Everything in the rehab program is slowly progressed according to two things: your tolerance and X-rays taken showing the progress of the graft repair. Over time, you will be allowed to add activities such as walking, light jogging, and some time with your sport (if you are an athlete). Sport-specific training will be included at the very end for those patients heading back into sports activity. The graft site must show fully mature, healed tissue. Care must be taken to avoid compromising this very delicate healing process.

Ellis Kevin Nam, MD, et al. Autologous Chondrocyte Implantation of the Ankle. A 2- to 5-Year Follow-Up. In The American Journal of Sports Medicine. February 2009. Vol. 37. No. 2. Pp. 274-284.

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