Physio Fitaal rehabilitation in Tilburg

Along with rupture of the anterior cruciate ligament, we often see that other damage occurs during the injury moment. When there is no other damage we speak of isolated injury of the anterior cruciate ligament. When there are multiple structures that are damaged, for example, the meniscus, capsule of the knee or the subchondral bone, we see that post-traumatic osteoarthritis occurs more quickly over time. The more forces are released during the injury moment the greater the chance of collateral damage in the joint. Read all about the development of osteoarthritis after knee trauma here Post-traumatic osteoarthritis after a knee injury - PhysioFitaal

Especially for the first 14 days, your knee will be swollen. After that, the swelling will slowly begin to subside. Be aware that swelling is a natural reaction to a procedure such as anterior cruciate ligament surgery. If your knee receives little rest, swelling will worsen or not decrease. Unencumbered exercise will cause the swelling to decrease. When the swelling is completely gone varies from person to person.

The surgery itself takes about 60-90 minutes. The procedure is performed through keyhole surgery. The new anterior cruciate ligament is placed at the original site of the anterior cruciate ligament. After surgery, you will see one or two scars, depending on the graft used to repair the anterior cruciate ligament. In most cases, you may return home the same day.

On average, you will walk with crutches for 4-6 weeks after surgery. This often depends on other injuries that were also treated during surgery. In most cases, this involves the meniscus. With damage to the meniscus, a choice may be made to suture or cut the meniscus. When suturing the meniscus also known as meniscopexy, you will have to walk with crutches for 6 weeks. When the meniscus is cut, called meniscectomy, the use of crutches can be reduced quickly depending on the symptoms. With the use of crutches, it is important that you move to an active and dynamic walking pattern as soon as possible. That is, despite walking with crutches, you mimic the natural movement while walking as much as possible.

During your rehabilitation, measurements will be taken at regular intervals to chart your progress. Every 6 weeks there will be an evaluation where your current training schedule will be examined and adjusted. Measurements take place every 12 weeks. Based on the results of the past period we assess whether you are ready for the next step in your rehabilitation.

Your knee needs to recover from the surgery. So it is important that your knee is rested. For this we use the 80/20% rule. This means that 80% of the day you let your knee rest/recover. The other 20% you are doing small exercises or all movement indoors. Put your leg up regularly. CAUTION! there should be no cushion under your knee. This is because stretching in the first phase is one of the most important goals of rehabilitation. Especially for gait, full extension in the knee is incredibly important. Limit physical activity for the first 5-7 days after surgery to avoid excessive pressure and pulling forces acting on the wound.

Successful rehabilitation consists of several stages and steps. Proper strength, stability and control of the knee is necessary to safely return to your sport. Both after an operative procedure and with a conservative policy. For this we use our specialized FITAAL method, with the result that you can get back to your own strength. In our brochure, which you can find below, you can see schematically which phases you go through and which objectives go with these phases. Cruciate ligament rehabilitation in Tilburg Center and the Reeshof (physiofitaal.nl)

In all cases, there is pain and discomfort after anterior cruciate ligament surgery. In most cases, you will be given pain medication from the hospital or clinic where you had surgery. In addition to pain, you may feel stretching in the hollow/side of your knee. There is also a chance that your knee will be quite a bit swollen or blue in response to the surgery. Because incisions were made in the skin during surgery, the skin around the knee may be extra sensitive or dull in some areas. This is normal. In most cases feeling returns to normal, in some cases it may take longer (up to 9 months). Pain is mainly present in the first phase after surgery 0-3 weeks. After that, the pain you experience from the surgery will decrease. Other pain symptoms may also occur during the remainder of rehabilitation.

Showering with stitches is fine, however, keep it short and absolutely do not bathe. After all, you don't want to soak the wound. After showering, you can pat the wound dry (do not rub it).

Limit the amount of UV radiation on the wound area for the first 6 months. If you do go out into the sun, make sure the scar is covered and always apply sunscreen to the scar properly. Note; you should not apply sunscreen until the wound is completely closed.

If there is pain and swelling, you may cool the knee for 15 minutes two to four times a day. Be sure not to place the cooling element directly on bare skin. Put a towel between them, for example. Cooling has an effect primarily on pain relief and less on swelling as has always been thought.

During anterior cruciate ligament reconstruction, the orthopedist will replace the anterior cruciate ligament through keyhole surgery.
Different tissues can be used to form the new cruciate ligament from for this purpose.

The first is hamstring plastic surgery. This uses tendons from the back of the thigh to make the new anterior cruciate ligament.

Another tissue that can be used is part of the quadriceps tendon. This involves using the middle 1/3rd of the quadriceps tendon to create a new cruciate ligament. This tendon is often seen as the first choice in young female athletes (14-25 years old). This is because it is more common in this target group that hamstring tendons are not thick enough to make a strong new cruciate ligament. Apart from the fact that the tissue is taken from a different place, the rest of the surgery is identical to hamstring plastic surgery.

A final but much less common is the bone-patella-bone plasty. This involves using tissue from the patellar tendon to make a new cruciate ligament. Two bone pieces are then also attached to either side of the tendon. An advantage of this method is that the bone pieces allow the new ligament to grow in more quickly.

In people who are highly active and would like to play a sport where you have to jump, turn or cut, in most cases surgery is the best solution. Without surgery, knee function and stability often simply won't be good enough to play these types of sports. An anterior cruciate ligament reconstruction also reduces the risk of additional injury in the knee in the long run.

Being able to stretch your knee again is one of the most important goals during the first phase of rehabilitation after anterior cruciate ligament surgery. This is often related to being able to properly tighten and use your upper leg muscles (quadriceps) If this is not successful in the first few weeks of your rehabilitation, it can be a predictor of further complications in rehabilitation such as a cyclops (scar tissue formation) in the knee. Read all about extension limitation after knee surgery here Stretch restriction after knee surgery - PhysioFitaal

Do you have surgery scheduled in a few weeks? Then it is important to start strengthening the surrounding muscle groups before you go into surgery. We know that if you go into surgery stronger, you will come out of it stronger. This means that if you have built muscle mass prior to your surgery, you will regain strength faster after surgery. It has also been scientifically proven that people who go through a pre-operative process are often more satisfied with their long-term functioning. We would like to support you in this! That's why we offer you a free six-week pre-operative training program. This means that six weeks before your surgery, you come and train with us twice a week. For more information about the six weeks of free pre-operative training, please visit

Rehabilitation after surgery for a sports injury is covered by the health insurance company with the exception of the first 20 treatments. The first 20 treatments are (partially) covered by the supplementary insurance for physiotherapy. You also need a referral from your doctor. Furthermore, you pay the excess. This is often already used up in the current year in which the operation took place. If no operation has taken place beforehand, the health insurance company will reimburse the physical therapy treatments from the supplementary insurance. Physiotherapy is only reimbursed from the supplementary package. Not sure where you stand with regard to your insurance? Please contact us. We are happy to look into it with you! For more information visit Physiotherapy in Tilburg Center and the Reeshof (physiofitaal.nl)

In most cases, the sutures used during surgery are dissolvable. It may take up to 6 weeks for the sutures to completely disappear. If the sutures are not dissolvable, you will often get an appointment 14 days after surgery to have the sutures removed.

Between 9 months and a year, partial resumption of sports can be considered. The length of the rehabilitation regimen has a major impact on being able to successfully resume your sport. Research shows that each month extension of the course (up to 12-15 months after your surgery) decreases the likelihood of another anterior cruciate ligament injury. Even if it feels good and you think you are ready, really take your time for the full recovery of strength & coordination in the knee.

This depends a lot on what kind of work you do. If you have an office job then you can think about resuming work sooner. With physically demanding work this is different and the load is gradually built up again after about 12 weeks. Always discuss this with your employer and company doctor if necessary. When the knee is calm and there is sufficient mobility (especially extension) in the knee, in many cases you can resume work.

After 6 weeks, in most cases you will be allowed to drive a car again. This is often related to the use of crutches. These are also phased out over a 6-week period to walking again independently without aids. When you can drive a car again, always practice in a safe place like a parking lot. You must be able to react well and especially quickly enough to different traffic situations. Sufficient strength, mobility and speed are therefore important.

About 12 weeks after your rehabilitation, you may start running again. This is always in consultation with the treating physical therapist and is based on objective outcomes. This means that the force difference between the operated leg and non-operated leg MUST be less than 30%.

After surgery, you will get pressure bandages around the operated area. This bandage should not get wet. You may carefully remove the pressure bandage after one to two days. Plasters were also probably used to cover the wound. Do not use closing plasters (for too long), it is good to let the wound heal dry to the air. Two days after surgery, you may carefully remove the plaster.

Physical therapy is started as soon as possible after surgery. Often it is pleasant to recover for the first day after surgery. The second day after surgery it is already possible to start physical therapy. In the first phase it is especially important to monitor how the recovery is going. Stretching the knee as soon as possible is an important goal of rehabilitation after surgery. Therefore, the physical therapist will try to promote this as much as possible. Passive movement especially in a CPM/ arthromot can help reduce swelling in the knee and provide more mobility.

After surgery, you will need to walk with two elbow crutches. So it is convenient to have these at home. Also, in the first phase after surgery, it is advised to cool down with regularity. So it is advisable to have a cool pack or cool brace in the house. Furthermore, it is useful to discuss with those around you how to get to physical therapy locations, for example. You will not be able to ride a bike or drive a car during the first few weeks.

In a meniscectomy (cutting), the orthopedic surgeon chooses to remove the damaged section of meniscus by shaver. This involves removing the patches attached to the meniscus. In a meniscopexy, these are sutured. The choice made depends on several factors. If at all possible, suturing of the meniscus is preferred. This is because we know that patients in whom part of the meniscus is removed are more likely to develop osteoarthritis-related symptoms later in life.

Physical therapy after surgery is reimbursed only if that condition is on the chronic list of physiotherapy. For example, after surgery on your anterior cruciate ligament. You also need a referral from your attending physician. Furthermore, you always pay the deductible. However, this is often already consumed because of the cost of the surgery. What else is important to know:
-The authorization runs for up to 12 months after the start of rehabilitation (the first physical therapy treatment after surgery)
-The insurer will reimburse all costs starting from the 21st treatment
-The first 20 treatments come out of your supplementary package to the extent possible