the fital method
A phased treatment
in cartilage injuries
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 will be able to progress again under your own steam.
This is how we treat cartilage injuries:
In this phase, we focus primarily on symptom reduction. There is often swelling, pain and reduced mobility of the knee. In addition, it is important to regain good control of your quadriceps(upper leg muscle). After a cartilage injury or surgery on that knee, we often see a significant decrease in quadriceps strength and mass. So it is critical to quickly regain proper function of the quadriceps. In addition, it is important to return to a normal gait pattern.
In this phase, there is more of a build-up in strength. Stabilizing exercises also come into play. In the meantime you may work on your general condition. This makes you improve your mobility and vitality by leaps and bounds.
The final stage involves working with you to see what possibilities remain with regard to sports/hobbies.
What does the health insurance company reimburse?
Physiotherapy following surgery is reimbursed only when a condition is on the chronic list of physical therapy. For example, surgery due to a bone fracture or after surgery on your knee, think about repairing your anterior cruciate ligament or placing a knee replacement. You also need a referral from the doctor. Also, 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 up to 12 months after the start of rehabilitation(the first physical therapy treatment)
- 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
Are you having trouble figuring it out? Then contact us. We'll be happy to take a look with you!
Fysio Fitaal has three locations. Our first physio practice is located in Tilburg Centrum, at Veldhovenring 57. Our second location is located in Tilburg Reeshof, at Spaubeekstreet 89 near the Basic-Fit gym. Our third location is located in a health center in Tilburg West, at Professor Verbernelaan 37-D.
Frequently Asked Questions
Does my cartilage injury make me more likely to develop osteoarthritis?
Cartilage injury can indeed increase the risk of osteoarthritis. With cartilage injury, we see that the cartilage's ability to repair decreases. The injury also affects the healthy surrounding cartilage. After cartilage injury, it is important to follow your practitioner's recommendations for recovery and minimizing further damage to the joint. Regular checkups and a healthy lifestyle can help reduce the risk of further osteoarthritis. It is always wise to check with a medical professional for advice regarding your personal situation.
How long will my knee remain swollen after surgery?
Especially for the first 14 days, the knee will be swollen. After that, the swelling will slowly begin to decrease. The decrease in swelling also depends on the intensity of the loading that takes place. If your knee gets little rest, the swelling will worsen or not decrease. When the swelling is completely gone varies from person to person.
How long does cartilage rehabilitation take?
The length of rehabilitation after a cartilage injury depends on several factors. These are: the severity of the injury, the location of the injury and the treatment method chosen to treat the injury. In general, cartilage rehabilitation can take several months to a year.
How long should I walk with crutches?
How long you have to walk with crutches after surgery depends on several factors. Usually this is a period of up to 6 weeks during which the use of crutches is gradually phased out. It is important to get clear in advance how long you will need to walk with crutches after surgery. So listen carefully to your treating physical therapist and doctor. They have the best understanding of your situation.
How do I know where I am in my rehabilitation?
At Fysio Fitaal in Tilburg, we work with a test and measurement protocol that we use to chart your progress in rehabilitation. We look at differences in strength, endurance, agility, quality of movement and chart your progress with various questionnaires.
What does my rehabilitation after surgery look like?
Rehabilitation after surgery for cartilage injuries is divided into several phases. In the acute phase, it is especially important to allow the joint to recover from surgery. The inflammatory reaction in the knee should be managed as much as possible. In the next phase, it is important that norms regarding mobility (bending, stretching) are met before a regain of strength and coordination can be made.
Can I avoid joint replacement surgery?
You may not think about it yet, but this is another important reason for surgery; the future. We know that in the long run, people with (untreated) cartilage defects often come in for joint replacement surgery. For younger people with cartilage defects, repair surgery may allow joint replacement surgery to be delayed or avoided later in life.
Can I shower and bathe after surgery?
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).
Can I go out in the sun with my scar?
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.
Can I cool my knee after surgery?
Yes. 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.
Should cartilage injuries always be treated?
Not every cartilage defect needs to be treated surgically. In many cases, less severe injuries can be treated just fine with physical therapy, without additional long-term risk. The decision to undergo surgery is usually based on factors such as the size and location of the defect, the patient's age, activity level and overall health.
Pain after surgery, what can I feel?
After surgery, it is natural to experience pain symptoms. The degree of pain is different for everyone. 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, you may find that the skin around the knee is extra sensitive or feels dull in some areas. This is perfectly normal. In most cases, sensation returns to normal; this may take up to 9 months after surgery.
Rehabilitation after cartilage surgery
Comprehensive and adequate rehabilitation is essential to achieve optimal results after cartilage surgery. Exactly what your rehabilitation protocol will look like depends on several factors. For example, the surgical technique has an influence on this, but also the extent to which injury was present and factors such as age, overall health status and so on. Your orthopedist will play the determining role in this. The primary goals of rehabilitation after cartilage surgery are to reduce pain and swelling, improve mobility and gradually restore strength and function.
Above all, try to take your time with your rehabilitation. The average cartilage rehabilitation simply takes 1 year. In fact, cartilage repair is a very slow process. Overhaste carries risks that can ruin the results of the surgery, and that is the last thing we want.
Why operate on cartilage injury?
Cartilage injury can cause localized pain in the joint. Depending on the degree of injury, the underlying bone may be exposed. You may experience stiffness, movement restrictions and difficulty performing daily activities. Another reason to operate on cartilage defects is to prevent further damage. This is because an untreated defect can worsen over time.
Why train prior to surgery (pre-operative)?
We know that if you go into surgery stronger, you will also come out of surgery stronger. This means that if you have built muscle mass prior to your surgery, you will regain strength faster after surgery. That's why we offer you a free six-week preoperative training program. This means that six weeks before your surgery, you will come train with us twice a week. For more information about the six weeks of free pre-operative training, visit Free pre-operative workout - PhysioFitaal
When will my stitches come out?
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.
When may the pressure dressing/plaster come off?
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. Are you having trouble with this? We are happy to help you!
When can I drive again after cartilage surgery?
Driving is not allowed in the first weeks after surgery. In many cases, this can be resumed 6-8 weeks after surgery when you are no longer using crutches. Always consult with your physical therapist if it is wise to get back into the car.
When can I ride a bike again after cartilage surgery?
Cycling generally has a low impact on the knee and so can be performed again relatively quickly. You do need a green light to be allowed to flex the knee beyond 90 degrees. However, there is a big difference between cycling outside or cycling on a home trainer. The risk of outdoor cycling is not the movement itself but outside influences can cause difficulties. Having to brake and dismount unexpectedly is one of them. In most cases, you can only cycle outside if you are not using crutches.
When will I be allowed to exercise again?
When you can resume sports also depends greatly on which sport and how your rehabilitation is going. Sports that put less strain on the joint such as cycling, swimming or fitness can often be resumed within a few months. Contact sports such as soccer or sports involving explosive movement often require up to a year before they can be resumed.
When will I be allowed to work again?
The time when you can return to work after cartilage surgery depends on the work you do. With a sedentary job, you can often spare the knee relatively well and thus start sooner. If your work is physically demanding and you are very active with your operated knee, it may take longer before you can return to work. Should modified work be necessary, you can discuss this with your physical therapist, employer and the company doctor.
When to start physical therapy after surgery?
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. Especially passive movement of the joint in a limited range of motion will contribute to recovery.
What does AutoCart mean?
AutoCart is a surgical procedure where cartilage damage is treated with the body's own cartilage, which is collected from another part of the knee that is not used or is used minimally. So you have no long-term complaints from this. The collected cartilage is mixed with PRP and applied to the damaged part of the knee. This is done in one operation.
What does autologous chondrocyte implantation (ACI) mean?
In ACI, a small sample of healthy cartilage cells is taken from the knee from a part of the joint that receives little stress. These cells are cultured in a laboratory. These cells are then placed during a second surgery. Often at 6 weeks after surgery. Spherox is the name of the drug used to repair the area along with the cartilage. Then the spheres are applied to the cleaned cartilage. The spheres adhere to the cartilage within about 20 minutes. This method is suitable for cartilage defects larger than 2cm2 and brings good long-term results.
What does a Hydrogel procedure mean?
The Hydrogel procedure to treat cartilage lesions is based on a liquid consisting of two components that are mixed and applied to the cartilage lesion. Once the mixture consisting of Dextran and Hyaluronic Acid is applied, it will begin to adhere to the surrounding cartilage and bone within 30-40 seconds. The purpose of this adhesion is to prevent further damage in the joint. Cells then begin to grow in and with the help of other cells from the healthy surrounding tissue, new smooth hyaline cartilage can be formed.
What is the policy with my brace?
In some cases, you will use a brace after surgery to protect the operated area. Your orthopedist will determine how long you'll use the brace and any accrual in range of motion.
What is microfracturing?
This technique is used to stimulate the growth of new cartilage. Small holes are made in the underlying bone, creating a blood clot that contains cells for the development of new cartilage tissue. This technique is usually used if the defect has not been previously treated and is no larger than 1 to 1.5 cm2 and is performed through keyhole surgery. Although this method brings good results, the quality of the tissue is not comparable to the original cartilage.
What may I do immediately after surgery?
In the initial phase, it is important to take time for your recovery. Your knee really needs some time to recover from the procedure. It is important that your knee gets adequate rest. In addition to rest, depending on the surgical technique, you are engaged in various exercises to improve mobility and regain control.
What tools will I need after surgery?
After surgery, you will walk with two elbow crutches. Also, in the first phase after surgery, regular cooling is advised. It is also useful to discuss with those around you how you can get to your physical therapy appointments, for example. It is not possible to ride a bike or drive a car during the first weeks.
What cartilage damage classifications exist?
Cartilage damage is often classified into different grades based on the severity of the damage. A commonly used classification is the International Cartilage Repair Society (ICRS) classification:
-Grade I: soft site with less resistance than the surrounding, healthy cartilage.
-Grade II: superficial cracks or defects in the cartilage surface, less than half the total thickness.
-Grade III: deep cracks or fissures in the cartilage surface, more than half the total thickness.
-Grade IV: tear to the subchondral bone, affecting the total thickness of the cartilage surface.
-Grade V: impairment of the total thickness of the cartilage surface with involvement of the subchondral bone ('full-thickness defect').
What surgical techniques are available to treat cartilage?
There are several surgical techniques available to treat cartilage damage. The choice of technique depends on several factors such as the extent of the damage, age and your (desired) activity level.
Will my course be reimbursed?
Physical therapy after surgery is covered by health insurance starting from the 21st treatment. You also pay a deductible over the rehabilitation course. You can possibly use your supplementary insurance. 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)