Surgical observation to assist with planning a rehabilitation pathway post-operatively

In the world of rehabilitation, it is commonplace for Physiotherapists and Accredited Exercise physiologists (AEP) to work alongside Doctors and Orthopaedic Surgeons to assist with planning a rehabilitation pathway post-operatively. This coordinated treatment allows for the best possible patient outcome, with a clear understanding of the goals and targets required to reach a full recovery. Most commonly, the treating AEP will receive relevant surgical notes and scan reports detailing information on the surgical procedure and the outcome. In some circumstances, this may not occur which can delay treatment, however, most practitioners are happy to share this information. One step above receiving this information is the opportunity to observe the surgical procedure being undertaken. This first-hand experience allows the AEP to gain a clear idea of the exact details and outcome of the surgery and implement a far more comprehensive rehabilitation pathway post-operatively.

I have recently completed this process for a current rehabilitation client who re-injured his knee 6-months post ACL reconstruction. I was invited by the orthopaedic surgeon to observe his surgery prior to commencing the rehabilitation programme. The clients MRI scan showed an unknown floating body within the knee joint with significant crepitus, instability and joint effusion; his re-injury was originally assessed as a potential full rupture of the ACL graft. Upon commencement of the arthroscopic surgery it was found that the anterior 1/3 of his graft had indeed ruptured and was causing the knee joint to lock, explaining the client’s symptoms and the unknown floating body in the MRI scan. The remaining 2/3 of the graft was in-tact but with some laxity. After discussing the injury mechanics and structures involved with the surgeon during the surgery, we then developed a plan for his rehabilitation pathway post-operatively. Observing the surgery allowed me to witness exactly what structures within the knee were re-injured and using this objective information along with details of the mechanism of injury I was then able to develop a very specific rehabilitation programme for the client. The client is now back at work on full pre-injury duties in a shorter space of time than originally intended and will hopefully also be cleared to return to sport at his next surgical review.

Surgical observations are not only helpful in obtaining positive outcomes for rehabilitation clients, they also play an important role in providing ongoing professional development for allied health professionals (AHPs), particularly AEPs, which is a requirement to maintain accreditation. New surgical procedures and techniques require different techniques for rehabilitation, so it is important for all AEPs to stay up-to date on the latest evidence-based research along with practical training such as surgical observation to ensure rehabilitation clients are provided the best care possible.

Alixe Luckins – B.Sc. Exercise Physiology

Senior Accredited Exercise Physiologist (AEP)(ESSAM)