Anesthesia-Assisted Manual Manipulation for Knee Recovery

The issue of manual mobilization under anesthesia?

Hello Doctor, I had a car accident three and a half months ago that resulted in a femur fracture.
After surgery, my knee cannot bend properly.
Although I have been undergoing physical therapy, the range of motion returns to its original state after each session.
A few days ago, my attending physician suggested that I undergo a manual mobilization procedure under anesthesia.
I have a few questions regarding this procedure:
1.
Will I be able to bend my knee normally immediately after the procedure? Is there a possibility that pain will prevent me from bending it, causing it to revert to the pre-operative angle?
2.
Can this procedure be performed under either general anesthesia or regional anesthesia? The doctor mentioned that it does not require an incision and does not necessitate hospitalization, so will I be able to go home to rest once the anesthesia wears off? I am concerned about potential pain afterward; should I bring crutches with me?
Thank you for your assistance!

Jane, 20~29 year old female. Ask Date: 2017/11/10

Dr. Li Yongheng reply Orthopedics

Hello, you have had a femoral fracture for three and a half months, and currently, your knee cannot bend normally.
Manual mobilization under anesthesia is an appropriate treatment.
Typically, intravenous medication is administered, and once the patient is anesthetized, the manual mobilization technique is performed.
After the anesthesia wears off, you can go home to rest.
If you are concerned about pain afterward, you may use crutches as needed.
Additionally, it is important to emphasize that you must intensify your rehabilitation post-procedure to avoid fear of pain leading to reluctance in bending, which could revert to the pre-operative angle.
Wishing you a speedy recovery.

Reply Date: 2017/11/10

More Info

Understanding Anesthesia-Assisted Manual Manipulation for Knee Recovery
Hello! It sounds like you’ve been through quite a challenging recovery process after your accident. The recommendation for anesthesia-assisted manual manipulation (often referred to as "manipulation under anesthesia" or MUA) is a common approach for addressing stiffness and limited range of motion in the knee following significant injuries or surgeries. Let’s address your questions one by one.

1. Will I be able to bend my knee normally right after the procedure?
While manipulation under anesthesia can significantly improve the range of motion, it’s important to understand that immediate results can vary. After the procedure, many patients experience increased flexibility, but there may still be pain and discomfort that can inhibit movement. This pain can be due to the manipulation itself, as well as the underlying condition of the knee. It’s not uncommon for patients to feel hesitant to bend their knee fully due to fear of pain or re-injury. Therefore, while you may achieve a better angle immediately post-manipulation, consistent and diligent rehabilitation is crucial to maintain that range of motion. Engaging in physical therapy after the procedure will help reinforce the new range of motion and prevent the knee from returning to its previous state.

2. Can this procedure be done under general or regional anesthesia?
Yes, manipulation under anesthesia can be performed under both general and regional anesthesia. The choice depends on the specific circumstances and the preference of your healthcare provider. General anesthesia means you will be completely unconscious during the procedure, while regional anesthesia (such as a spinal block) numbs only the lower half of your body. Your doctor will discuss the best option for you based on your medical history and the specifics of your knee condition.
Regarding the recovery process, since this procedure is typically outpatient, you will not need to stay in the hospital overnight. Once the anesthesia wears off, you will be able to go home, but you may still experience some pain and swelling. It’s advisable to have someone accompany you home, as you might feel groggy or unsteady after the anesthesia.

3. Will I need crutches after the procedure?
It’s quite possible that you may need crutches or a knee brace for a short period after the manipulation. This is especially true if you experience significant pain or instability in the knee. Your healthcare provider will give you specific instructions based on your condition and the extent of the manipulation performed. It’s essential to listen to your body and not push through pain, as this can lead to setbacks in your recovery.

In summary, while manipulation under anesthesia can provide significant benefits in terms of knee mobility, the success of the procedure largely depends on your commitment to rehabilitation afterward. Engaging in physical therapy, following your doctor’s advice, and being patient with your recovery process are key components to achieving the best outcomes. Remember, the goal is not just to regain motion but to ensure that your knee functions well in the long term. Best of luck with your recovery, and don’t hesitate to reach out to your healthcare team with any further questions or concerns!

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