Challenges in Straightening the Knee After Tibial Plateau Fracture: Rehab Insights

Difficulty in extension after comminuted fracture of the tibial plateau?

Hello Doctor, I had a comminuted fracture of the tibial plateau six months ago.
My orthopedic surgeon has said that I can start practicing walking without crutches.
Currently, I am facing some difficulties.
When my injured leg is resting on the bed, I can straighten it without any pain.
While walking, there is no pain in the injured leg, but I have difficulty lifting my leg to straighten it.
When I try to extend from about 30 degrees to 0 degrees, I experience pain behind my knee.
I can only straighten my injured leg without pain if I lean against something.
If the bone has healed enough to stop using crutches, I would like to ask what might be causing the difficulty and pain when straightening my leg.
Do you have any recommended rehabilitation exercises to help improve this? Thank you.

cc, 20~29 year old female. Ask Date: 2022/10/10

Dr. Wang Zhaomin reply Rehabilitation

Joint stiffness often occurs after a fracture.
Once the bone has healed, it is important to actively engage in joint movements.
During this process, pain is usually unavoidable; therefore, stretching should be performed within a tolerable range.
Applying heat before stretching or taking analgesics can help alleviate discomfort.
Since each individual's condition varies, it is advisable to consult a rehabilitation specialist.
After a thorough assessment and diagnosis, follow the physician's recommendations and receive guidance from a therapist to avoid secondary injuries.

Reply Date: 2022/10/10

More Info

After a tibial plateau fracture, the rehabilitation process can be quite challenging, especially when it comes to achieving full knee extension. It’s great to hear that you are six months post-injury and your orthopedic surgeon has cleared you for weight-bearing activities. However, the difficulties you’re experiencing with straightening your knee and the associated pain are not uncommon.

Understanding the Challenges
1. Pain During Extension: The pain you feel when trying to extend your knee from 30 degrees to 0 degrees could be due to several factors. One possibility is that there may still be some residual swelling or inflammation in the knee joint, which can cause discomfort during movement. Additionally, scar tissue formation around the knee joint can limit your range of motion and cause pain when you attempt to stretch the knee fully.

2. Muscle Weakness and Imbalance: After a significant injury like a tibial plateau fracture, the muscles around the knee, particularly the quadriceps, can become weak due to disuse. This weakness can make it difficult to fully extend the knee without assistance. Furthermore, muscle imbalances can develop, where some muscles are stronger than others, leading to difficulties in achieving a smooth range of motion.

3. Joint Stiffness: Stiffness in the knee joint is another common issue following a fracture. This can be due to the immobilization period during recovery, where the joint is not used as much, leading to a decrease in flexibility and range of motion.

Rehabilitation Strategies
To address these challenges, here are some rehabilitation strategies that may help improve your knee extension and reduce pain:
1. Physical Therapy: Working with a physical therapist is crucial. They can provide tailored exercises that focus on improving your knee extension. Stretching exercises targeting the quadriceps, hamstrings, and calf muscles can be particularly beneficial.
2. Strengthening Exercises: Incorporate exercises that strengthen the quadriceps, such as straight leg raises, wall slides, and mini squats. Strengthening these muscles can help support the knee joint and improve your ability to extend the knee.

3. Range of Motion Exercises: Gentle range of motion exercises should be performed regularly. These can include heel slides, where you slide your heel towards your buttocks while lying down, and then slide it back out. This can help maintain and improve your knee flexibility.

4. Use of Modalities: Applying heat before exercises can help relax the muscles and improve blood flow, while ice can be used after exercises to reduce any swelling or pain.
5. Gradual Weight Bearing: Since you’ve been cleared to practice walking without crutches, gradually increasing your weight-bearing activities can help strengthen the muscles around the knee. Start with short distances and gradually increase as tolerated.

6. Assistive Devices: If you find that you need support to extend your knee, using a towel or strap to assist in pulling your leg into extension can be helpful. This can provide the necessary assistance while you work on strengthening the muscles.

7. Patience and Consistency: Recovery from a tibial plateau fracture can take time, and it’s essential to be patient with yourself. Consistency in your rehabilitation exercises is key to regaining full function.

When to Seek Further Help
If you continue to experience significant pain or if your range of motion does not improve with these strategies, it may be beneficial to consult with your orthopedic surgeon or a physical therapist for further evaluation. They may recommend imaging studies to rule out any complications, such as malunion or hardware issues, that could be contributing to your symptoms.

In conclusion, while the journey to full recovery after a tibial plateau fracture can be challenging, with the right rehabilitation strategies and support, you can work towards regaining full function of your knee. Stay committed to your rehabilitation program, and don’t hesitate to reach out for professional guidance as needed.

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