Proposal of East-West Integrative Medicine Manual for Rehabilitation after Knee Surgery

무릎 수술 후 재활 치료에서의 한양방협진 매뉴얼 제안

  • Received : 2017.12.26
  • Accepted : 2018.01.11
  • Published : 2018.01.31


Objectives This is one of the manuals of East-West integrative medicine which was created by the committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision-making and communication between Korean and western medical staff in a Korean medicine hospital during the rehabilitation of patients after knee surgery. Methods The draft was made by two rehabilitation specialists in Korean medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision-making for rehabilitation after arthroscopic partial meniscus resection, meniscus refixation, reconstruction of anterior and posterior cruciate ligaments. Therefore, it contains the schedule of rehabilitation treatment by the surgical technique, general goal of the rehabilitation by phase, guide for patients and postoperative infection management. Conclusions Despite some limitations, this manual has significance as the first example of a decision-making protocol suggestion for East-West integrative rehabilitation treatment after a knee surgery in one medical institution.


Supported by : 청연의학연구소


  1. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care. Ann Rheum Dis. 2001 Feb;60(2):91-7.
  2. Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. 2011 Dec 6;155(11):725-32.
  3. Calmbach WL, Hutchens M. Evaluation of patients presenting with knee pain: Part II. Differential diagnosis. Am Fam Physician. 2003 Sep 1;68(5):917-22.
  4. Buchbinder R, Richards B, Harris I. Knee osteoarthritis and role for surgical intervention: lessons learned from randomized clinical trials and population-based cohorts. Curr Opin Rheumatol. 2014 Mar;26(2):138-44.
  5. Cullen KA, Hall MJ, Golosinskiy A. Ambulatory surgery in the United States, 2006. Natl Health Stat Report 2009;(11):1-25.
  6. Kruse LM, Gray B, Wright RW. Rehabilitation after anterior cruciate ligament reconstruction: a systematic review. J Bone Joint Surg Am. 2012 Oct 3;94(19):1737-48.
  7. Gadea F, Monnot D, Quelard B, Mortati R, Thaunat M, Fayard JM, Sonnery-Cottet B. Knee pain after anterior cruciate ligament reconstruction: evaluation of a rehabilitation protocol. Eur J Orthop Surg Traumatol. 2014 Jul; 24(5):789-95.
  8. Weber AE, Kopydlowski NJ, Sekiya JK. Nonsurgical management and postoperative rehabilitation of medial instability of the knee. Sports Med Arthrosc. 2015 Jun; 23(2):104-9.
  9. Velazquez-Saornil J, Ruiz-Ruiz B, Rodriguez-Sanz D, Romero-Morales C, Lopez-Lopez D, Calvo-Lobo C. Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture. Medicine (Baltimore). 2017 Apr;96(17):e6726.
  10. Ortega-Cebrian S, Luchini N, Whiteley R. Dry needling: Effects on activation and passive mechanical properties of the quadriceps, pain and range during late stage rehabilitation of ACL reconstructed patients. Phys Ther Sport. 2016 Sep;21:57-62.
  11. Usichenko TI, Kuchling S, Witstruck T, Pavlovic D, Zach M, Hofer A, Merk H, Lehmann C, Wendt M. Auricular acupuncture for pain relief after ambulatory knee surgery: a randomized trial. CMAJ. 2007 Jan 16;176(2):179-83.
  12. Kwon MG, Jo HG, Kim JH, Jeung CW, Go YJ, Seol JU, Lee SY. The analysis of east-west integrative care system in a korean medicine hospital. J Korean Med Rehab. 2017;27(2):93-9.
  13. Weiss WM, Johnson D. Update on meniscus debridement and resection. J Knee Surg. 2014 Dec;27(6):413-22.
  14. Boutin RD, Fritz RC, Marder RA. Magnetic resonance imaging of the postoperative meniscus: resection, repair, and replacement. Magn Reson Imaging Clin N Am. 2014 Nov;22(4):517-55.
  15. Lee DW, Ha JK, Kim JG. Medial meniscus posterior root tear: a comprehensivereview. Knee Surg Relat Res. 2014 Sep;26(3):125-34.
  16. Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, Lee MY. Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy. 2011 Mar;27(3):346-54.
  17. Bogunovic L, Matava MJ. Operative and nonoperative treatment options for ACL tears in the adult patient: a conceptual review. Phys Sportsmed. 2013 Nov;41(4):33-40.
  18. Hubert MG, Stannard JP. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and medial- side injuries of the knee. Sports Med Arthrosc. 2011 Jun;19(2):104-9.
  19. Suomalainen P, Kannus P, Jarvela T. Double-bundle anterior cruciate ligament reconstruction: a review of literature. Int Orthop. 2013 Feb;37(2):227-32.
  20. Kim JG, Lee YS, Yang BS, Oh SJ, Yang SJ. Rehabilitation after posterior cruciate ligament reconstruction: a review of the literature and theoretical support. Arch Orthop Trauma Surg. 2013 Dec;133(12):1687-95.
  21. Voos JE, Mauro CS, Wente T, Warren RF, Wickiewicz TL. Posterior cruciate ligament: anatomy, biomechanics, and outcomes. Am J Sports Med. 2012 Jan;40(1):222-31.
  22. Dias JM, Mazuquin BF, Mostagi FQ, Lima TB, Silva MA, Resende BN, Borges da Silva RM, Lavado EL, Cardoso JR. The effectiveness of postoperative physical therapy treatment in patients who have undergone arthroscopic partial meniscectomy: systematic review with meta-analysis. J Orthop Sports Phys Ther. 2013 Aug;43(8):560-76.
  23. Levy BA, Stuart MJ. Treatment of PCL, ACL, and lateral- side knee injuries:acute and chronic. J Knee Surg. 2012 Sep;25(4):295-305.
  24. World Health Organization. International classification of functioning, disability and health. World Health Organization. 2001.
  25. Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A. Meniscus pathology,osteoarthritis and the treatment controversy. Nat Rev Rheumatol. 2012 May 22;8(7):412-9.
  26. Lind M, Nielsen T, Fauno P, Lund B, Christiansen SE. Free rehabilitation is safe after isolated meniscus repair: a prospective randomized trial comparing free with restricted rehabilitation regimens. Am J Sports Med. 2013 Dec; 41(12):2753-8.
  27. Kozlowski EJ, Barcia AM, Tokish JM. Meniscus repair: the role of accelerated rehabilitation in return to sport. Sports Med Arthrosc. 2012 Jun;20(2):121-6.
  28. Neogi DS, Kumar A, Rijal L, Yadav CS, Jaiman A, Nag HL. Role of nonoperativetreatment in managing degenerative tears of the medial meniscus posterior root. J Orthop Traumatol. 2013 Sep;14(3):193-9.
  29. Frizziero A, Ferrari R, Giannotti E, Ferroni C, Poli P, Masiero S. The meniscus tear. State of the art of rehabilitation protocols related to surgical procedures. Muscles Ligaments Tendons J. 2013 Jan 21;2(4):295-301.
  30. Cavanaugh JT. Rehabilitation of meniscal injury and surgery. J Knee Surg. 2014 Dec;27(6):459-78.
  31. Malempati C, Jurjans J, Noehren B, Ireland ML, Johnson DL. Current Rehabilitation Concepts for Anterior Cruciate Ligament Surgery in Athletes. Orthopedics. 2015 Nov;38(11): 689-96.
  32. Yabroudi MA, Irrgang JJ. Rehabilitation and return to play after anatomic anterior cruciate ligament reconstruction. Clin Sports Med. 2013 Jan;32(1):165-75.
  33. Pierce CM, O'Brien L, Griffin LW, Laprade RF. Posterior cruciate ligament tears: functional and postoperative rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1071-84.
  34. Wieck JA, Jackson JK, O'Brien TJ, Lurate RB, Russell JM, Dorchak JD. Efficacy of prophylactic antibiotics in arthroscopic surgery. Orthopedics. 1997 Feb;20(2):133-4.
  35. Babcock HM, Carroll C, Matava M, L'ecuyer P, Fraser V. Surgical site infections after arthroscopy: Outbreak investigation and case control study. Arthroscopy. 2003 Feb; 19(2):172-81.
  36. Judd D, Bottoni C, Kim D, Burke M, Hooker S. Infections following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy. 2006 Apr;22(4):375-84.
  37. Curtis RJ, Delee JC, Drez DJ Jr. Reconstruction of the anterior cruciate ligament with freeze dried fascia lata allografts in dogs. A preliminary report. Am J Sports Med. 1985 Nov-Dec;13(6):408-14.
  38. Sherman OH, Fox JM, Snyder SJ, Del Pizzo W, Friedman MJ, Ferkel RD, Lawley MJ. Arthroscopy--"no-problem surgery". An analysis of complications in two thousand six hundred and forty cases. J Bone Joint Surg Am. 1986 Feb;68(2):256-65.
  39. Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: is it necessary? Arthroscopy. 2007 Jan;23(1):4-6.
  40. Iwagaki H, Saito S. Effects of a Kampo medicine on postoperative infection. Nihon Geka Gakkai Zasshi. 2013 Sep;114(5):241-5.
  41. Schraeder TL, Terek RM, Smith CC. Clinical evaluation of the knee. N Engl J Med. 2010 Jul 22;363(4):e5.
  42. Liu QQ, Xin B. Beijing TCM Hospital diagnosis and treatment of conventional medical technology and hospital preparations. Beijing:Beijing Science and Technology Press, 2016.
  43. Min HJ, Ryu JS, Yun YJ. Changes in the Attitudes of Doctors toward Cooperative Practices between Western Medicine and Traditional Korean Medicine - A Systematic Review in Korean Literature-. Kor. J. Oriental Preventive Medical Society. 2012;16(1):15-29.
  44. Pezzullo DJ, Fadale P. Current controversies in rehabilitation after anterior cruciate ligament reconstruction. Sports Med Arthrosc. 2010 Mar;18(1):43-7.
  45. Chen CC, Yang CC, Hu CC, Shih HN, Chang YH, Hsieh PH. Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial. Reg Anesth Pain Med. 2015 Jan-Feb;40(1):31-6.
  46. Mikashima Y, Takagi T, Tomatsu T, Horikoshi M, Ikari K, Momohara S. Efficacy of acupuncture during postacute phase of rehabilitation after total knee arthroplasty. J Tradit Chin Med. 2012 Dec;32(4):545-8.
  47. Carey T, Oliver D, Pniewski J, Mueller T, Bojescul J. Anterior cruciate ligament augmentation for rotational instability following primary reconstruction with an accelerated physical therapy protocol. J Surg Orthop Adv. 2013 Spring;22(1):59-65.
  48. Lee SJ, Shin BC, Song GS, Hwang EH, Yun YJ, Cho HW. A systematic review of the effectiveness of eastern- western integrative medicine for musculoskeletal disorders. J Oriental Rehab Med 2011;21(4):87-96.
  49. Kim BJ, Shin BC, Heo I, Lim KT, Park IH, Hwang EH. Clinical research of korean medicine and western medicine collaboration registry for low back pain: a pilot study protocol. J Korean Med Rehabil. 2017;27(3):117-24.