Looking for major knee/lower leg rehab advice

Pain & Rehab Forum [Moderated]
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This is likely better suited for a consultation but I thought I’d shoot my shot here first. I’m trying to help my brother get back to being independent after a gruesome/freak basketball injury.

While playing, he stepped on somebody’s foot and hyperextended his knee joint during a twisting motion. Pretty much everything that could go wrong, besides bone fractures, did.

To keep it relatively short, my understanding of what all happened is a dislocated knee, both menisci torn - along with all four ligaments, severed popliteal artery, severe peroneal nerve damage( and compartment syndrome.

Roughly 2 months and 8 surgeries - including the split-thickness skin graft on the inner calf - later, he just got the ex fix off and PT begins. His ortho wants at least 120° degrees of knee flexion pre-op or he pretty much guarantees needing another knee surgery soon after the first reconstruction procedure.

I’m not here looking for conflicting ideas to his medical team, just wish they would communicate more clearly without looking irritated when I ask questions. I’m mainly here just looking for any tips/advice for how to help him through this process.

I’ve been doing all of his at-home wound care and helping with his daily PT thus far but this is really beyond the scope of my expertise - I manage a blood bank and lift weights.

Anything you all recommend I could do to help him manage his nerve pain, restore knee ROM(29° day 1 of PT to 61° after one week) and try to avoid permanent foot drop(he can slightly wiggle his toes now but has no control of the foot/ankle) would be greatly appreciated.

Either way, thanks for reading this and everything else you all do. Been a follower and happy customer for almost 3 years now.

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Hey man, this definitely sounds like a complex case. Some of my answers are going to be on the “armchair advice” side of things as I would need a ton more information to really be able to nail this down. If you want to have some good questions, I would ask…

  1. What are the surgeries performed thus far and why?
  2. What the surgeons expectation for regaining ankle strength?

His ROM is pretty typical for what happens in the first few weeks. I really try and push with my athletes that it is more about volume than intensity in the initial phases. He is much better off trying to do a lot of reps subthreshold and not trying to grind out a specific amount of reps. For the never pain you can do some things like desensitization to work on this. We typically have people start rubbing different material on the area experiencing pain like a very soft cloth, something a little rougher like terry cloth, or various other things. It is much more about exposing to some different sensations. This might be limited due to the wound care at this point. Here one of the best things you can do is make sure he understands this is going to be a process and even though it does suck now, it will get better. Often in the initial phase one of the hardest parts is not only that you can’t do anything yet but that all you end up doing is sitting around thinking about all the things you can’t do. Finding some wins, even if it is just getting the ex fix off, are important steps.

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This is exactly the type of response I was looking for. Thank you for the time and advice. I’ll do my best to try and implement some of these tips and get him back on his feet.