physiotherapy protocol after arthroscopic lateral meniscus repair 1 month rehabilitation

https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/spor…

mkdir -p /home/daytona/workspace/physio-protocol && ls /home/daytona/workspace/p…

~/physio-protocol/generate_abhishek_protocol.js

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                    children: [new TextRun({ text: "Left Knee Arthroscopic LM Repair", size: 18, color: "555555", italics: true })]
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      // ─── PATIENT INFO TABLE ────────────────────────────────────────────────────
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          new TableRow({ children: [dataCell("Patient Name", true), dataCell("Mr. Abhishek Dadhich"), dataCell("Patient ID", true), dataCell("309057")] }),
          new TableRow({ children: [dataCell("Age / Sex", true), dataCell("39 Years / Male"), dataCell("Department", true), dataCell("Orthopaedics")] }),
          new TableRow({ children: [dataCell("Surgery Performed", true), dataCell("Left Knee Arthroscopic LM Repair (All-Inside)"), dataCell("Date of Surgery", true), dataCell("23 June 2026")] }),
          new TableRow({ children: [dataCell("Surgeon", true), dataCell("Dr. Nilesh Kamat"), dataCell("Protocol Start Date", true), dataCell("24 June 2026 (Day 1 Post-Op)")] }),
          new TableRow({ children: [dataCell("Protocol Duration", true), dataCell("4 Weeks (1 Month)"), dataCell("Goal", true), dataCell("Restore function, reduce pain, prepare for Phase 2")] }),
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      // ─── IMPORTANT PRECAUTIONS ─────────────────────────────────────────────────
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              bullet("NO active resisted hamstring exercises or open-chain knee flexion for 8 weeks"),
              bullet("NO deep squatting (>90° flexion) for minimum 8 weeks"),
              bullet("NO tibial rotation or twisting movements during first 4 weeks"),
              bullet("NO submerging knee in water for 4 weeks post-surgery"),
              bullet("Brace LOCKED in full extension (0°) during all walking for first 4 weeks"),
              bullet("Weight bearing restricted — use crutches as instructed by surgeon"),
              bullet("Stop any exercise immediately if sharp pain, locking, or significant swelling occurs"),
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      // ─── PHASE I ───────────────────────────────────────────────────────────────
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      boldPara("Goals", 22, "154360"),
      bullet("Control pain, swelling, and inflammation"),
      bullet("Protect the meniscal repair — NO excess stress on the sutures"),
      bullet("Restore full passive knee extension (0°)"),
      bullet("Achieve 0–90° flexion range of motion by end of Week 2"),
      bullet("Activate quadriceps and regain muscle control"),
      bullet("Restore patellar mobility"),
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      boldPara("Weight Bearing & Brace", 22, "154360"),
      bullet("Weight bearing: Touch-down / toe-touch only, with 2 crutches"),
      bullet("Brace: LOCKED at 0° (full extension) at all times during ambulation"),
      bullet("Brace may be unlocked (0–90°) when sitting or lying — NOT during walking"),
      bullet("Wear brace at night until surgeon advises otherwise"),
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      boldPara("Modalities (Pain & Swelling Control)", 22, "154360"),
      bullet("Cryotherapy (Ice pack / cryotherapy cuff) — 20 minutes, every 1–2 hours while awake"),
      subBullet("Do NOT place ice directly on skin — use a cloth/towel"),
      subBullet("Apply after every exercise session for the first 6 weeks"),
      bullet("Elevation of the limb above heart level as much as possible"),
      bullet("Compression bandage as applied — change dressing as advised"),
      bullet("TENS / IFT (Interferential Therapy) for pain: 10–15 min per session, once daily"),
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      boldPara("Therapeutic Exercises — Phase I (3× per day)", 22, "154360"),

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          new TableRow({ children: [dataCell("Quad Sets (Isometric quadriceps contraction)"), dataCell("3 × 10 reps; hold 10 sec"), dataCell("Tighten quad with knee straight; essential for VMO activation")] }),
          new TableRow({ children: [dataCell("Straight Leg Raises (SLR)"), dataCell("3 × 10 reps"), dataCell("Only if no extension lag. Use NMES if quad is weak.")] }),
          new TableRow({ children: [dataCell("Ankle Pumps"), dataCell("10 reps every hour"), dataCell("Prevents DVT; perform frequently throughout the day")] }),
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          new TableRow({ children: [dataCell("Patellar Mobilisation"), dataCell("2 × 1 min each direction"), dataCell("4 directions: medial, lateral, superior, inferior — gentle glides")] }),
          new TableRow({ children: [dataCell("Passive Knee Flexion ROM"), dataCell("Weeks 1–2: 0–90° only"), dataCell("Heel/wall slides; passive only — do NOT force flexion")] }),
          new TableRow({ children: [dataCell("Hip Abduction (Side-lying or standing)"), dataCell("3 × 15 reps"), dataCell("Support knee in brace if standing")] }),
          new TableRow({ children: [dataCell("Hamstring Stretch (Passive)"), dataCell("3 × 30 sec hold"), dataCell("With towel under ankle — avoid active hamstring contraction")] }),
          new TableRow({ children: [dataCell("Seated Knee Flexion (Gravity assist)"), dataCell("3 × 10 reps, 5-sec hold"), dataCell("Allow gravity; use unaffected leg for support on the way up")] }),
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      boldPara("Criteria to Progress to Phase II (must meet ALL):", 22, "154360"),
      bullet("Knee extension ROM: 0° (full extension, equal to other side)"),
      bullet("Knee flexion ROM: ≥90°"),
      bullet("Strong quad contraction with visible patella glide and full active extension"),
      bullet("Able to complete 3 sets of 20 SLRs without extension lag"),
      bullet("Minimal pain and swelling at rest"),
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      // ─── PHASE II ──────────────────────────────────────────────────────────────
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      boldPara("Goals", 22, "154360"),
      bullet("Progress knee flexion ROM toward 115° by end of Week 4"),
      bullet("Normalise gait pattern with crutches progressing to single crutch (as tolerated)"),
      bullet("Strengthen quadriceps to 50% limb symmetry index (LSI) vs unaffected leg"),
      bullet("Begin closed-chain lower extremity strengthening"),
      bullet("Improve proprioception and neuromuscular control"),
      bullet("Maintain full extension ROM achieved in Phase I"),
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      boldPara("Weight Bearing & Brace", 22, "154360"),
      bullet("Week 3: Continue touch-down weight bearing; brace locked at 0° for walking"),
      bullet("Week 4: May progress to partial weight bearing if quad control is adequate (MD discretion)"),
      bullet("Brace may be unlocked 0–90° when sitting or lying"),
      bullet("Blood Flow Restriction (BFR) training may be introduced once unlocked ambulation is achieved"),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun("")] }),

      boldPara("Modalities (continuing as needed)", 22, "154360"),
      bullet("Cryotherapy: Continue after each exercise session for 15–20 minutes"),
      bullet("IFT / TENS: Continue for pain management (if still required)"),
      bullet("Ultrasound therapy: 1 MHz, pulsed mode (1:4 ratio), 5–7 min over knee joint — promotes healing"),
      bullet("Laser therapy (Low Level): Optional — reduces inflammation, promotes tissue repair"),
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      boldPara("Therapeutic Exercises — Phase II (2–3× per day; formal PT 2–3× per week)", 22, "154360"),

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          new TableRow({ children: [dataCell("ALL Phase I exercises continued"), dataCell("As prescribed"), dataCell("Progress reps/sets as tolerated; continue ROM work daily")] }),
          new TableRow({ children: [dataCell("Passive Knee Flexion ROM"), dataCell("Weeks 3–4: Target 0–115°"), dataCell("Progress heel/wall slides; passive overpressure if plateau")] }),
          new TableRow({ children: [dataCell("Mini-Squat / Wall Slide"), dataCell("3 × 15 reps"), dataCell("Flexion MUST stay <90°; no deep squats yet")] }),
          new TableRow({ children: [dataCell("Leg Press (Bilateral)"), dataCell("3 × 15 reps, light resistance"), dataCell("Range 0–60° only; avoid deep angles; progress load gradually")] }),
          new TableRow({ children: [dataCell("Hip Extension (Prone or Standing)"), dataCell("3 × 15 reps"), dataCell("Strengthens glutes and hamstring synergy without knee stress")] }),
          new TableRow({ children: [dataCell("Calf Raises (Bilateral)"), dataCell("3 × 20 reps"), dataCell("Progress to single leg only after week 4 if pain-free")] }),
          new TableRow({ children: [dataCell("4-Way Hip Exercises"), dataCell("3 × 15 reps each direction"), dataCell("Flexion, extension, abduction, adduction — all supported")] }),
          new TableRow({ children: [dataCell("Stationary Cycle (low resistance)"), dataCell("10–15 min"), dataCell("HIGH seat to limit flexion; introduce in Week 3 only if flexion ≥90°")] }),
          new TableRow({ children: [dataCell("Weight Shifts (Bilateral)"), dataCell("3 × 1 min"), dataCell("Sagittal and frontal planes; progress to single leg balance week 4")] }),
          new TableRow({ children: [dataCell("Prone Knee Flexion ROM"), dataCell("3 × 10 reps"), dataCell("NO resisted hamstring curl — gravity only at this stage")] }),
          new TableRow({ children: [dataCell("Retro (Backward) Walking"), dataCell("2 × 5 min"), dataCell("Low speed; builds quad and proprioception; start in Week 4 if gait normal")] }),
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      boldPara("Criteria to Progress to Phase III (post 4-week review — future phase):", 22, "154360"),
      bullet("Knee flexion ROM ≥120° with extension equal to contralateral side"),
      bullet("Normalised gait — no limp (antalgic gait resolved)"),
      bullet("Minimal to no joint effusion (Modified Stroke Test negative)"),
      bullet("Quad strength LSI ≥50% (confirmed by physiotherapist)"),
      bullet("Able to perform 1 minute single leg squat with Vail Sport Cord criteria"),
      new Paragraph({ spacing: { after: 100 }, children: [new TextRun("")] }),

      // ─── HOME PROGRAMME ────────────────────────────────────────────────────────
      phaseHeader("HOME EXERCISE PROGRAMME — DAILY CHECKLIST", "To be performed every day in addition to PT clinic sessions"),
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        rows: [
          new TableRow({ children: [headerCell("Time of Day"), headerCell("Exercise"), headerCell("Duration / Reps")] }),
          new TableRow({ children: [dataCell("Morning", true), dataCell("Ice pack on knee + Ankle pumps + Quad sets"), dataCell("Ice 20 min; Pumps 10×; Quads 3×10")] }),
          new TableRow({ children: [dataCell("Morning", true), dataCell("Heel prop (extension stretch, prone or supine)"), dataCell("2 × 10 minutes")] }),
          new TableRow({ children: [dataCell("Mid-Morning", true), dataCell("SLR + Hip abduction"), dataCell("3 × 10–15 reps each")] }),
          new TableRow({ children: [dataCell("Afternoon", true), dataCell("Passive knee flexion (heel slides) + patellar mobilisation"), dataCell("3 × 10 reps; patella 1 min each way")] }),
          new TableRow({ children: [dataCell("Evening", true), dataCell("Stationary bike (Week 3+) OR seated ROM exercises"), dataCell("10–15 minutes")] }),
          new TableRow({ children: [dataCell("Evening", true), dataCell("Ice pack after exercises + limb elevation"), dataCell("20 minutes")] }),
          new TableRow({ children: [dataCell("Bedtime", true), dataCell("Prone hang or heel prop for extension"), dataCell("10 minutes")] }),
        ]
      }),
      new Paragraph({ spacing: { after: 100 }, children: [new TextRun("")] }),

      // ─── MILESTONE FOLLOW-UP ───────────────────────────────────────────────────
      phaseHeader("MILESTONE FOLLOW-UP SCHEDULE", "Clinic visits and physiotherapy milestones"),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun("")] }),

      new Table({
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        rows: [
          new TableRow({ children: [headerCell("Week"), headerCell("Visit Type"), headerCell("Expected Milestones")] }),
          new TableRow({ children: [dataCell("Week 1 (Day 7)", true), dataCell("Surgeon: Wound / Incision Check"), dataCell("Pain controlled, no wound infection, SLR possible, extension 0°")] }),
          new TableRow({ children: [dataCell("Week 2 (Day 14)", true), dataCell("Physiotherapy Assessment"), dataCell("Flexion 90°, extension 0°, SLR 3×20 without lag, minimal swelling")] }),
          new TableRow({ children: [dataCell("Week 3 (Day 21)", true), dataCell("Physiotherapy Progress Review"), dataCell("Flexion 100–110°, improved gait, stationary bike started")] }),
          new TableRow({ children: [dataCell("Week 4 / 1 Month (Day 28)", true), dataCell("Surgeon: Motion Check + Full Review"), dataCell("Flexion 115°, gait normalised, quad strength improving, Phase III planning")] }),
          new TableRow({ children: [dataCell("Week 6", true), dataCell("Surgeon: Brace & Strength Check"), dataCell("Brace review — likely discontinued if quad control adequate, flexion 130°")] }),
          new TableRow({ children: [dataCell("Week 12", true), dataCell("Surgeon: Full Strength Assessment"), dataCell("Quad LSI >70%, ROM near full, begin progressive loading")] }),
        ]
      }),
      new Paragraph({ spacing: { after: 100 }, children: [new TextRun("")] }),

      // ─── MEDICATIONS & WOUND CARE ──────────────────────────────────────────────
      phaseHeader("MEDICATIONS & WOUND CARE REMINDERS", "As per discharge summary — consult Dr. Nilesh Kamat for any changes"),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun("")] }),

      boldPara("Prescribed Medications (Discharge):", 22, "154360"),
      bullet("Continue prescribed oral analgesics / anti-inflammatory medicines as directed"),
      bullet("DVT prophylaxis: Inj. Clexane 0.4cc S/C was given — confirm if any oral anticoagulant to continue"),
      bullet("Do not self-medicate or stop medicines without consulting your surgeon"),
      new Paragraph({ spacing: { after: 60 }, children: [new TextRun("")] }),

      boldPara("Wound Care:", 22, "154360"),
      bullet("Keep incision sites clean and dry"),
      bullet("Steri-strips: leave in place until first post-op visit (7 days)"),
      bullet("Change gauze + ace bandage every 72 hours (or as instructed)"),
      bullet("Do NOT soak the knee in water for 4 weeks (no swimming, bathing in tub)"),
      bullet("Showering permitted after first post-op visit — keep knee dry initially"),
      new Paragraph({ spacing: { after: 100 }, children: [new TextRun("")] }),

      // ─── RED FLAGS ────────────────────────────────────────────────────────────
      phaseHeader("RED FLAGS — SEEK IMMEDIATE MEDICAL ATTENTION", "Contact Dr. Nilesh Kamat or go to emergency if any of the following occur"),
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          insideH: { style: BorderStyle.SINGLE, size: 2, color: "DDDDDD" },
          insideV: { style: BorderStyle.NONE }
        },
        rows: [
          new TableRow({ children: [new TableCell({
            shading: { type: ShadingType.SOLID, color: "FADBD8", fill: "FADBD8" },
            children: [
              bullet("Sudden severe increase in pain, especially with a locking or catching sensation"),
              bullet("Significant rapid swelling of the knee (joint effusion worsening)"),
              bullet("Signs of infection: increasing redness, warmth, discharge from wound, fever >38°C"),
              bullet("Calf pain, swelling, or redness (possible deep vein thrombosis - DVT)"),
              bullet("Loss of sensation or persistent pins-and-needles in the foot"),
              bullet("Inability to weight-bear that was not present before"),
              bullet("Wound edges separating or sutures loosening"),
            ]
          })] })]
        ]
      }),

      new Paragraph({ spacing: { after: 100 }, children: [new TextRun("")] }),

      // ─── DISCLAIMER ────────────────────────────────────────────────────────────
      new Paragraph({
        spacing: { after: 40 },
        children: [new TextRun({
          text: "DISCLAIMER: This protocol is a general rehabilitation guideline for arthroscopic lateral meniscus repair (all-inside technique). It is prepared based on the discharge summary of Mr. Abhishek Dadhich (Patient ID: 309057) and accepted clinical rehabilitation standards from MGH Sports Medicine, Texas Health, and Brigham & Women's Hospital. It must be supervised and modified by the treating physiotherapist and surgeon based on individual progress, pain levels, and clinical findings. Do not progress phases without meeting stated criteria.",
          size: 18, color: "888888", italics: true
        })]
      }),
    ]
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync("/home/daytona/workspace/physio-protocol/Abhishek_Dadhich_Physio_Protocol.docx", buffer);
  console.log("SUCCESS: Document created.");
});

cd /home/daytona/workspace/physio-protocol && node generate_abhishek_protocol.js…

~/physio-protocol/generate_abhishek_protocol.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/physio-protocol/generate_abhishek_protocol.js'

~/physio-protocol/generate_abhishek_protocol.js

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/physio-protocol/generate_abhishek_protocol.js'

cd /home/daytona/workspace/physio-protocol && node generate_abhishek_protocol.js…

python3 /home/daytona/workspace/scripts/office/validate.py /home/daytona/workspa…

python3 /home/daytona/skills/office/validate.py /home/daytona/workspace/physio-p…