The following are post-operative instructions for patients who have undergone arthroscopic knee surgery. There are two groups of knee arthroscopy surgery both performed as outpatient surgery. The first is a simple surgery to remove or repair torn cartilage, joint tissue, meniscus, or release the kneecap (lateral release). Reconstructive arthroscopic knee surgery uses the arthroscope and small open incisions to reconstruct the anterior cruciate ligament (ACL), or stabilize the kneecap with a graft tissue (MPFL reconstruction). Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact the office.
The sutures utilized in closing any of the knee wounds are absorbable and buried under the skin, and will not need to be removed unless you are told otherwise. With a routine arthroscopic procedure, these are covered with a Steri-Strips. Schedule an office appointment for about 7-10 days from your surgery so the wound can be checked. For simple procedures, you can remove your dressings to shower on the third day following surgery (i.e., surgery on Monday, shower on Thursday). For a reconstructive procedure, we want to leave the dressing on for 5 days or until changed by your therapist or our office. Remove the dressings to the Steri-Strips (which are small tapes glued to the skin) and you can remove the dressings including the yellow gauze. The Steri-Strips can get wet and do not require changing unless there is drainage from the wound. You can use the ACE wrap for swelling. If there is any noticeable or persistent drainage from the incision sites or any surrounding red areas, please contact us immediately. Some swelling, bruising and warmth is expected after surgery. If you develop increased redness, drainage, or a fever, CALL THE OFFICE. Bruising around the knee, thigh or leg area is not uncommon. This may even extend down to the ankle and will resolve in over 3-4 weeks.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
You might also be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 400-600 mg 3-4 times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an anti-nausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
Swelling around the knee and down the leg to the foot and ankle region is NORMAL. Reducing the swelling as much as possible will improve comfort and mobility. The following will help to reduce swelling. Wear the TED stockings (white) for 2-4 weeks after surgery. For the first couple weeks when you go to bed, elevate your leg on 1-2 pillows (so that the knee is above the level of your heart). Also, 3 or 4 times during the day, lie flat on your back with your leg above the level of your heart (on 1-2 pillows) for 1/2 hour. If you feel the swelling is excessive you should call the office.
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days. You can keep ice packs on the knee for 30 minutes every 1-2 hours during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. Once you have removed the original dressing I would recommend ice applications to the region for only 20 minutes at a time every 2 hours as needed for pain and swelling.
Following many simple knee procedures, you could walk out of the hospital bearing fully on your operative leg. On your discharge directions, the exact amount of weight bearing will be specified. Even if it states full weight bearing we prefer that you unload the leg by using a pair of crutches for a few days. We feel you will be more comfortable, with less pain and swelling, if you utilize the crutches for a few days to lessen or avoid the weight bearing impact to your knee. If we did a reconstructive procedure we will usually be using the crutches 4 to 6 weeks.
You will be in a knee brace with hinge joints locked at 0 degrees. You should use it at all times to protect the knee. Your physical therapist or doctor will open the hinges when good muscle control returns. You may open the brace when awake for comfort. If the brace is not comfortable it may need to be adjusted and let us know. I recommend the brace for the first 6 weeks after surgery.
Depending on the type of surgery you underwent you may be provided a prescription for formal physical therapy when you leave the hospital. All of the different therapy firms in our area are excellent with knee rehabilitation, so you are free to select your therapist. Although formal physical therapy is not 100% essential to obtain a good result with simple arthroscopic knee surgery, we believe it is definitely helpful in achieving the quickest and smoothest course to full recovery. I feel it is mandatory with our reconstructive procedures and lateral releases. Please schedule your therapy to begin within a few days following surgery. If you want to avoid a course of formal supervised rehab, please inform us so that we can discuss some independent home rehab options and techniques with you. Here are a few simple exercises that everyone can begin immediately.
Isometric Quadriceps Setting
Hold your knee straight and tighten your thigh as much as possible. Hold for three to five seconds, and repeat several sets. You can do this frequently throughout the day, whether sitting, standing, or lying down.
Straight Leg Raising: While lying on your back, hold your knee straight with the opposite knee bent and tighten your thigh. Then lift your leg a few inches off the floor and hold for several seconds.
Bend and straighten your toes frequently. Pump your ankle up and down frequently.
Office Follow Up
Please call our office within a few days following surgery to schedule your first follow-up visit for 7-10 days after surgery or as specified on your post op directions from the nurses. This can vary plus or minus several days depending on your schedule and ours, as there are no sutures to be removed.
Arthroscopic knee surgery is a fairly simple and minimally invasive outpatient surgery, so postoperative complications are fortunately quite rare. The incidence of an infection deep within the joint is literally one out of thousands. Onset of symptoms would be approximately 5-7 days following surgery, and would consist of a significant increase in pain, swelling, warmth, and redness of the extremity, fever, chills or night sweats. A small superficial infection or irritation at one of the skin incisions can occur. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and a blood thinner. If we did not start this let us know. If we recommended aspirin for blood clot protection you should use a baby aspirin twice a day for 2 weeks or as long as the leg or arm is immobilized. A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical lower extremity pain) or tightness in the upper arm or more commonly the leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital.
If you then still have any questions or concerns please notify me, my nurse, or physician assistant.
Bryan Bomberg, MD