Arthroscopic Knee Surgery
Arthroscopic knee surgery (also called microsurgery) is performed on the shoulder for a variety reasons, among the most common is partial removal or repair of a torn meniscus, and debridement of a chondral injury.
Pre Surgery Preparation
A complete health assessment and patient profile is given to an anesthesiologist, who is a doctor of medicine experienced in matching the proper anesthetic and dosage to the patient.
Patients are encouraged to fill prescriptions for pain and other medications on or before the day of their surgery, as pain following arthroscopic surgery can be moderate. Pain medication is prescribed by Dr. Sanders and administered to the patient in the operating room.
At the Sanders Clinic, shoulder surgery patients are given the benefit of multimodal analgesia. By attacking the pain through several different pathways, fewer narcotics will be necessary, and subsequently, the negative side effects of narcotic use can be diminished or eliminated. These medications include an anti-inflammatory such as Meloxicam, a nonnarcotic analgesic such as Tramadol, acetaminophen, also known as Tylenol and gabapentin which calms down peripheral nerve pain. These medications are taken around the clock. The need for a Class 3 narcotic analgesic, such as hydrocodone, is drastically diminished so fewer side effects such as effects such as nausea and/or constipation occur. Phenergan is prescribed to help with nausea. Taking two Tylenol every four hours is a good alternative.
And Tylenol PM (a preparation that includes benedryl) is encouraged over other medications in the event of sleep disturbance, which is common after such procedures. Ambien, which is also prescribed, is a stronger sleep aid.
Too often patients come in for surgery, particularly outpatient surgery, having had very little to drink and subsequently become dehydrated following the surgery. It is important that patients rehydrate following a surgical procedure – consuming sufficient quantities of water and a sports aid drink containing sugar and electrolytes. Proper hydration is the key for the body, particularly one in recovery.
A Cryo/Cuff® is placed compression stockings which cover the dressing, delivering cold therapy as well as compression. With the exception of showering and exercising, it should remain on for one complete week. Typically, no sutures are used to close up the arthroscopic incisions, also known as portals. The dressing may saturate with bloody fluid over the first day. There is no reason to become alarmed when this occurs. This is simply the egress of the arthroscopic fluid from the knee. On the day after surgery, the dressing may be removed, and patients may take a shower, but not a tub bath. During the first seven days. The cuts should be washed with a 50/50 mixture of Hibiclens® (4% Chlorhexadine Gluconate) and water and used as soap.
During surgery, antibiotics are administered by vein to prevent the risk of infection. No other antibiotics are needed, but patients are encouraged to follow all the above instructions regarding the care of their wound and monitor it closely to further reduce the risk of infection.
If a portion of the surgery was performed through an open incision, the wound may be closed with staples or nylon sutures. The sutures should be left in for three weeks or until determined by Dr. Sanders. Occasionally, there is a small amount of drainage from the wound – a normal bodily response and NOT an infection.
During this phase, the emphasis is on minimizing postoperative swelling, attaining full knee passive hyperextension and knee flexion of the operated limb. It also focuses on strengthening and walking in a normal fashion without crutches or braces. Although patients will visit the Clinic for therapy on the first and fourth postoperative day, they are urged to restrict activities and rest with their legs elevated during the first postoperative week.
The primary focus at this stage is avoiding stiffness that would make a return to sports impossible. This is why certain steps are taken to control swelling and prevent stiffness.
The operated knee rests straight with two pillows under the heel and nothing under the crease of the knee. This will maintain knee extension. Four times every hour patients must actively put their knees through a range of motion, beginning straight to bending completely – heel touching buttock. These Active Range of Motion exercises are critical for a successful return to sports and optimal recovery.
To flex the knees, the cannonball position is preferable. The patient grasps the back of both thighs and pulls them up to the chest. As this occurs, the quadriceps muscle relaxes and gravity causes the knees to bend. Patients are asked to breath and exhale deeply. The trainer or coach can determine if both knees are flexing equally. If not, then some gentle pressure can be placed on the foot of the deficient knee to cause it to flex as much as the opposite one. During this time it is important to concentrate on breathing – and in particular the exhalation. The flexion and the extension exercises should be done four times per hour while awake.
On the night of the surgery, patients are able to walk 300 feet in a normal fashion without crutches or braces. Knee Range of Motion is from full extension through greater than 120 degrees of flexion. By the fourth day following surgery, patients are allowed to resume regular sedentary activities and have a normal gait without crutches. Patients should continue their active exercises four times per day. A follow-up appointment is made for the day following surgery, and further exercises such as the stationary bicycle are started.
By the end of the tenth to fourteenth day, the patient who has undergone an arthroscopic menisectomy should be able to return to most recreational sports activities.