A GUIDE TO KNEE ARTHROSCOPY

 


 

 

 

 

At Taos Orthopaedic Institute, we are genuinely concerned that our patients have a full understanding of their injury, treatment options, and the rehabilitation required for a full, speedy recovery.  This handout is meant to complement the information you receive during your doctor's visit.  We encourage you to read this and feel free to ask any questions concerning your treatment.  Our goal is to help you make a fully informed decision about your knee.

Taos Orthopaedic Institute is a center of excellence for sports medicine and arthroscopy.  Utilizing state-of-the-art diagnostic and treatment techniques, the physicians offer a wide variety of conservative and surgical options for the patient with knee injuries.  Our orthopaedic surgeons have specialty training and extensive experience in the use of arthroscopic surgery to diagnose and treat the injured knee.

 Our treatment philosophy for all patients is the same as it is for the athletes under our care; we pledge to deliver the highest quality care using state-of-the-art diagnostic and treatment techniques.

 

What is arthroscopy?

The arthroscope is a fiber optic instrument, narrower than a pen.  It is placed into the knee through a tiny incision (portal).  A small camera attached to the arthroscope, allows the surgeon to view the knee structures on a television monitor.  Using additional portals (usually 1), small instruments ranging in size from 3-5 millimeters are inserted into the knee.  These instruments allow the surgeon to inspect and feel the joint structures, more accurately diagnose the injury, and then repair, reconstruct, or remove the damaged structures.

 

In the past, many orthopaedic injuries required complicated operations with large incisions, long hospital stays, and extensive physical therapy.  Today, many procedures are done entirely or in combination with the arthroscope, allowing for more accurate diagnosis, less invasive surgical intervention, and an accelerated rehabilitation process.  It must be kept in mind that not all surgery can be done through the arthroscope

 

What types of procedures can be done with arthroscopy?

Some of the more common arthroscopic procedures in the knee are partial menisectomy

(removal of torn cartilage) or meniscal repair, removal of loose fragments, smoothing of joint surfaces (chondroplasty), removal of inflamed joint lining (synovectomy), and lateral release of unbalanced kneecap (patella).

 

What is the difference between meniscal repair and partial menisectomy?

The meniscus is a cushion in the knee joint between the leg bone (tibia) and the thigh bone (femur).  It is commonly torn by twisting and bending activities in sports or even in routine daily activities.  Sometimes the tear is degenerative, meaning the damage is the result of worn-out tissue.

 

The location of the tear is an indication of whether the meniscus can be repaired or removed.   If the tear is in the outer third of the meniscus, there is usually an adequate blood supply so that it can be stitched together and healing will occur.  If the tear is located in the inner two-thirds of the meniscus, where most tears occur, the torn portion needs to be removed.  There is not an adequate blood supply in the inner two-thirds of the meniscus to permit adequate healing.

 

If the tear is removed, the patient can walk on the knee immediately.  If the tear is repaired, the meniscus requires six weeks to heal.  During the initial six weeks, the patient may bear weight on the knee, but must wear a brace to walk with the knee locked straight.

 

Don't I need the meniscus?

If the meniscus is damaged it can cause further joint destruction, so it is better to remove the torn portion.  In the past, when the whole meniscus was removed, patients had good knee function for many years but eventually developed arthritis.  The arthroscopic procedure removes only part of the meniscus; normal knee functioning is expected unless pre-existing arthritis or chondromalacia (bad cartilage) is detected.

 

What are possible complications?

While complications are not common, all surgery has associated risks.  Possible complications include excessive stiffness after the surgery or pain in the knee or under the kneecap.  Your rehabilitation after surgery is specifically designed to address these issues.  Other complications, although rare, can arise from infection of the wounds, phlebitis, bleeding into the knee, or nerve injury.

 

What do I need to do to prepare for surgery?

Our staff will work with you to set up the surgery through your insurance company if you have health insurance.

Prior to surgery you may be asked to perform some exercises at home or with a physical therapist.  These exercises prepare the knee for surgery by decreasing swelling, increasing motion, and maximizing the strength of your leg.

 

What type of anesthesia is used?

Local, spinal, epidural, or general anesthesia can be used for arthroscopic surgery.  Except for when general anesthesia is used, the patient can stay awake and watch the procedure on the television monitor.  An anesthetist is always present if there is a need for further sedation or pain control.  Prior to surgery, an anesthetist will discuss with you the various options and answer your questions.  Because our surgeons are extremely experienced, the operation can be performed rather quickly.  The shorter amount of surgical time decreases the amount of anesthesia and limits the side effects of the anesthesia.

 

What happens the day of surgery?

The day before surgery you will be told what time to report to the hospital the next day.  It is very important to arrive on time.  You will be admitted to the hospital and taken to a pre-operative area where you will be prepared for your surgery and then taken to the operating room.

Note:  You may not eat or drink anything after midnight the night before your surgery.  If you must take medicine then you will be permitted  to do so with just a sip of water.

  After the operation, you will be taken to the recovery room to be monitored.  Here the staff will check that the effects of the anesthesia are wearing off properly and they will provide you with medication for any pain you are having.  Most patients go home the same day.  You will be given specific instructions to follow at home and discharged after you have adequately recovered. 

 

How should I care for my knee after surgery?

Prior to your discharge from the hospital you will be given specific instructions on how to care for your knee.  It is important to follow these instructions.  In general, you can expect the following. 

 

Diet:  Resume your regular diet as soon as possible.

Medication:  You will be given a prescription for pain medication and an anti-inflammatory medication.  Follow the directions from your pharmacy.

Bandage:    You will have an elastic bandage from your foot to your thigh.  There will be bulky dressings under the elastic wrap.  Keep these on for two to three days after your surgery as instructed.  Under these dressings you will have several small incisions with stitches.  You may cover these with bandages after you remove the original dressing.

Bathing:     You will be able to shower within two to three days following surgery.  Do not soak your operated leg in a tub or whirlpool for at least three weeks after surgery.  The incisions are not fully closed and soaking the leg would increase the risk of infection. 

Ice:     Use ice over the knee.  It is best to apply ice for 20 minutes at a time, usually three to four times per day.  During the first two days after surgery, the heavy bandages may make it difficult for ice to penetrate.  Do not apply ice directly to the skin for extended periods as this may cause frostbite.   DO NOT put heat on your knee.

Elevation:     Keeping your leg elevated above the level of your heart will help with swelling and discomfort.  DO NOT put a pillow directly under your knee as this encourages the knee to stay in a bent position.  Instead, place the pillow under the calf and foot. 

Crutches:     Crutches are required for walking at first.  Most patients use crutches for the first 2-3 days.

Follow-Up Office Visit:    You will be instructed to follow-up at our office one and one-half weeks after your surgery.  At this time, your stitches are removed, and your surgery is reviewed.  You will be instructed on making further follow-up appointments at this time.

Exercise:     You may be taught some exercises to do initially after surgery.  After 1-� weeks you may be given a prescription for formal rehabilitation to do with a physical therapist.

Return to work or school:     Most people are able to return to their jobs or school within 5-7 days.  The exception to this is for people who have strenuous jobs that require them to be on their feet a lot, lifting objects, climbing or driving.  It is very important to minimize activity (stay home and elevate your leg) for four days after surgery.  This will speed the ultimate recovery by preventing excessive post-operative inflammation.

 

Preliminary Exercises - Early Postoperative Period:  0-1 Week

 

1.  Isometrics:

     Tighten muscles in front and back of thigh.  Hold five seconds, relax.  Repeat 10 times                               

     an hour.

 

2.  Straight Leg Raise:

     Hip flexion - Leg straight.  Raise leg off bed approximately 12 inches.  Hold     

     five seconds, relax.  Repeat 10 times.

     Hip abduction - Leg straight.  Lie on unoperated side, raise leg                                                                                                          

     approximately six inches off bed.  Hold five seconds, relax.  Repeat 10 times.

 

 

     Hip adduction - Leg straight.  Lie on operated side, raise leg approximately

     six inches off bed.  Hold five seconds, relax.  Repeat 10 times.

     Hip extension - Leg straight.  Lie on stomach. Raise leg approximately

     six inches off bed.  Hold five seconds, relax.  Repeat 10 times.

 

3.  Range of Motion:

     Begin passive range of motion using your unoperated leg to assist your operated leg.

     Sit on edge of bed or chair.  Using unoperated leg to support your operated leg, lower

     the operated leg until the knee bends to 90 degrees.  Use unoperated leg to straighten

     operated knee.  Repeat 10 times four times a day.  Depending on the type of surgery

     you undergo, you might not be able to start these motion exercises immediately after

     surgery.

 

4.   Extension:

      Place a pillow or folded towel under your heel (with nothing under the knee for

      comfort).  Push the knee straight, 3 times a day for 20 minutes.