What is knee arthroscopy?

The arthroscope is a fiber optic instrument narrower than a pen, which can be put into a joint through small incisions less than 5 millimeters in length. A camera is attached to the arthroscope and the image is viewed on a television monitor. Small instruments ranging from 3-5 millimeters in size can be inserted through the incision. These instruments allow the surgeon to feel the various joint structures, to diagnose the injury and then to repair, reconstruct or remove the damaged structure. To help your surgeon view the knee joint, sterile fluid is pumped into the joint.

How long is surgery?

1-2 hours. You will be in the recovery room approximately 1 hour, depending on how fast you wake up and are able to eat and drink.

What are the possible risks?

In consultation with your orthopedic surgeon, you have decided that surgery is the appropriate treatment for your knee condition. It is important to understand this is elective surgery. Other treatment options include medicine for pain and inflammation, use of crutches or a walker, physical therapy, lubricant injections, cortisone injections and restricting your activities. Many patients try these measures before choosing surgery.

Generally, knee surgery is very successful. Pain is relieved and patients resume many activities. The long-term success rate depends on your age, knee condition and your activity level.

Potential risks include, but are not limited to, blood clot, problems from anesthesia, infection, surgical bleeding, damage to nerves or blood vessels, infection, weakness, stiffness, continued pain, and possibly tearing of the repaired tendon, ligament or cartilage, requiring the need for further surgery.

How long will I be out of work or school?

Take at least 1 week off from work and at least 3 days off from school. Try not to take any exams the first days back to school (if you are taking pain medication you will not be thinking clearly). If your job requires climbing or squatting it may be 3-4 months before you return. We will discuss this further at your preop visit.

Disability forms

If you have disability insurance, check your coverage and bring your disability forms to our office. Make sure your portion is filled out before dropping off. We are required to mail them directly and cannot return the forms to you.

Traveling

Do not travel by airplane in the first 4 weeks after surgery, this will increase your risk of getting a blood clot in your leg. If you need to travel by car, sit in the back and pump your feet up and down 10 times every ½ hour. Get out of the car at least once every 1-2 hours and move around.

We also recommend you take aspirin 325 mg, 1 pill per day for the first month after surgery to help prevent against a blood clot, even if you are not traveling.

Stay in the area until your first postop visit. If you have any problems or complications after surgery it is difficult to treat if you are more than a couple hours away. Take this into consideration when making travel plans.

When will therapy start?

This depends on your surgery:

Manipulation (surgery to increase the motion of a stiff knee)-start therapy the day after surgery.
ACL reconstruction- start 3 days after surgery.
Meniscus repair or partial mensicectomy- 7 days after surgery

You will be given the therapy prescription and referrals for a therapist

at your preop visit. Therapy will last several months.

How long do I need crutches/brace?

Manipulation or debridement or partial meniscectomy - crutches for 2 days
ACL reconstruction-crutches for 1 week. Patients with ACL repairs will wear a brace until their quadriceps muscle contracts well, usually 2-4 weeks
Meniscus repair- crutches for 3-6 weeks

Should I exercise before surgery?

Yes, keep as much motion in your knee as you can, without causing severe pain. Walk, swim and ride stationary bike as tolerated, do not jog, run or pivot on the knee. Try to keep your muscles from shrinking by doing straight leg raises, leg extensions, and isometrics. Keep swelling down by icing at the end of the day. Try to meet with a therapist before surgery to be given a preop and postop exercise program.

Physical Examination/EKG/ Labs

If you have diabetes, heart or lung disease, a physical examination by your internist is required to ensure you are well enough to undergo surgery. You will need to schedule this appointment. You will also need an EKG and blood test within a month of your surgery.

If you are over 50, or have high blood pressure even if you are younger than 50, you will also need an EKG and labs. If your surgery is at Alta Bates this will be done at the preop visit scheduled with Alta Bates.

If your surgery is scheduled at one of the surgery centers you will need to have the EKG done at your medical doctor’s office or at one of the hospitals in the area. You will need to call your doctor or a hospital to schedule this. Please let us know if you do not have a prescription for the EKG and labs. The results should be faxed to 510-704-7765 and you should be given a copy to bring to your preop visit at our office.

IceMan (cold therapy)

Iceman unit

Game ready ice unit

Gameready is a cooling unit used for ACL reconstructions, this is not the same as the polar care. Please see link http://www.gameready.com

We have ordered an iceman unit to help decrease pain and the need for narcotics. This is the treatment of pain and/or inflammation by lowering the temperature of the skin over the affected area. It can significantly improve swelling after an injury or surgery. The representative from the company will call your home 1-2 days before surgery to discuss insurance coverage and cost of the unit. The IceMan is for purchase, the gameready is a rental.

The IceMan, and Game ready units are designed to maintain a constant cool temperature over the joint or extremity where you are having pain. You are able to set the temperature and the device will maintain it constantly by continuously recirculating the ice water flowing to the pad.

How does it work?

Simply fill the cooler up with ice, and then top it off with water. Apply the included pad to wherever you are experiencing pain (it has velcro straps which keep the pad in place and conform it to your body). Then simply plug it in, and set the temperature to whatever feels comfortable. You will need to refill the ice in approximately 6 hours. You will need to have extra ice in your freezer.

Why not just use an ice bag?

Well, that certainly is an option. However ice bags are messy. They need to be refrozen constantly. They have the capacity to cause skin burns if not used properly.

Prepare your home

Stock your freezer and pantry. Have extra ice available for the iceman. Prepare to prop your leg up with 2-3 pillows for first 2 nights after surgery.

Prepare for the hospital

Discuss hospital and discharge plans with family and friends. You will need someone to pick you up after surgery. You cannot drive yourself home. Have someone stay with you for the first 2 nights. If this is not possible, you should have family, friends or neighbors check with you a couple times per day to make sure you are ok.

Review insurance coverage, deductible, therapy coverage and co-payments. Although we will get authorization for your surgery, it is your responsibility to make sure the facility, anesthesiologist, surgeon and physician assistant are covered by your insurance. You should also be aware of the cost of your deductible and co-payment. Knee surgery cost including the facility fee, equipment, staff, anesthesiologist and surgeon can average between $10,000-20,000 dollars.

What should I do the week before surgery

Check your paperwork from our office.

Schedule physical therapy for after surgery.

Fill your prescriptions for pain medications (You will get the prescriptions at your preop visit).

Buy stool softeners (narcotics cause constipation), gauze, bandage tape, iodine or hibiclens soap and waterproof dressings at the pharmacy.

Decide if you want the icemachine or game ready and let us know at your preop visit.

Buy bland food to have after surgery- toast, oatmeal, banana, soup, rice.

surgery- toast, oatmeal, banana, soup, rice.

A week before surgery, stop taking any blood thinners, which includes Coumadin, Plavix, Aspirin, Advil, Motrin, Ibuprofen, Aleve, Glucosamine Chondroitin, Ginger, Ginseng and all herbal medicines or any prescription anti-inflammatory drugs. Please contact your prescribing doctor before discontinuing Coumadin or Plavix or if your doctor told you to take Aspirin. You may take Tylenol for pain up until the night before surgery.

If you get a cold or flu before surgery and have any of the following; a cough, sore throat, temperature or are not feeling well, please cancel your surgery. If you are unsure please call our office.

What to do the night before surgery

You should not have anything to eat or drink 8 hours before surgery. This includes water, coffee, candy and gum. This is to prevent getting fluid in your lungs.

If you normally take heart or high blood pressure medication in the morning, you should take it as soon as you get out of bed the morning of surgery with just a sip of water.

Take off all rings, watches and bracelets. You may leave on body jewelry but inform the nurse the day of surgery.

Check your cell and home phone incase your surgery time was changed.

Find loose clothing, something you can easily get over the knee, like shorts, exercise pants or skirt. Put this on the day of surgery.

What happens on the day of surgery?

You will meet with the nurse and the anesthesiologist. The anesthesiologist will explain the anesthesia – general anesthesia, (if the procedure is an acl reconstruction or tibial tubercle osteotomy a femoral block is also given for pain control postop).

Your intravenous line will be started. Your surgeon will answer any final questions and mark your knee.

When the operating room is ready you will be brought into the room. You will be introduced to the operating team, which includes the nurse, scrub tech, surgeon, PA and anesthesiologist.

The anesthesiologist will then put in a femoral nerve block for the knee surgery. This is to help relieve postop pain and decrease the amount of general anesthesia. The block will last 16 hours. You will then be given medication in the IV to put you to sleep.

After surgery

You will have a bandage on your knee, a ted hose and the iceman. If you have an ACL reconstruction or tibial tubercle osteotomy, you will also have a drain, and a brace on. You will be discharged when you are awake, tolerating fluid and able to go the bathroom.

You will be given instructions for home, arthroscopic pictures and a DVD of your surgery.

When you get home have small bland meals that night then advance to your regular diet the next day if feeling well.

You may move around as tolerated. Take it easy for the first 2 days, in other words do not make plans to go out to dinner, to a party etc. Increase your activity slowly.

You must give your knee time to heal. You cannot use pain as a guide on activity in the postop period. If you decide to have surgery, you will need to follow instructions and guidelines to avoid failure of the surgery. Repairs can be pulled apart if directions are not followed. Please take this into consideration when making plans for after surgery.

Pain medication

You will need pain medication for the first 2-3 days. After that take only as needed. You will not be pain free. Surgery is painful and you may have pain for several months.

Driving

You should not drive if you are taking narcotic medication. Wait at least 1 week after knee arthroscopy and 3 weeks after ACL reconstruction. You must be able to move your foot up and down, as well as put all your weight on the leg, if it is your right leg. Try to borrow an automatic car if possible. You must decide if you can safely control your vehicle. Please check with your insurance agent about driving with a brace or crutches. Practice in a remote area before going onto a main road.