L. Ryan Smart, MD Knee Arthroscopy Post-op Packet Contents: Post-op Reference Sheet Physical Therapy Prescription Exercise Sheet Surgical Pictures SOS Fayetteville 4115 Medical Center Drive, Fayetteville, NY 13066 Tel: 315-329-7600, Fax: 315-329-7608 SOS Liverpool 5100 West Taft Road, Liverpool, NY 13088 Tel: 315-452-2120, Fax: 315-452-2118 L. Ryan Smart, MD Patient Post-op Reference Sheet: Knee Arthroscopy Pain Control and Ice      A pain medication prescription will be provided prior to discharge. You may take the prescribed medication as directed. You should expect to experience minimal to moderate knee discomfort for several days and even weeks following the surgery. Patients often only need prescription narcotics for a few days following the surgery and then switch to over-the counter medications such as Tylenol or Ibuprofen. Ice bags and elevation should be utilized to decrease swelling and pain. Ice should be applied to the knee up to three times a day for 20 minutes until swelling subsides Wound Care     If there is bleeding through the bandage, reinforce it with additional dressings for the first 24 hours. After 48 hours, remove the bandage, if the incisions are dry (no bleeding) place band aids. If the knee is still bleeding, place new sterile dressings over the incisions and change to Band-Aids after an additional 24 hours Showering is acceptable after 48 hours. Do not submerge or scrub the knee Rehabilitation/ General Post-op Care       You will be able to put as much weight as tolerated on your leg utilizing crutches Home physical therapy may all you need to do. Sometimes formal PT is needed. Take one 325 mg (full strength) aspirin daily for 14 days (unless otherwise instructed or allergic) to prevent blood clots. First post-op appointment is 7-10 days for suture removal You may drive once you establish control of you operative extremity. If your right knee was operated on, this may take approximately 3-5 days to achieve. You may not drive under influence of pain medication. Plan at least 2-3 days away from work or school. Utilize this time to decrease swelling and participate in your home exercise program. You may be able to resume work once the pain and swelling resolves (this varies based on job activity). Sample Pictures for Education Purposes Grades of Osteoarthrits Types of Meniscal Tears (Remove from packet and bring to your initial physical therapy appointment.) L. Ryan Smart, MD Physical Therapy Prescription Patient Name: _________________________________________________ Diagnosis: ____________________________________________________ Prescription: Progressive range of motion, modalities for edema and pain reduction, progressive resistive exercise Frequency: 2-3x a week Precautions: ______________________________ Signature ____________________________________ Physical Therapy Facility SOS Fayetteville 4115 Medical Center Drive, Fayetteville, NY 13066 Tel: 315-329-7600, Fax: 315-329-7608 SOS Liverpool 5100 West Taft Road, Liverpool, NY 13088 Tel: 315-452-2120, Fax: 315-452-2118 L. Ryan Smart, MD General Post-op Rehabilitation Guide Phase 1 (Week 0-1): Goals: Minimize effusion, Full range of motion, Initiate CKC exercises, Normalize gait pattern/balance - independent mobility and proprioception abilities Treatment plan: 1) Swelling Control with ice and compression wrap 2) Progress towards full range of motion 3) Initiate quadriceps and hamstring muscle activation and general leg control  Quad setting, SLR, heel slides, isometric hamstring/quadriceps contraction  Ankle pumps 4) WBAT with crutches 5) Electrical stimulation to quadriceps muscle Phase 2 (Weeks 1-3): Goals: Progress quadriceps/hamstring strengthening, independent mobility Treatment plan: 1) Continue with swelling control 2) Progress strengthening 3) Balance and Proprioception: Single leg stance/weight shifting Phase 3 (Weeks 3-5): Goals: Full lower extremity strengthening/conditioning program, Full activity in gym Treatment plan: 1) Progress CKC strengthening – lunges/ reverse lunges/ single leg squats 2) Full ROM – Full revolution on bike 3) Progress dynamic balance training 4) Sports specific strengthening and conditioning Post-op exercise program until formal physical therapy is started: Frequently asked questions 1) There is bleeding through the ace wrap on my knee, what do I do? You may experience some bleeding or staining of the ace wrap/ dressing that has been placed over the incisions of your knee. This is normal. Reinforce the current dressing with sterile gauze and an additional ace wrap. All of this equipment can be purchased at your local pharmacy. Remove all dressings 24 hours later and re-evaluate. 2) When can I drive? You can drive when you have full control of the leg and you are not utilizing narcotic pain medication. 3) Do I need to use crutches? The crutches while recommended for at least 48 hours are not mandatory assuming you did not have a meniscal repair. If you can ambulate with out pain or instability you do not need to use crutches. 4) I have some numbness at the incision sites, is this normal? Numbness at the region of the incision is a normal result of cutting the skin. The numb region will likely decrease in size with time but may be permanent. No loss in function is expected as a result of this small region of decreased sensation 5) What can I do to decrease the swelling in the knee? Post operative swelling is normal after knee arthroscopy. You can decrease the swelling by utilizing a compression wrap (ace wrap), ice and elevation 6) I have become constipated since the surgery, what should I do? Post-operative constipation is often a side effect of the narcotic pain medication. There are numerous over the counter remedies for this problem. Your pharmacist is a great resource for this. Often Collace, a stool softener will do the trick. If you go past 3 days without a bowel movement please call the office or you primary care physician for guidance.