Knee Arthroscopy Handout

This handout provides information about what to expect and how to care for your knee after an arthroscopy. It is provided as a general guide and does not constitute nor replace specific medical advice.

A knee arthroscopy allows examination of the inside of your knee using two or more small incisions. A camera is inserted into the knee allowing a variety of surgical procedures to be performed, and your recovery will depend upon the type of procedure you have.

Local Anaesthetic is injected into your knee at the time of surgery and as this wears off, your knee may become more painful. Therefore, the next day it may be more painful than the day of surgery. It is better to use pain control when the pain is commencing rather than waiting until it it too late. Often regular doses of paracetamol (Panadol) will suffice, but if they are not working then you will be prescribed something stronger.

Ice is also really effective particularly in the first few days following your surgery. Apply an ice pack to your knee for twenty minutes, 4-5 times a day (after exercises and any longer walks) for the first week post operatively. Thereafter, use ice packs as required. Avoid heat in the first week as this can cause further bleeding and swelling.

Dressings

The small incisions are usually closed with small tapes (steristrips). Sometimes and additional non- dissolving stitch is also used. The wounds are covered with a showerproof plastic dressing and a bandage. For most knee arthroscopies ,dressings are left intact on discharge. The next day, take all bandages off and leave the showerproof plastic dressing. Only change this dressing if it has lifted and fluid has oozed out. Shower, pat the dressing down and apply the Tubigrip stocking that was given to you at discharge. The showerproof dressings may be removed after 7 days.You will be informed by your nurse if your surgeon prefers for it to be done differently. Some altered sensation or numbness may occur on the front of the knee as a result of small nerves being damaged during the procedure. This is common and unavoidable; usually this will gradually remove and the area will get smaller.

Swelling

During the first 3 days it is important to elevate your leg as much as possible. You can then gradually increase your activity guided by pain and swelling over the next week or so. Respect your knee for a month or so, heavy impact and twisting activities are likely to irritate your knee. It is common for the knee to remain swollen for 3- 4 weeks.

Review

You should have an appointment made 1-3 weeks following your surgery.

Driving

Essentially you can drive when your knee feels comfortable; a good guide being when you can walk without limping. Remember you may be required to brake suddenly in an emergency. Driving in the first 72 hours is not recommended due to the increase risk of your knee bleeding in this period.

Activities

Unless otherwise instructed you can take as much weight on your leg as comfortable. Most patients find crutches helpful for the first couple of days following surgery. Stop using crutches when you no longer have discomfort, can walk without limping, and feel confident in your leg. You can use a single crutch or a stick on the opposite side of your operation for lighter requirements. You will be given specific instructions should you need to use crutches for a longer period of time.

To negotiate steps and stairs

UP – good leg first, then operated leg then crutches (if used)

DOWN – crutches first (if used), operated leg, good leg.

Time off work depends upon the type of procedure and the job that you do. Most patients return to sedentary work after a few days to a week. Manual workers may require 3-4 weeks off work. As general rule you can return to gentle low impact exercise after 2 weeks (exercise bike, walking) and more vigorous activities from 4-8 weeks. Swimming and hydrotherapy can commence once the wounds are well healed.

Flying

It is always preferable to wait 6 weeks to fly following any lower limb surgery. Short local or interstate flights are probably ok, but the risk of blood clots is greater than normal. Discuss any planned post operative flights with your surgeon, as there may be special precautions that may be considered on individual basis.

Medication

You will be provided with medication upon your departure from hospital. Follow the instructions as described to you by your nurse. As a general rule, your medication requirements should continue to decrease over the early post operative period.

Remember if you are using codeine based products that constipation can be an issue so keep up the water and a fibre based product such as Metamucil can be of assistance.

Physiotherapy

You will be seen by a physiotherapist whilst in hospital at the request of your surgeon (for uninsured patients there will be a small fee for this) to ensure your recovery is a quick as possible. Exercises and advice will be given to help get you going. Generally there is no need for further physiotherapy visits, however, depending on how you are progressing at your post operative review your surgeon may recommend further treatment.

Following is an exercise program designed by the Physiotherapy team to help get you going. Please attempt the exercises in the days following your operation and gradually increase the amount as your knee allows. Don’t push too hard or you will irritate the knee; see how it recovers before increasing the amount of exercise or activity you do. Too much is as bad as not enough! Please call the Physiotherapist on 9815 2555 if you have any queries.

Clicking

This is common during the recovery phase and shouldn’t be painful. It usually relates to poor muscle control and usually settles with gradual strengthening and rehabilitation.

Squelching noises are also common and relate to excess fluid in the joint which will dissipate with time.

Complications

Arthroscopy is generally a very safe procedure and complications are uncommon, however despite the highest surgical standards and precautions they can occur. Potential serious problems include infection and calf vein thrombosis (blood clots).

An onset of fevers or sweats, or increasing redness and discharge from or around the wound can indicate that an infection is present. Please call if this occurs.

Likewise, please call if there is discomfort caused by bandages that are too tight or are loose and have become ineffective.

If you experience fevers, persistent swelling or bleeding or pain in the calf you should call the ward or contact your surgeon or attend to your GP or nearest hospital emergency department.

EXERCISES

The following exercises help to maintain circulation, strength and flexibility whilst you are recovering from the operation. They will suffice until you have your review when you should be ready to progress to higher levels of activity such as the exercise bike and walking. Try to perform them 2-3 times a day, starting on the day of your operation.

Ankle pumps:

Move your feet up and down from the ankles for 30 seconds.

Quads exercises:

a) Quads tightening: Push the back of your knee down toward the bed, locking your knee fully straight, by tightening your thigh muscles (quads). Hold for 3 seconds.

Repeat 10 times.

b)  Straight leg raise: Lock your knee straight, then slowly lift your leg up about 20 cm. Lower slowly. Repeat 10 times.

c)  Knee straightening over roll:  Place a rolled up towel under your knee. Straighten your knee as far as possible by tightening your thigh (quads) muscle. Lower slowly. Repeat 10 times.

Knee bending:

a)  Lying: Gently bend your knee, sliding your foot toward your bottom.  Use your hands to assist if necessary.  Repeat 10 times.

b)  Sitting: Gently bend your operated knee as far as is comfortable over the edge of a bed or couch. You can support your operated leg with your unoperated leg if necessary. Repeat 5 times.

If any of these exercises cause significant pain, please contact your physiotherapist or surgeon.The advice contained in this handout is appropriate for the first week after your operation, however the average recovery from knee arthroscopy takes 3-4 weeks. Further physiotherapy to reduce swelling, regain range of motion and strength, and prepare for return to work or sport, is often required. Glenferrie Sports and Spinal Clinic is located within Glenferrie Private Hospital and The Hawthorn Aquatic and Leisure Centre, specialises in orthopaedic surgery rehabilitation. We work closely with the surgeons who performed your operation.

It is usually possible to arrange a physiotherapy review to follow immediately after your review with your surgeon. Call our office on 9815 2555 if you would like to book an appointment.