Basic information about this procedure:
You are scheduled for an arthroscopic surgery to remove torn meniscus and/or cartilage tissues from your knee. For this surgery, most people “go to sleep completely” during surgery with a general anesthetic. Surgery with a spinal anesthetic is also an option. Three small incisions are made to allow special instruments, including a fiber-optic camera, to be placed into your knee. Sterile saline (saltwater) is brought into the knee joint continuously with tubing to provide a clear view for the surgeon. Torn parts of the meniscus and/or damaged cartilage on the bone surfaces are carefully removed with special arthroscopic instruments. The end result is a knee lined with smooth and stable tissues rather than rough, torn, and unstable edges. The actual surgery time is usually about 30 minutes, but if extensive work is needed, the procedure may last slightly longer. At the end of the surgery, local anesthesia medication is injected into the knee and reduces pain for about 10 to 12 hours after surgery. This explains why patients often note that their pain is not severe at first, then worse the day after surgery.
In most cases, the small incisions are closed with Steri-strips only and no skin stitches are used. Steri-strips are somewhat waterproof, lasting seven to ten days, and then they begin to peel back at the edges. If nylon stitches are used at the skin level, they will need to be removed at roughly 7 to 14 days after surgery. This will be done at your first post-operative visit.
The initial bandage often gets soaked with fluid and blood, and may need to be changed several times during the first 48 to 72 hours . Drainage after surgery should gradually decrease within 48 hours. If desired, dry sterile gauze pads and an Ace wrap can be continued beyond 48 hours to protect the incisions from irritation from clothing, pets, young children, etc. Other patients elect to use large Band-Aids only after 48 hours if there is no major drainage from the incisions. Once the incisions are completely dry, the use of Band-Aids or a bandage is optional.
Expectations / Risks / Recovery:This surgery has a very high success rate. In almost all cases, your recovery will be smooth and relatively quick, allowing you to resume all activities that you want to participate in within 4 to 6 weeks. However, everyone heals from knee surgery at a different pace; a small number of people still experience pain and swelling several months after surgery.
Arthroscopic knee surgery has a very low complication rate (less than 1%). The standard risks of surgery include post-operative infection, blood clots in the leg (DVT), nerve or blood vessel injury, or anesthesia complications.
Immediately after surgery, if your pain is minimal when walking, then the use of crutches or a walker is not required. If necessary due to pain, patients may opt to use crutches or a walker for a few days after surgery. Once more comfortable, most people are able to walk with a minimal limp within one or two weeks after surgery. Most patients realize a benefit from arthroscopic knee surgery within 4 to 6 weeks. Reduction of pain and swelling, and improvement in knee strength, motion, and coordination may continue for three to four months after surgery.
Frequently asked questions after surgery:
Do I need a knee brace?
Knee braces after simple arthroscopic knee surgery are rarely used. However, if your surgery involves more than just removal of torn cartilage or meniscus – for example, if you have a meniscal repair – your knee may be placed in a brace after surgery.
When can I shower?
You can shower 48 hours after your surgery if there is no drainage from your incisions. Do not scrub directly over your incisions and gently pat the incisions dry after showering.
When can I immerse my knee in water to bathe or swim?
Two weeks after surgery if there is no drainage from your incisions.
How long will I be on pain medications?
You will likely need some form of pain medication for roughly one or two weeks after surgery. Again, there is a high degree of variability, with some using narcotic medication for less than one week, and others for up to four weeks. Most people are able to wean off narcotic medication in less than two weeks and switch to an over-the-counter pain medication such as Tylenol or ibuprofen. If you are running low on your pain medication and need a refill, please contact us at least 24 business hours before you expect to run out so that we have ample time to make arrangements for you to receive a refill prescription.
Do I need physical therapy?
Some but not all patients are sent to physical therapy after knee arthroscopy, and this is usually decided at the first post-operative visit. Some patients regain motion very quickly and have minimal swelling, and thus therapy may not be necessary for them. Alternatively, some patients may go to see a physical therapist once or twice to learn a home program. Your surgeon or the physician assistant will decide what is best for you.
What exercises should I do after surgery?
You are encouraged to bend and straighten your knee as much as pain allows immediately after standard knee arthroscopy. Remember, however, that your knee may be swollen and achieving full motion is often difficult for the first few days. You may tighten your quadriceps muscle right after surgery and we encourage straight leg raises if they are not too painful.
You can put as much weight on your leg as is comfortable immediately after surgery. Again, the potential need for crutches or a walker is usually less than two or three days. Riding on an exercise bike, walking on a treadmill or using an elliptical machine, or just plain walking are all good exercises to begin once the knee becomes less painful.
When can I drive?
You can drive as soon as you feel comfortable and safe, but YOU MUST NOT DRIVE IF YOU ARE TAKING NARCOTICS! If you drive a standard transmission vehicle and had surgery on your left knee, you should probably wait about one or two weeks before driving to avoid causing more pain and irritation from operating the clutch. If you need to drive long distances within two weeks after your surgery, you should take frequent breaks to stand up, stretch, and walk to decrease the risk of a blood clot forming in your leg.
Should I use ice or heat?
Ice should be used for the first several days, particularly if you have a lot of swelling or discomfort. Ice is also helpful if you develop swelling after exercising. Once the initial swelling has decreased, you may use either ice and/or heat depending on which helps you the most. Some patients report that using heat prior to activities helps “warm up” the knee.
Routine follow-up and return to work:Follow-up appointments should be made post-operatively at 7 to 10 days, again at 4 to 6 weeks, and then again at roughly 3 months if you are not improving. The 3 month appointment is often not necessary unless things are not going well.
The timing of returning to work depends on your profession. Typically, if your work is sedentary at a desk, you may be able to return within one week. If your work is very strenuous, you may require six to eight weeks before you return to full duty. Your physician will help you determine an appropriate return-to-work date, and can also provide work-related paperwork as necessary.
Call our office if you have:
- Increasing redness, particularly spreading from the incisions
- Rapidly increasing pain and swelling
- Fevers greater than 101.5◦ F
- Persistent drainage from your wounds
- Calf swelling or pain, particularly if associated with ankle motion