Arthroscopic Knee Surgery
What is an arthroscopy?
Arthroscopy has become one of the most frequently used procedures for diagnosis
and treatment of knee injuries. It is a minor surgical procedure that is done as
an outpatient. The physician inserts the arthroscope into your knee through
several small incisions. This allows the physician to see the entire knee joint
and permits the repair of some injuries. Arthroscopy has revolutionized the treatment of joint injuries. In the past,
treatment of orthopedic injuries involved extensive surgery, including large
incisions, a hospital stay, and a prolonged recovery period. But today, with the
help of an arthroscope, today's orthopedic surgeon can easily examine, diagnose,
and treat problems in the joint that previously may have been difficult to
identify.  The arthroscope is a small fiber-optic viewing instrument made
up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or
4 mm in diameter), but appear much larger when viewed through an arthroscope.
Shown below -- both as it appears on the operating table and when viewed
arthroscopically
 -- is a probe, used for examination of internal structures (in
this case the underside of a patella, or kneecap).
The surgeon inserts the arthroscope into the joint through a tiny incision
(about 1/4 of an inch) called a portal. Two or three incisions may be made for
portals. Other portals are used for the insertion of surgical instruments, such
as the probe shown above.
 Typical incision sites and sizes for knee arthroscopy are shown. These
incisions result in very small scars which in many cases are unnoticeable.
Preparing for Surgery
Before Surgery
It is very important that you observe the following instructions:
 | Do not eat or drink anything after midnight unless otherwise instructed by
your physician or the anesthesiologist. Your surgery may be canceled if
you eat or drink after midnight or as instructed.
| Take routine medications only as directed by your anesthesiologist or
physician.
| Remove all nail polish and do not wear make-up the day of surgery.
| Leave all jewelry, money, watches and valuables with family. The facility can not be responsible for your valuables.
| Wear comfortable casual clothing that is easy to get on and off
(drawstring-style sweat pants, boxer-style shorts, or loose clothing).
| If you have crutches, a knee immobilizer, or a brace, please bring them
with you on the day of surgery. You may need these after surgery.
| You may wish to bring reading material or crossword puzzles to occupy your
time.
| Arrange to have an adult (someone over 18) available to drive you
home after discharge, and have someone stay with you at least 24 hours once
you are home.
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Day of Surgery
You will be asked to change into a hospital gown and remove
jewelry and contacts. (We suggest you leave your contacts out the day of
surgery.) The nurses will check your (pulse, blood pressure and temperature),
and ask you a few questions. You will then be directed to a
waiting area until the operating room notifies the nurses. Then you will be taken
to the operating room on a cart. The anesthesiologist will talk with you briefly, an
IV (needle inserted to give you fluids) is inserted, and final preparations are
carried out.
Waiting room
Your family will be directed to waiting rooms. Medical staff will notify them
when your procedure is completed, and how you are doing. They will be directed
to the appropriate area once you have completed your recovery room stay.
After Surgery
When surgery is completed, you will be taken to the recovery room. The usual
length of stay in the recovery room is 1 hour, but may be longer according to
the surgical procedure and the type of anesthesia.
While you are in the recovery room, the nurses will be checking your blood
pressure, pulse, respirations, and temperature frequently. They will also be
checking the sensation and circulation in your surgical leg.
You may have a large bandage, a brace or an ice cuff on your knee.
After your stay in the recovery room you will be transferred to an inpatient
floor. The nursing staff will continue to monitor your recovery, provide medication
for pain and/or nausea, and give you ice chips and liquids. During this final
recovery stage, your nurses review discharge instructions and obtain
prescriptions. You may be seen by a physical therapist. Discharge is based upon your recovery from the effects of
anesthesia and your degree of pain. Your physician determines if you are ready for
discharge. If additional observation is required, you may be admitted to the
hospital.
What happens at home?
It is normal to feel drowsy for 24-48 hours after surgery and to require pain
medication at regular intervals. These symptoms will gradually subside and each
day you will feel less sleepy and painful.
Activity:
| Crutches are used for a short time. Put only as much weight on your
surgical leg as advised by your physician.
| Always wear your brace when walking, or as instructed by your physician.
| Daily knee exercises are important for the return of function. |
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Wound care:
| Keep your wound and bandage clean and dry. Change and remove bandage as
instructed.
| Your wound should not come in contact with water. Change any bandage
immediately if it becomes wet or bloody.
| You may shower with a plastic bag securely taped beyond the upper edge of
your brace. It is recommended that you sit on a chair in the shower, keeping your
bandaged leg out of the direct water spray. |
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Pain control:
| Applying ice for the first 24-48 hours after surgery will reduce pain and
swelling.
| Elevating your leg above heart level as much as possible will also reduce
pain and swelling.
| Elevate your leg after exercises and always at night, with your knee above
heart level.
| Take pain medication as prescribed. Do not drink alcohol when you are
taking this medication. Take medication 30 minutes before exercises.
| Eventually pain subsides and Tylenol should control your pain. |
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Rehabilitation program:
A physical therapist will instruct you on crutch ambulation, range of motion and
strengthening exercises. Continuing these exercises after your surgery is
important to maintain knee range of motion, reduce scar tissue and strengthen
weakened muscles. Your physician will specify when you should begin an exercise
program to gain motion and/or to strengthen muscles above your knee. Two
commonly-used exercises are quadriceps setting and straight leg raises.
Quadriceps setting:
Lie on your back with your knees straight, legs
flat and arms by your side. Tighten the muscles on the top of the thigh
(quadriceps), and at the same time push the back of the knee down into the table
and raise only the heel. Hold for 5 seconds, relax 5 seconds. Repeat this
exercise 6 times on a firm surface at least 4 times a day.
Straight leg raising:
Lie on your back with your operative knee flat
and straight. Keep the other leg bent with foot flat on the floor. Slowly raise
your operative leg about 6 inches off the floor, keeping the leg as straight as
you can. Hold for a count of 5 seconds, then lower the leg. Repeat this exercise
6 times on a firm surface at least 4 times a day.
Return appointments:
Follow-up visits are necessary for your doctor to chart progress, change
bandages, check for any complications and evaluate your rehabilitation progress. Reminders:
Call us immediately if any of the following occur:
| Swelling, tingling, pain or numbness in your toes which is not relieved by
elevating your knee above heart level for 1 hour.
| Drainage that is foul smelling, green or yellow, or drainage where there
was none before.
| Chills or temperature above 38.5° C (101.3° F). or if greater than 38°
C (100.4° F) for 24 hours. |
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