Knee arthroscopy is an outpatient procedure. It is performed under anesthesia, usually general anesthesia. The surgery itself takes about 30 minutes, and is performed thru two small incisions in the front of the knee on either side of the kneecap. These incisions are generally about 1 /4 inch in length.
A small telescope (the arthroscope) is placed into one of these incisions and the entire inside of the knee can be visualized. The arthroscope is connected to a tiny camera, allowing the entire surgery to be visualized on a TV monitor. The other incision is used to place various instruments into the knee to perform the surgery.
Many different types of surgery can be performed thru these two incisions, the most common of which are to be remove meniscal (cartilage) tears, shave down arthritic areas, and remove loose Fragments of tissue within the knee.
Before surgery, preoperative evaluation is necessary. The extent of the testing depends on each patient's age, gender, and medical condition. Everyone needs at least a history and physical examination which will usually be performed at your primary doctor's office.
Instructions for scheduling your pre-admission testing (PAT's) are included in a separate instruction sheet from our office.
You will be seen in the preoperative area before your surgery to answer any questions you may have. Dr. Vernace will mark your knee with his initials to identify the correct knee for surgery. From the time you leave the preoperative area and walk back to the operating room to the time you are in the recovery room will be approximately 45 minutes. You will be in the recovery room for approximately 1 to 1 1/2 hours. Someone will need to drive you home that day. You are not allowed to drive for 24 hours after anesthesia.
At the time of your surgery, Dr. Vernace will observe any and all abnormalities in your knee and correct any of those that can be corrected or addressed with the arthroscopy (which are most things). Photographs will be taken that will be shown to you at your follow-up
visits. These will be a permanent part of your office and hospital record.
Your incisions will be close with either stare strips or one stitch each. A gauze dressing and ace bandage will be placed on your knee. No brace or cast is needed.
At the end of your surgery, long acting Novocain (marcaine) will be injected into your knee. This should keep you fairly comfortable for several hours. Many patients actually feel better the first day of surgery than the next day due to the lingering effects of the marcaine. For this reason, you should limit walking on your operated leg for the first 24 hours. Use the crutches or a walker to get around the first day.
You will use ice packs the first few days. Instructions on its use and full instructions regarding your dressings and pain medicine will be given to you at the hospital.
KNEE ARTHROSCOPY POST-OPERATIVE CARE
The day after surgery is generally your worst day. Many patients say they are fairly comfortable the first day due to the marcaine injection. By the second postoperative day, much of the swelling is down and you may start putting more weight on the leg, but that first day after surgery, is quite variable and often somewhat painful. This is common and should not alarm you if your knee hurts more the day after surgery than it did the day of surgery. You are allowed to start putting weight on your leg immediately after surgery, but should limit this the first few 24-48 hours using crutches or a walker as needed. Usually by the second day after (48 hours later), most patients begin to walk around without the crutches. The knee is still swollen and uncomfortable at this time but is improving.
As you continue to improve over the next several days you should bend your knee as much as possible without causing significant pain, as you are starting your recovery.
Icing the knee at painful intervals even 4 or 5 days after surgery is helpful. Taking over the counter medicines such as ibuprofen (Advil,Motrin, etc.) or Aleve is often helpful and can actually reduce your need for stronger pain medicine.
Returning to work depends on your specific job. Many patients who have desk jobs will be able to return to work within 2 to 4 days. If it is your right knee, driving is usually possible by 3 to 4 days as well.
You will return to our office one week after surgery to have your incisions checked and to discuss further treatment, such as the need for physical therapy.
This appointment will be made at the time you schedule your surgery. At the end of that appointment you will be given another follow up appointment for 3 to 4 weeks.
KNEE ARTHROSCOPY POST-OPERATIVE THERAPY
Most patients with simple arthroscopic surgery (meniscal tears, etc.) will be fully recovered in 3 to 6 weeks. This means returning to running, sports, etc. If you have any significant arthritis findings, recovery is usually more prolonged. If you need physical therapy, the therapist will help us in guiding you back to your normal activities.
Some problems inside the knee cannot be fully corrected but can be improved temporarily. This is true of arthritic conditions especially. This will be discussed with you when your photographs are reviewed.
Regarding postoperative physical therapy, many patients wait to see how they are doing one week after surgery to see if they need to attend PT. If you desire a more rapid recovery from surgery, we recommend that you start therapy 3 to 4 days after surgery, even before returning for your first postoperative visit.
We strongly recommend our therapy center, Founders; Physical Therapy, which is located next to our office. We have chosen our therapists and therapy assistants for their experience, expertise and their warm and friendly manner in which they conduct their therapy sessions. They have over 40 years of combined experience and have been recognized by many patients as the best therapy group on the main line. You will receive individualized therapy, tailored to your needs. We work closely with them throughout your recovery. If you are having difficulties, you will be right next door and the therapist and you will have easy access to your surgeon to promptly address any concerns. Our facility is arranged for your comfort and needs, with a full service bathroom and shower, plasma screen televisions and private treatment rooms to be used as needed by the therapists. The phone number for the therapy office is 610-527-3300.