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Knee Arthroscopy - Postoperative Care

Introduction

This brochure provides guidelines of how to care for your knee after an arthroscopy.

Your operation

You have had an arthroscopy. This procedure involves the examination of the inside of your knee using a telescope (arthroscope), through two or more small punctures at the front of your knee. A variety of surgical procedures can be done with this technique.

Pain relief

Local anaesthetic has been injected into your knee. When this wears off, your knee may become more painful. It may also swell. Therefore, the day after surgery may be more uncomfortable than the day of surgery. It is better to use painkillers when the pain is starting, rather than wait until it has already built up.

As a general principle, it is best to start with regular paracetamol (2 500mg tablets, every 6 hours). If this is not enough you will have been prescribed something stronger, such as Endone, Tramadol or Panadeine forte. Endone and Tramadol can be taken in addition to paracetamol. Panadeine forte is used instead of paracetamol.

You may also have been prescribed anti-inflammatory tablets to help with pain relief in the first few days after surgery. These should be taken with food. If you get indigestion or have ongoing nausea, the anti-inflammatory tablets should be stopped.

An increase in pain and swelling at about four or five days following surgery is not uncommon.  Ice, compression and elevation will also help reduce your symptoms (see below).

Dressings

The small puncture wounds are held together by small tapes (Steristrips). They are covered by waterproof plastic patches, so you can shower directly onto the knee.  The dressings and Steristrips can be removed after 5 days.  The cuts can be left open if healed and dry, or covered with a Band-Aid if still moist.

Swelling

Swelling is common after an arthroscopy. Fluid in the joint results in generalised swelling and is most obvious above the patella (kneecap). Swelling is also common around the incisions and this can take some months to resolve.  Swelling will be helped by applying the R.I.C.E. principles.

 

  • REST: Recovery will be aided by taking things easily, especially during the first few days. You can then gradually increase your activity, guided by your pain and swelling.
  • ICE: Any kind of ice pack will do. A good option is a large bag of frozen peas (you will probably need two, so that one can be re-frozen while the other one is in use). For the first week you should try to ice your knee 3 times a day for 20 minutes at a time. After this, ice the knee following exercise and at the end of the day until your swelling reduces (usually about 2-4 weeks).
  • COMPRESSION: You will usually have a Tubigrip stocking around you knee. Sometimes you will have a bandage. The bandage can be replaced by a compression stocking on the day after surgery. The compression stocking should be worn during the day until your swelling reduces (usually about 2-4 weeks).
  • ELEVATION

Crutches

Unless otherwise instructed, you can place as much weight on the leg as comfortable. Crutches may be helpful for the first 3-5 days following surgery.

To start with, the pattern of walking is “crutches, bad leg, good leg”. Once you are more comfortable, the crutches and operated leg go forward together. You may find it easier just to use one crutch. Use it with the opposite arm i.e. for a left knee operation, use the crutch with your right arm.

To manage steps with crutches, use the following guide:

 

  • UP: good leg, bad leg, crutches.
  • DOWN: crutches, bad leg, good leg.

Exercises

Begin this exercise program the day after your operation and continue it for the first two weeks.

Knee locking using the quadriceps muscle

With a rolled towel under your heel, tighten the quadriceps muscle at the front of your thigh and push your knee into the bed. Hold for 5 seconds and relax. Repeat 10-20 times, 2-3 times a day.

Straight leg raises

Lying flat, lock your knee straight and then lift the whole leg about 30cm off the bed. Hold for 3 seconds and relax. Repeat 10-20 times, 2-3 times a day.

Knee bending

Slide your heel up towards your bottom as far as comfortable. Hold 3 seconds. Repeat 10 times, 2-3 times a day. Gradually regain your full movement.

Knee bending on your stomach

Begin this exercise about 3 days after your operation. Lie on your stomach and bend your knee as far as comfortable. Hold for 3 seconds and relax. Repeat 10 times, 2-3 times a day.

4) Stationary bike

After 7-10 days you should be able to start riding an exercise bike. You may find it more comfortable to raise the seat. Start out with no resistance and for 5-10 minutes on the first day. Gradually increase the resistance and the time as pain and swelling allow. Build up to 20-30 minutes, 3 or 4 times a week.

Post-operative review

You will usually have a review appointment within the first 2-3 weeks. They will discuss further progression of activities at that time. The following list provides an approximate guide, but times will vary according to the details of your surgery and the status of your knee:

Return to activities

After 7-10 days you should be able to start riding an exercise bike. You may find it more comfortable to raise the seat. Start out with no resistance and for 5-10 minutes on the first day. Gradually increase the resistance and the time as pain and swelling allow. Build up to 20-30 minutes, 3 or 4 times a week.

Return to activities

Driving

When comfortable: 1-5 days.

Exercise bike

1-2 weeks

Swimming

2-4 weeks

Gym

2-4 weeks

Exercise walking

2-6 weeks

Golf

3-8 weeks

Running

4-12 weeks: Very variable. Do not run on a swollen knee.

Sport

6-10 weeks

Return to activities

Sedentary

2-5 days

Manual

2-4 weeks

These notes have been prepared by Prof Julian Feller at OrthoSport Victoria. They are a general overview aimed for use by his patients and reflect his views, opinions and recommendations. The contents are provided for information and education purposes only and not for the purpose of rendering medical advice. Please contact the office with any questions regarding medical conditions and treatment.