Arthroscopy of the Knee Information for the Patients of Dr M R J Coolican INTRODUCTION: Knee arthroscopy provides direct inspection of the joint with further arthroscopic surgery as directed by the findings. All surgery is usually performed at the one time with admission and discharge on the same day. Knee arthroscopy is performed to treat problems with the menisci (which footballers call “cartilages”), the synovium or the bearing surfaces (which doctors call hyaline cartilage). Occasionally surgery will be to remove loose bony fragments, trim a loose piece of bone, take a sample of tissue (biopsy), or diagnose or treat joint infection. You should stop any non-steroidal anti-inflammatory medications (eg Feldene, Voltaren or Clinoril), three days before surgery and aspirin (eg Cardiprin) two weeks before surgery. These drugs may interfere with blood clotting mechanisms. If you are taking aspirin or Warfarin for anti-clotting purposes associated with previous blood clots or heart disease, you may need to continue with this medication. This should be discussed with Dr Coolican. Remember to bring your radiographs and any imaging studies you may have (eg MRI) to hospital. HOSPITAL: Prior to surgery you will meet the anaesthetist who will discuss your past medical problems and anaesthetic history. We will almost always use a general anaesthetic. After settling into hospital, nursing staff will help shave your leg (if necessary) prepare it with Betadine and wrap it with sterile drape. This helps prevent infection and also identifies the correct side for surgery. You will be repeatedly asked “which side”. Don’t be alarmed, it is not that we don’t know but is a check. After anaesthesia is commenced your leg is examined to assess ligamentous stability, and then a tourniquet is applied, the leg placed in a thigh support and prepped and draped. The arthroscope and instruments are inserted by two small incisions approximately one centimetre long at the front of the joint. The joint is distended with fluid and a third incision is made for the fluid to drain via a small tube. Surgery is performed through the small incisions with vision provided via a television monitor. Local anaesthetic and Morphine are injected into the joint and around the portals to reduce pain after surgery. This wears off after 12 hours and you may notice an increase in pain at this time. Following surgery, a three layer padded dressing of gauze, wool and crepe is applied which should remain in place for approximately 2 days. You should keep this dressing dry. You will see Dr Coolican in the recovery area or ward after surgery. He will give you a brief report of the operation with an instruction sheet and a referral for your physiotherapist. If you do not have a regular physiotherapist, Dr Coolican will recommend a physio near to your home or work. It is helpful if a relative is with you after the surgery as you may not retain all that you are told because of lingering effects of anaesthetic agents. POSTOPERATIVE PAIN: The local anaesthetic and Morphine injection into the joint at surgery wears off approximately 12 hours after the surgery. You may notice a gradual increase in pain at this time. Rest, elevation, ice and pain medication are all helpful in relieving pain for the first 1 to 2 days after surgery. Pain the day after surgery usually occurs with activity and a quiet day at home should be planned. Too high an activity level soon after surgery can prolong recovery time and cause unnecessary setbacks. DRESSINGS: On the second morning after surgery remove the dressings down to the paper tapes (called Steri- strips) which hold the portals closed. Usually there are no sutures. Leave the Steri-strips in place and partly cover with a band-aid applied in a transverse direction. You may shower at this stage but after each shower change the band-aids. The Steri-strips will peel off over a day or two. Band-aids are required until the portals have healed. REHABILITATION: Rehabilitation starts immediately after surgery.
a) Tense your thigh muscle (quadriceps for 10 seconds then relax for 10 seconds). Repeat
b) Ankle movement exercises to prevent blood pooling in the calf. Move toe from fully
pointed down to up every 2 seconds for 10 seconds every half hour.
c) Straight leg raising exercises to 45 degrees, 3 sets of 10, three times daily. d) Physiotherapy—you will be given a referral to a physiotherapist for post-operative
supervised rehabilitation. Usually only 3-5 visits are required with the physiotherapist teaching exercise routines that are appropriate for your age and activity level.
FOLLOW UP VISITS: Please call Dr Coolican’s office the next working day to schedule a follow up visit 2-3 weeks after surgery. Usually one visit only is required. RETURN TO WORK AND SPORT: Sedentary work: 2 to 3 days Physical work:
Light training: 10 days - 2 wks depending on swelling Competitive sport: 3 to 4 weeks depending on progress RISKS: Arthroscopic knee surgery is very commonly performed and usually without any significant complications. However all surgery carries risks including infection, blood clots, problems related to the anaesthetic and inadvertent injury to blood vessels or nerves.
Infection is exceedingly rare following arthroscopic knee surgery. When it occurs it is manifested by increasing pain, swelling, fever or redness around the incision. If in doubt check with Dr Coolican. Blood clots may present as calf pain or unexplained swelling and should be reported to Dr Coolican. If you have any questions about your proposed surgery, its risks, potential complications or likely benefits, please do not hesitate to speak with Dr Coolican.
COSTS: Dr Coolican charges fees recommended by the Australian Medical Association. These were once the same as the rebates given by Medicare and your health fund but unfortunately these rebates have not kept pace with inflation. This will produce a gap payment which for your surgery will be approximately $ although this ould vary a little depending upon the findings are surgery. Your anaesthetic fee is in addition to the surgery fee.
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