Post Operative Instructions

Arthroscopic Meniscal Repair

Michael E. Joyce, MD

Bandages & Ace Wrap:

Your post-operative dressing has three layers you need to understand in order to properly
care for your knee for the two weeks following surgery. Your incisions were closed with a
single long stitch, which were covered with small white tapes called Steri-Strips. Your Steri-
Strips should be left in place until your sutures are removed 10 to 12 days after surgery.
The second layer is a large white fluffy dressing that is loosely wrapped around your
knee. Since arthroscopy is performed with water, this second layer can absorb some water that
will leak from your knee for the first couple hours after surgery. Occasionally, there will also be
a small amount of blood mixed with this water, which is nothing to worry about. The third and
final layer is a long ace wrap that was wrapped around your leg from the foot up to your thigh.
We wrap the whole leg, not just the knee, so that the ace wrap does not act like a tourniquet
causing the lower leg to swell.
While you can remove the white fluffy dressing the day after surgery, you should use the
ace wrap for at least a few days after surgery, or as long as your leg or knee has some swelling.
Many patients that undergo meniscal repair also had other surgical procedures performed
on their knee. You post-operative instructions will take into account both surgeries and you
physical therapist will review this with you.

Ice, Elevation & Cryo Cuff:

One important goal following surgery is to minimize swelling around the knee. The best
way to achieve this is with the frequent application of ice and by keeping the leg elevated. This
is most important the first 72 hours following surgery. The ice pack should be large (like a big
zip-lock bag) and held firmly around the front of the knee. While we wrap your ace bandage
from your foot to your thigh to prevent the calf from swelling, it is still important to keep the
entire leg elevated on a couple of pillows. We follow the "one to four" rule - which means that
for every hour your leg is down (like sitting in a chair or walking) it takes four hours to reverse
the swelling.
Many patients will have a cryo-cuff to cool the knee after surgery. If you do not have
one simply follow the same instructions using a bag of ice. For the first few days after surgery
the cryo-cuff is placed over your dressing, later it can be placed directly on the knee or over a
thin towel. The brace should be removed to properly use this device. Use the cryo-cuff for 20 to
30 minutes every 1-2 hours for the first 3 to 4 days, then use it after physical therapy or times of
increased activity for the next several weeks.

Brace:
 A brace is used to protect your knee after surgery. The only time you really must wear
the brace is when you are ambulating. While in bed or resting feel free to remove the brace. The
brace's hinges are locked so that the knee is held in a fully extended position (straight out), do
not change the hinges on the brace. Once your rehabilitation has begun the physical therapist
may begin allowing you to walk without the brace. Feel free to adjust the brace in order to
make it more comfortable. Depending on the size and location of your meniscal repair you may
have to wear the brace for up to 6 weeks

Washing & Bathing:

You should be careful to keep the wound clean and dry for the first 48 hours after
surgery. Beginning on the forth day after surgery it is OK to shower directly over your Steri-
Strips (they won't come off). It is also OK to use soap on your leg and over the Steri-Strips.
This shower should be quick. I would prefer that you do not take a bath until one week after
surgery. It is OK to go into a swimming pool a week after surgery, but no lakes or ocean until
two weeks after surgery.
The yellow discoloration you will find on your leg is a long lasting surgical prep called
DuraPrep. This is used because it will kill bacteria on your skin hours longer than old fashion
iodine surgical preps. This yellow discoloration will not come off with soap and water, instead
you will need rubbing alcohol to remove it. This can be done the day after surgery unless it is
causing your leg to itch, then it can be removed sooner.

Walking & Crutches:

One of the wonders of arthroscopic surgery is the quick recovery that we expect. We
allow you place your full weight on the operative knee when walking as soon after surgery as it
feels comfortable. Remember that walking with your brace on is perfectly safe and may actually
speed your recovery. It is fine to use your crutches for a day or two if needed, but keep testing
how you can do without them. Almost all patients are off crutches within a week of surgery.

Physical Therapy

Your physical therapy appointment should have been made for you before your surgery
day. It is important to start physical therapy within two to three days after surgery. The goal of
physical therapy is to first assess how your knee responded to the surgical procedure, therefore
they will remove your dressing and look at your wound. They will re-introduce you to your knee
so that you feel comfortable with your surgery and aren't afraid to start doing things. Your
therapist will start range of motion, gait, and strength exercises on your first visit. If they find
anything unexpected they will let Dr. Joyce know right away.
Follow up appointment:

We try to give all of our patients a follow-up office visit at the same time we schedule
your surgery. Sometimes I find things, or do things, I didn't anticipate during your surgical
procedure, therefore I may want to see you in the office sooner than originally planned.
Typically I want to see my patients in the office a week and a half after surgery.

Medications:

I will usually prescribe two medications for the control of your post-operative pain.
During surgery I will often inject a painkiller, like novocaine, that will give some pain relief for
several hours after surgery. It is important to begin to take your pain pills before this medicine
wears off.
This first medication I use is Vicodin (hydrocodone) which is a strong narcotic pain
medication. It will begin to work within 15 minutes after taking it with a maximal effect in one
to two hours. For some sensitive patients, when taking the first few doses of Vicodin you may
experience nausea or an episode of vomiting. The best way to prevent this is to take the
medicine with a little food, start with just one pill, and be patient while the medicine begins to
work. Usually, after the first few doses the nausea will go away. If the nausea persists, it is
possible that a similar response will occur with other narcotic pain pills, therefore we should try
the Anaprox as the main medication to control your pain. It you take a full dose of this
medication for more than 4 or 5 days it can lead to constipation. Normally, Vicodin is taken
every 6 hours but if the pain is severe, it can be used every 4 hours.
The second medication I prescribe is Anaprox, which is a non-narcotic painkiller in the
NSAID class. The advantage of this medication is that nausea is a very infrequent side effect
and it can also be taken with the Vicodin for even better pain control than any pain medication
alone. This medication should be taken with food. For patients that get stomach irritation from
NSAIDs I will substitute Vioxx for the Anaprox.
Many patients end up taking the Vicodin at night and the Anaprox during the day.
Whatever combination works best with you is fine with me.

DVT Prophylaxis – Prevention of Blood clot following surgery:

The risk of a leg blood clot following minor surgery is very rare. The majority of patients
that suffer this complication usually have a prior history of a blood clot, or a positive family
history of DVT. The medical literature is unclear what method of prevention is best, and you
will find that each surgeon does this a little different. Upon my review of the medical literature I
recommend for patients with no prior risk factors, over the age of 40, to take one baby aspirin
(81mg) once a day for 45 days following surgery.
What to watch out for:

 Pain that is increasing every hour in spite of the pain medication.

 Drainage from the wound more than 2 days after surgery.
 Increasing redness around the knee
 Pain or swelling in your calf
 Fever greater than 101o
 Increasing pain with walking.
 Locking or catching within the knee that is getting worse not better.
 Unable to keep food or water down for more than one day.

Who To Call for Questions and Problems:

If you are having problems or there are questions you need answered then please call our
office at 860-652-8883 and our nurse will help you. We are open between 8:30 and 4:30 pm,
Monday to Friday.
We realize the after surgery some problems or questions are urgent and can not wait until
normal working hours. Under these circumstances please call 860-652-8883 anytime (24 hours a
day, 7 days a week) and the doctor on-call, or myself will return your call. If you do not receive
an answer within 20 minutes there may be a problem with the beeper so please call again.
If an emergency were to occur you can always go straight to the emergency room for
immediate attention.

Driving:

There are no restrictions on driving after surgery as long as the following precautions are
followed. First, do not attempt to drive with the brace on. Remove the brace after getting into
the car then proceed with operation of the vehicle. Second, you should not drive if you are still
taking a large dose of pain medication. Third, you should not drive until the pain in the knee has
decreased to a tolerable level and the knee has more than 90 degrees of motion. The first time
you drive, test your skill in an empty parking lot with another passenger.

Wishing you - All the Best,

Michael Joyce, MD