Knee Arthroscopy: Post-Operative Instructions

These instructions cover the first 2 weeks after surgery.

When You Go Home

1. Keep the operative leg elevated above your heart as much as possible. Avoid putting a pillow behind your knee, as this makes it harder to regain full extension (getting your knee straight) after surgery.
2. Your weight-bearing status (how much weight you may put on your leg) will be given to you at the time of surgery. Follow it carefully.
3. Ice your knee with a cold therapy unit, a bag of ice, or a bag of frozen peas. For the first few days you may ice for 30–45 minutes at a time because the dressings are thick. After the bandages are removed, do not ice for more than 20 minutes at a time, to avoid frostbite.
4. Do not drive until you have stopped narcotic pain medication and have been approved by your surgeon.
5. Return to work will depend on your type of employment.
6. Bruising on your leg, above and below the knee, is common after surgery.

Exercises: Start Post-Op Day 1 or 2

Quad Sets

Tighten your thigh muscles and hold for 5 seconds. It will feel like your knee is being pushed into the ground. Do at least 3 sets of 10 repetitions.

Straight Leg Raises

Once you can complete a set of 10 quad sets, begin straight leg raises. Tighten your thigh muscle as in a quad set, lift your leg about 12 inches off the ground, hold for 5 seconds, then lower. Do at least 3 sets of 10 repetitions. If you have a brace, do this with the brace locked fully straight.

Heel Slides (Bending the Knee)

Unlock the brace (keep it on) and slide your heel toward your buttock. Hold for 5 seconds, then straighten the knee. You can use a towel around your foot to assist. Do 3 sets of 10 repetitions. Do not bend the knee beyond the brace’s preset limits.

Heel Props (Straightening the Knee)

Keeping your knee fully straight is important early after surgery. Place a rolled towel or pillow under your heel with nothing under your knee or thigh, and hold this position for 5–10 minutes. Gravity will slowly help straighten your knee. You can also sit in a chair with your foot resting on another chair or ottoman, and rest your hand on your thigh near the knee to assist.

Calf Pumps

Move both feet up and down at the ankle at least 10 times an hour, every 1–2 hours, until you are up and around regularly. This encourages blood flow in the lower legs and helps reduce the risk of a blood clot (DVT).

Wound Care and Dressings

1. Expect a small amount of bloody drainage on your dressings. Contact our office if the bandage becomes saturated or is leaking. Do not remove your bandages or dressings unless instructed to do so.
2. You will be told whether to remove your dressing on post-op day 3, on post-op day 5, or to leave it for removal at your first post-op visit.
3. Sponge bathing is preferred after surgery. You may shower with a plastic bag taped around the leg and brace, but it is very important to keep the dressing completely dry. Showering is usually allowed after the dressing is removed. Do not soak the knee (no bathtub, hot tub, pool, lake, or ocean) until your surgeon says it is OK.
4. Do not put ointment on or touch your incisions until your surgeon says it is OK.

Diet

After surgery, begin with liquids and light foods such as gelatin and soup. Progress to your normal diet if you are not nauseated. Digestion can be slow after anesthesia and narcotic pain medication; a stool softener or mild laxative may help with constipation.

Physical Therapy

You will be told when to begin formal physical therapy. Contact a local physical therapy provider to schedule your first visit, and bring the physical therapy prescription you were given at the time of surgery.

Medications After Surgery

You will receive several prescriptions before or at the time of surgery. Take each exactly as prescribed. They typically include:

1. Narcotic (such as oxycodone): a strong pain medication that makes pain tolerable but does not eliminate it. Use it only as directed in the early post-operative period, and stop once your pain decreases, as it can be addictive. Side effects include drowsiness, constipation, nausea, and itching. Drink plenty of water to reduce constipation.
2. Tylenol (acetaminophen): very effective at reducing pain after surgery. Take as prescribed. Talk with your doctor if you have a history of liver disease.
3. Anti-nausea medication (such as Zofran or Compazine): anesthesia and narcotics can cause significant nausea in the first 24–48 hours. Take as needed during this period.
4. Anti-constipation medication (such as docusate, senna, or Miralax): the combination of anesthesia and narcotics often causes constipation. Use over-the-counter medications as directed and drink plenty of water.
5. Aspirin: knee surgery places you at a slightly higher risk of a blood clot. Take aspirin as prescribed to help reduce that risk.

Pain Control After Surgery

Many patients receive a nerve block for pain control during and immediately after surgery. It temporarily causes numbness and difficulty moving the leg, and there will be some pain once it wears off. Pain is typically worst in the first few days.

• Starting after surgery and before your nerve block wears off, follow this regimen for the first 24–48 hours:
  • Take Tylenol as prescribed. It is your first-line pain medication.
  • Take your narcotic pain medication as prescribed, on a regular schedule, during this period.
• Ibuprofen (Advil), 600–800 mg every 6–8 hours, may be alternated with the narcotic. Do not take ibuprofen or other NSAIDs if you have an allergy to them or a history of ulcers.
• After about 48 hours, gradually wean off the narcotic by spacing doses further apart, then stop. Continue the Tylenol and ibuprofen as directed.
• Many patients arrive at their first post-op appointment taking only Tylenol and ibuprofen and are completely off narcotics.

Follow-Up Care

Your first post-op visit should already be scheduled, generally 10–14 days after surgery. If it is not, contact our office.

Call the Office If You Have Any of the Following

• Unrelenting pain
• Fever greater than 101.5°F (38.5°C), or chills
• Excessive nausea or vomiting from pain medication
• Increasing swelling, numbness, or color change in the toes (your toes should be pink and warm)
• Continuous drainage or bleeding from the dressings
• Any other worrisome condition

Call 911 for severe symptoms, including severe pain in the back of the calf, shortness of breath, or chest pain, which may be warning signs of a blood clot or pulmonary embolism.