A complete physical examination that provides an assessment of the patient's overall health.
An examination of the range of movement in both the injured and uninjured knee.
Expectations for Recovery
Surgically treated cartilage damage, if rehabilitated properly, will allow the patient to eventually regain complete strength, stability and motion of the knee.
Patients with more severe symptoms that require surgery can expect a longer recovery. The patient may return to activity after more than a month, in a limited capacity. Ongoing physical therapy combined with modifications to previous athletic activities will likely be required for more than three months.
To help maintain a healthy knee, continued gentle use of the knee will be required. Running or other pounding and impact producing activities should be considerably reduced or eliminated.
In all cases, physical therapy is required to restore the muscle strength, flexibility and stability lost after the initial damage to the cartilage, and the time required to rehabilitate the joint.
Post Operative Recovery
Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
The knee will remain tender and slightly painful after surgery. However, the pain will tend to decrease as painkillers are administered and the knee recovers from the operation.
POST-OPERATIVE INSTRUCTIONS:
Diet:
Begin with clear liquids and light foods (jellos, soups, etc.).
Progress to your normal diet if you are not nauseated.
Activity:
Follow general post operative guidelines.
Be wary of any signs of infection.
Elevate the operative leg above chest level for 48 hours after surgery.
Do not place pillows under knees.
Use crutches to assist walking, do not place weight on the operative leg until instructed otherwise by the doctor.
Do not engage in activities which increase knee pain or swelling.
Return to sedentary work (school or desk work) only after 3-4 days if the pain is tolerable.
Avoid long periods of sitting and long distance traveling for two weeks.
Do not drive until permitted by the doctor.
Ice Therapy:
Begin ice therapy immediately after surgery.
Use a cryocuff continuously or as tolerated for the first week after your operation or until your follow-up appointment with your doctor. If you have not been instructed to use a cryocuff, icing should be performed every two hours for twenty minutes until swelling is controlled.
Rehabilitation Program Initial care will focus on rest and avoidance of activities that aggravate the condition. Actions that involve any pounding force against the knee, such as running or jumping which cause pain, should be avoided. Physical therapy will work to increase strength and stamina within the quadriceps and hamstrings, which will help stabilize the knee and tracking of the knee joint.
If muscle imbalances are contributing to a poorly aligned knee joint, proper conditioning of the thigh muscles will work to re-establish a healthy biomechanical relationship.
Weight loss, if applicable, is recommended. This will help reduce stress on the joint, particularly while walking, climbing stairs or during other daily activities.
Non-steriodal anti-inflammatory medication (NSAIDs) may be administered which reduces irritation and swelling in the joint.
Therapists may recommend changes in activity and specialized bracing to support the knee during movement or while it is under load. This may include a knee support, knee brace or, in more severe cases, a knee immobilizer.
If over-pronation of the feet is a factor, orthodic shoe inserts may be used to correct the patient's stance, reducing strain on the kneecap.
Medication and Medical Products
NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
Pain resulting from inflammation or swelling.
Pain after injury.
Joint pain and arthritis.
Knee: Cold Therapy Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.
Cold therapy can be used to treat:
Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.
Knee Examples include:
Pre-operative ACL/PCL injuries.
Non-surgical ACL/PCL injuries.
General knee pain or swelling.
Soft tissue injuries.
Possible Complications and Risks
Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection and reactions to anesthesia.
Re-injury to the cartilage is possible if physical therapy or other activities during rehabilitation are overly strenuous, causing damage to the recently supplemented cartilage.
The repaired cartilage structure is not as durable or long lasting as the body's natural cartilage. However, the material will tend to remain robust if not subjected to abuse.
