Arthroscopic Surgery Patient Information Sheet (Dr. Longobardi)

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					                    UNIVERSITY ORTHOPAEDIC CENTER, PA
                    RAPHAEL S. F. LONGOBARDI, MD, FAAOS

                    ARTHROSCOPIC SURGERY

The following is designed to present an overview of arthroscopic surgery so that you might better understand what
it is, what will happen during surgery, and what to expect before and after surgery.
DEFINITIONS
First, a few definitions. There are two kinds of cartilage
in the knee joint. One kind is located behind the bones
of the joint, and there are two of these – one on the in-
side of your knee and one on the outside of your knee –
called the medial and lateral meniscus, or the medial carti-
lage and lateral cartilage. These are fairly thick, fibrous,
somewhat C-shaped structures and often torn in the inju-
ries. The other kind of cartilage lines the joint surface
and acts like a cap to cover the ends of the bones. This
cartilage is called articular cartilage. It is a smooth, slick,
white substance in its normal, healthy state, which covers
and protects the joint itself, and allows the surfaces to
glide against each other. You have probably seen this on
the ends of animal bones, such as chicken joints, ham
hocks, etc. This is the type of cartilage which is affected
by the wearing-down process of arthritis. I have told
some of you that you may have chondromalacia of your
patella (aka, kneecap) or of the weight bearing surfaces of
the joint. This condition, chondromalacia, is the degen-
eration of the articular cartilage which is part of the proc-
ess of arthritis. The articular cartilage may become soft,
irregular, rough, or thinned out, or all of these. Sometimes a piece of articular cartilage, is loose or floating about
within the joint from an injury or other condition and we call these loose bodies. Sometimes they have a piece of
bone still attached to them and can be seen on x-ray and other times, if they do not have any bone, they cannot be
seen on x-ray but can, of course, be seen with the arthroscope. Another term which you have probably heard in
the conversations about the knee is ligaments. Ligaments are tough, rope-like structures which link the bones at
the joints and help hold the bones together.

Many patients who have this operation have a torn meniscal cartilage. The purpose of the operation is to remove
the torn part of the cartilage and leave undisturbed what normal meniscus that remains. Sometimes, it is necessary
to remove almost all of the cartilage, but this is unusual. Sometimes, it is necessary to remove almost all of the car-
tilage, but this is unusual. Sometimes the tear is able to be repaired using sutures or even tiny “tacks”. Regarding
arthritis and chondromalacia, some special instruments can be used to smooth the loose and frayed pieces of carti-
lage that is seen with this condition. This results in improvement, but not cure, of this problem. Conditions such
as a torn cartilage and chondromalacia are very often found in association with one another, and they will be
treated if present. There are, of course, several other conditions which can be treated arthroscopically, and I will
have discussed these with you.

  University Orthopaedic Center, PA Continental Plaza 433 Hackensack Avenue 2nd Floor Hackensack, NJ 07601
                                                                                      Revised November 2010
                                                                            UOC—Arthroscopic Surgery
                                                                          www.universityorthopaedic.com



     Unfortunately, many patients who have a tear of one of the important knee ligaments, such as the
     anterior cruciate ligaments, also may have a torn meniscus or injury to the articular cartilage. A
     very high percentage of people who tear the anterior cruciate ligament also tear their meniscus, and
     unfortunately, also have a fairly high incidence of developing future joint irregularities, such as ar-
     thritis. If I think you have a torn anterior cruciate ligament, I will have discussed the implications
     of this rather serious problem with you and give you an informational handout regarding that in-
     jury.

     My office will have discussed with you and arranged the date of your surgery, and they will talk
     with you about getting to the hospital and what time, etc. The majority of patients go home the
     same day of the operation, late in the afternoon or early in the evening. DO NOT EAT OR
     DRINK ANYTHING AFTER MIDNIGHT ON THE DAY OF YOUR OPERATION. If you
     have had anything to eat or drink during this period, you might vomit when you are given your
     anesthesia, and the consequences of that are severe pneumonia and possible death.

     I will see you just before the surgery and talk to your family after the surgery is over. Use your
     crutches, bearing weight and moving the knee as much as you can comfortably tolerate after the
     operation. When you can walk without a limp, you may discard your crutches. You may climb
     stairs as tolerated with or without your crutches, unless I have instructed you otherwise. Most of
     you will find that you can drive a car a day or so after the surgery, especially if your car has an
     automatic transmission. The dressing should stay on for about 24—36 hours after the surgery.
     You should keep it dry, if possible, when you shower or bathe by using a large garbage bag taped to
     your thigh or by wrapping the knee with Saran-wrap. If it gets wet, simply remove the dressing,
     and put some Band-Aids over the small steri-strips covering the puncture wound through which
     the arthroscope and other instruments were passed into your knee. As long as the wounds are dry
     and there is no blood or water draining from the wounds, you can shower and get the area wet. If
     your foot swells below the dressing, it is because the ACE bandage is too tight. Simply remove the
     ACE bandage and re-wrap it not as tightly as it was. Elevate your foot to the level of your face and
     the swelling will usually improve over the next 24 hours. If it does not, you should contact my
     office or myself. Please continue the exercises that you have been shown before surgery.

     You will be furnished a prescription for your pain, most probably Vicoden or Percocet. Most pa-
     tients, however, need very little, if any, pain medication. Some patients need a little medication a
     day or so after the surgery. The surgery itself is done with you asleep or with a regional or spinal
     anesthetic and occasionally a local. The anesthesiologist will talk with you just prior to your surgery
     regarding this. The arthroscope is a small telescope with a fiber optic light transmission system
     which enables me to see inside your knee. The knee is distended or filled with a salt solution,
     called saline, to make it easier for me to see inside and around your knee. You have three or four
     (or perhaps more) small, 3-5 mm puncture wounds to allow the passage of the arthroscope and
     other small instruments into your knee which are used to remove the damaged or diseased carti-
     lage, as well as to remove the saline. After you remove your dressing, you can expect to see some
     swelling about these puncture wounds, and also some soreness that gradually will go away over a
     period of three to four weeks.




University Orthopaedic Center, PA Continental Plaza 433 Hackensack Avenue 2nd Floor Hackensack, NJ 07601
                                                                                    Revised November 2010
                                                                           UOC—Arthroscopic Surgery
                                                                         www.universityorthopaedic.com




     If any problems in the knee itself require different exercise programs, you will be instructed
     individually by one of the physical therapists after your first post-op visit.

                                                     ●●●

     The information contained in this patient education packet is intended to help you and your fami-
     lies/caretakers better understand a particular diagnosis and/or the treatment options available. If
     you have any questions after reading this, please don’t hesitate to contact Dr. Longobardi’s office at
     201.343.1717 for a further explanation or you can also go to www.universityorthopaedic.com and
     click on Patient Education to gather more information. Thank you.




University Orthopaedic Center, PA Continental Plaza 433 Hackensack Avenue 2nd Floor Hackensack, NJ 07601
                                                                                    Revised November 2010

				
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