UNIVERSITY ORTHOPAEDIC CENTER, PA RAPHAEL S. F. LONGOBARDI, MD, FAAOS ARTHROSCOPIC KNEE SURGERY The following is designed to present an overview of arthroscopic surgery for the knee so that you might better understand what it is, what will happen during surgery, and what to expect before and after surgery. First, I would like to define and describe some of the structures that constitute the knee joint. The knee joint is formed by the junction of the end of the thigh bone (femur) and the top of the shin bone (tibia). The end of the femur is shaped like two crescents (called the femoral condyles); the top of the tibia (called the tibial plateau) is shaped essentially flat, with two slight depressions to ac- commodate the condyles. These shapes allow the knee joint to bend and straighten, and are the weight-bearing surfaces of the joint. There are two types of cartilage in the knee joint. The first type is located between the two bones of the joint, and these are called the medial and lat- eral menisci (meniscus, singular). The two of these carti- lage structures sit on top of the tibial plateau; one on the inner side or medial side of your knee, and other on the outer side or lateral side of your knee. These are fairly thick, fibrous, C-shaped structures that cushion, protect and stabilize the knee, yet are often torn in injuries. The other kind of cartilage lines the joint surfaces and acts like a cap to cover the ends of each bone. This cartilage is called articular cartilage. It is a smooth, slick, shiny white substance which, in its normal, healthy state, covers, pro- tects and cushions the joint itself, as well as allowing the surfaces to glide against each other. You have probably seen this on the ends of animal bones, such as chicken joints, 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, the kneecap) or of the weight bearing surfaces of the joint. This condition, chondromalacia, is the degeneration of the articular cartilage which is part of the process of arthritis. The articular cartilage may become soft, irregular, rough, fissured or thinned out, or even a combination of all of these. Sometimes a piece of articular cartilage becomes loose from an injury or other condition, and can “float” about within the joint; we call these pieces “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 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 link the bones together. University Orthopaedic Center, PA Continental Plaza 433 Hackensack Avenue 2nd Floor Hackensack, NJ 07601 Revised November 2010 UOC — Knee Arthroscopy www.universityorthopaedic.com Many patients who have knee arthroscopy have a torn meniscal cartilage. The purpose of the op- eration is to remove the torn part of the cartilage and leave undisturbed the normal meniscus that remains. Sometimes, it is necessary to remove almost all of the meniscus, but this is rare and un- usual. More frequently, 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 cartilage which are 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 together, if present. There are, of course, several other conditions which can be treated arthroscopically, and I will have discussed these other types of conditions and treatments with you. Many patients who have a tear of one of the important knee ligaments, such as the anterior cruciate ligaments, also may, unfortunately, have a torn meniscus or injury to the articular cartilage. These individuals have a fairly high incidence of developing future joint irregularities, such as arthritis. 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 injury. 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 an- esthesia, 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. 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 punc- ture wounds to allow the passage of the arthroscope and other small instruments into your knee which are used to remove the damaged or diseased cartilage and tissues, as well, as to remove the saline. 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 few days or so after the surgery, especially if your car has an automatic transmission. You will be given a separate sheet of instructions following your surgery. 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 Sa- ran-wrap. After 24-36 hours, you can simply remove the dressings, and if necessary, put some Band-Aids over the small steri-strips covering the puncture wound through which the arthroscope University Orthopaedic Center, PA Continental Plaza 433 Hackensack Avenue 2nd Floor Hackensack, NJ 07601 Revised November 2010 UOC — Knee Arthroscopy www.universityorthopaedic.com 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. After you remove your dressing, you can expect to see some swelling about these puncture wounds, as well as having some soreness that gradually will go away over a period of three to four weeks. If your foot swells below the dressing, it is often because the ACE bandage is too tight. Simply remove the ACE ban- dage and re-wrap it not as tightly. 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. 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. Please continue the exercises that you have been shown before surgery. If any problems in the knee itself require different exercise programs, you will be instructed individually by one of the physical therapists upon 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
"Knee Arthroscopy Surgery Patient Information Sheet (Dr. Longobardi)"