Knee Tendon or Fracture Repair

Loel Z. Payne, M.D.

Diet:

􀀀 You may resume clear liquids and light foods after surgery (jello, soup, etc.)

􀀀 Progress to your normal diet as tolerated as long as you are not nauseated.

􀀀 Many surgeries are done without general anesthesia. This allows you to resume a diet quicker with less nausea.

 

Managing the pain:

There’s no two ways about it, knee surgery is painful. I am going to describe the best ways I have found to try to manage that pain. The first 1-2 days are the hardest. Don’t worry, it will improve.

Before surgery you will be offered a nerve block which helps greatly with pain control and decreases your need to take narcotic medications. I would strongly encourage you to have the block as it does significantly help with pain after the procedure. Additionally, during surgery I will often inject a numbing medicine like novocaine that will give some pain relief for several hours after surgery.

It is important to begin taking your pain medication before this medicine wears off. This is usually about 6 to 8 hours after the procedure. However, it may be as little as 2 hours or (if you’re lucky) it could be 12 to 16 hours. It is important to stay on top of the pain as it is more difficult to catch up.

I do not use a “pain pump” which drips the numbing medicine continually into the joint for several days after the surgery. Several recent studies have shown an increased risk of damage to the joint cartilage and subsequent arthritis as a result of prolonged exposure to this medication.

I believe in using multiple different ways to reduce pain. Our goal is to reduce the amount of narcotics required to control the pain. Narcotic medications (morphine, Percocet (oxycodone), Vicodin (hydrocodone), codeine and Dilaudid) have significant side effects. They can easily become addictive. They can be overdosed, especially in patients already taking other sedating medication such as sleeping pills. Narcotics decrease the body’s trigger to breathe and I may prescribe a medication to reverse this narcotic side effect (Narcan) if you are currently taking anti-anxiety or sleeping medication. It is best to avoid these drugs (and alcohol) while on pain medication. Narcotics cause constipation. They alter your ability to concentrate, cause drowsiness and should not be taken while driving. They can cause hallucinations. They frequently cause constipation and a stool softener, such as Metamucil of Sennokot DS, should be taken daily while on them. They often cause nausea and a medication for nausea, such as Phenergan or Zofran, is often prescribed with them.  If you have a history of prolonged nausea you are likely going to be prescribed an anti-nausea medication.

Patients with significant reactions to all narcotics, may benefit from a newer drug called Nucynta (tapentadol) that does not typically have the same side effects. However, it may not be covered by many insurance formularies.

If you experience itching, take over the counter Benadryl one half hour before your narcotic.

            Surgery pain stems from multiple factors and you should address each of these to control the pain. Below is a chart to explain our multimodal pain control plan.

 

 

 

Preoperative pain management

Postoperative pain management

  1. Nerve block – anesthesia injections numbing medication around the nerves that go to the shoulder
  2. Local injection of numbing medication at the surgery site
  3. Anti-nausea medication such as Zofran or Scopolamine patch is given
  4. Tylenol or an anti-inflammatory such as Celebrex may be given
  1. Tylenol 650 mg every 6 hours around the clock. Limit to 3000 mg daily and avoid if history of liver disease. Use continuously for 3 days and then as needed.
  2. Naproxen 500 (2 Aleve) every 12 hours OR ibuprofen 800 (4 Advil) every 8 hours. Take with food and avoid if history of ulcers, severe reflux or kidney disease. Continue for 5 days and then as needed.
  3. Oxycodone 5 mg 1-2 every 4 hours as needed. This is the narcotic and should be used sparingly. However, if pain is severe and uncontrolled with other methods, you may take 3 pills at a time for the first 24 hours. Percocet and Vicodin (Norco) already have Tylenol in them so do not take Tylenol if you are on these medications. Straight Oxycodone does not.

Ice (see below) is very helpful

Physical therapy – stiffness is a common source of pain and therapy is often started several days postop

 

 

  • You should take 325 mg Enteric coated Aspirin twice a day for three weeks to help prevent blood clot formation.
  • If you have a history of blood clots you may be given a stronger blood thinner, this will replace any Aspirin medication,

 

Bandages & Sling:

  • Your post-operative dressing is a large, white fluffy dressing and absorbent pads that are held in place with an Ace bandage.
  • Unless directed otherwise, remove this dressing 3 days after surgery and

place band-aids and a small gauze pad over the incisions.

  • Because the surgery is performed arthroscopically, occasionally there will be water with a small amount of blood on this dressing. This is nothing to worry about. However, if you see a lot of bleeding, please call Dr. Payne.

 

Washing & Bathing:

  • You should be careful to keep the wound clean and dry for the first 7 days after surgery.
  • Beginning on the third day after surgery, it is OK to shower as long as the incisions are kept dry with plastic wrap. Remove the wrap after showering.
  • Do not go into a swimming pool until 3 weeks after the surgery and do not go in lakes or the ocean until six weeks after surgery.

 

Ice & Activity:

  • One important goal following surgery is to minimize swelling around your surgery site. The best way to achieve this is with the frequent application of ice. This is most important the first 48 hours following surgery. The ice pack should be large (like a big zip-lock bag or bag of peas) and held firmly on the area of your surgery. Apply for 20 minutes three to four times per day if possible.
  • You should not place weight on the leg unless instructed that you could so.
  • You will most likely have a knee brace and will be instructed on its use.
  • Do not place pillows under the operated knee as this can lead to stiffness. Instead place any pillows under heel when elevating the leg.
  • Place a towel roll under your ankle and tighten your thigh muscles to get your knee to

straighten out. This is very important and should be done at least four times a day for

twenty minutes if tolerated.

  • Move your ankle back and forth many times during the day to help your circulation.
  • You may return to sedentary work only or school in 3-4 days after surgery if your pain is

tolerable.

  • Avoid long distance traveling in cars or by airplane during the first week after surgery to

avoid increasing your risk of developing blood clots.

Follow up appointment:

  • We try to give all of our patients a follow-up office visit at the same time we schedule your surgery.
  • Typically, I want to see my patients in the office 10-12 days after surgery.

 

Physical Therapy:

 

  • The goal of physical therapy is to first assess how your body responded to the surgical

procedure. They help you feel comfortable with your surgery and make sure you aren't

afraid to start doing things. Your therapist will start range of motion and strengthening exercises on your first visit.

  • In most casers, you will start physical therapy four to five days after the surgery. This appointment is usually arranged at the time your surgery was scheduled.

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 surgical site
  • Fever greater than 101.5degrees
  • Unable to keep food or water down for more than one day