Nicholas K. Sablan, M.D.

MPFL Reconstruction

Post Operative Instructions after MPFL Reconstruction/Imbrication Helpful Hints & Important Precautions for Patients

Diet

Medications:

Before surgery, you will likely receive a nerve block that will last about 8 to 24 hours. It is important to begin taking your pain pills before this medicine wears off. This helps smooth the postoperative pain. Pain levels 5-7 out of 10 is typical in the first few days.

The first medication I use is Percocet(Oxycodone/Acetominophen) which is a strong narcotic pain medication combined with Tylenol. It will begin to work within 15 minutes after taking it, with a maximal effect in one to two hours. Normally, Percocet is taken 1 pill every 6 hours but if the pain is severe, it can be used 2 pills every 4 hours.
Common side effects are nausea, constipation, itching, and drowsiness.
The best way to prevent nausea is to take the medicine with a little food, start with just one pill, and be patient while the medicine begins to work. Usually, after the first few doses the nausea will go away. I also prescribe an anti-nausea medication called Zofran (Odansetron) to be taken if you have persistent nausea after surgery.
You will also be given a prescription for Naprosyn, which is a strong anti-inflammatory medication. Take this twice a day with food in addition to the Percocet. Both medications will work synergistically in pain relief. Do not take Naprosyn if you are on blood thinners or if you have a history of kidney dysfunction or stomach ulcers.
I strongly recommend you take an over-the-counter stool softener starting the day of surgery such as Colace 100 mg tablet a day and a laxative such as Miralax. Eat a homeopathic diet heavy in high fiber fruits such as prunes to avoid constipation.

Take Benadryl one half hour before your narcotic if you experience itching.
Do not drive or operate heavy machinery while taking Percocet or other narcotics.
You should take 325 mg Enteric coated Aspirin once a day for two weeks to help prevent blood clot formation.
Transition to Tylenol as your pain subsides but pay attention to the dosage, as Percocet has 325 mg of Tylenol in each pill. Patients with normal liver function should not consume more than 3000 mg of Tylenol per day.
All non-narcotic medications will be called into your pharmacy prior to surgery.

Bandages & Sling:

Your post-operative dressing has two layers you need to understand to care for your surgery site properly. Your incisions were closed with absorbable stitches that are covered with small white tapes called Steri-Strips. Your Steri-Strips should be left in place until I see you at your first post-operative date.
The second layer is a large white fluffy dressing and ABD pad that is loosely held in place with tape and the overlying compression stocking or ACE wrap.
Unless directed otherwise, remove this second layer of dressing 2 days after surgery and place a fresh ABD pad over the steri-strips. Use paper tape only on the bottom of the dressing. After changing the dressing, replace the compression stocking or ACE wrap and then the brace.
Keep an ABD pad over the incision at all times, aside from showering to avoid the brace irritating the skin around the incision.
Keep the compression stocking or ACE wrap on at all times aside from showering until the first post-operative visit.
Occasionally, the top elastic portion of the compression stocking can irritate the skin. If this is the case, take scissors and cut the top elastic portion of the stocking.
As the surgery is done arthroscopically and water is used, occasionally, there will be a small amount of blood mixed with water in this dressing. This is nothing to worry about, however, if you see a lot of bleeding, please call Dr. Sablan.

Washing & Bathing:

You should be careful to keep the wound clean and dry for the first 48 hours after surgery.
Beginning on the second day after surgery, it is OK to shower as long as the incisions are kept dry with plastic wrap. Remove the wrap after showering and replace your ABD pad and compressive stocking or ACE wrap.
Do not take a bath until after the first post-operative visit.
It is OK to go into a swimming pool after the first post-operative visit, but no lakes or ocean until two 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 in 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 15 minutes every hour while awake if possible.

Occasionally, Dr. Sablan will prescribe a cold compression unit. This can be used as much as possible under the brace.
Crutches will be given to you before surgery if you do not have them already. Use the crutches at all times before the first visit if you are up walking.
You will have a brace locked in full extension (straight out). Do not change the hinge settings until directed by Dr. Sablan. Keep the brace on at all times except while showering, icing your knee, during towel roll exercises, or during range of motion exercises.
You may put weight on the operated leg as tolerated unless directed.

Do not place pillows under the operated knee, which can lead to stiffness.
You may return to sedentary work only or school in 3-7 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.

Exercises

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 daily for twenty minutes if tolerated. This is a great time to also ice your knee.
Move your ankle back and forth many times during the day to help your circulation.

Physical Therapy

The goal of physical therapy is first to assess how your body responds to the surgical procedure. They help you feel comfortable with your surgery and ensure you aren't afraid to start doing things. Your therapist will start range of motion and strength exercises on your first visit. You will start physical therapy after your first post-operative visit.

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 5 to 10 days after surgery.

FOLLOW UP APPOINTMENT:

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

∞ Pain or swelling around your surgery

∞ Fever greater than 101.5 degrees.

∞ Unable to keep food or water down for more than one day.