Status/Post Anterior Cruciate Ligament Reconstruction

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POSTOPERATIVE PROTOCOL

Upon awakening in recovery, your knee will be wrapped from the ankle to mid thigh. A knee immobilizer will have been applied.

In some cases, an ice machine will have been applied around the knee for use in recovery and also at home. This provides continuous cold treatment to the knee diminishing pain.

Unless otherwise instructed, you will be allowed full weight bearing with crutches and with your brace locked in full extension in the knee immobilizer. The immobilizer may be discarded when you can straight leg raise without the brace on.

Physical therapy will have been arranged preoperatively and will begin on postop day one. Therapy is important to diminish pain and swelling and to improve range of motion and quadriceps/hamstring strength.

A home Continuous Passive Motion Machine (CPM), will be delivered to your home either preop or postop. Machine should be used at least 1-hour each morning/afternoon. Start motion from full extension, to maximum flexion possible. Increase flexion, (bending) as pain allows. Increase to greater than 90° as soon as possible.

The knee is to be kept clean and dry until sutures are removed postop day #7-10.

The postop bandage will be changed in physical therapy to a less bulky wrap. If significantly blood stained, new 4 x 4's and Ace bandage may be applied.

A physical therapy protocol outlining treatment will be given to you to give to your therapist postoperatively. It is IMPERATIVE that the therapist sees the protocol prior to surgery.

In the event a MENISCAL REPAIR has been performed in conjunction with your anterior cruciate ligament reconstruction, range of motion of the knee will be allowed in prescribed limits, weight-bearing status will be discussed by your doctor.

WARNINGS: PLEASE CALL THIS OFFICE IMMEDIATELY IF YOU EXPERIENCE:

1. Severe postop headaches or neck stiffness.
2. Temperature greater than 101° after postop day #2.
3. Redness or drainage from the knee.
4. Increased pain.
5. Numbness of the toes.

PAIN PUMP:

To remove pain pump:

1. Remove plastic patch over entry site.
2. Swab entry site with alcohol.
3. Pull pain pump catheter straight out.
4. Place catheter in bag and return to M.D.

Status/Post Shoulder Acromioplasty/Distal Clavicle Resection

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POSTOPERATIVE PROTOCOL

1. Upon hospital discharge, the shoulder will be wrapped in a bulky dressing. Beneath the dressing will be either Band-Aids or 4 x 4 bandages. If bloodstained, this dressing should be changed on the evening of surgery and replaced with a simple Band Aids. A simple alcohol or Betadine wipe of the incision sites will suffice. Dressing may be changed by therapist on postoperative day #1 or #2.



2. Once home, begin immediate icing of the shoulder moving ice from anterior to middle, to posterior aspect of shoulder.  Do not ice skin directly as this may cause a skin burn (wrap ice in bag and use with a small towel on skin).



3. Take pain medication at first sign of discomfort. Preventing pain is easier than stopping pain once present.



4. Sling is worn for comfort for the first 3-days.



5. Your arm may be removed from the sling for gentle flexion and extension of the elbow.  No shoulder motion until told.



6. On postoperative day #3, if the suture sites are clean and dry, you may shower getting the shoulder and sutures wet.  Dry the suture sites carefully and recover with a Band Aide.



7. If increasing redness, pain or drainage is noted at the incision site, please call our office for immediate evaluation.  Otherwise, postoperative visits are scheduled at 6-10-days following the procedure for suture removal.



8. If you are experiencing:
   • Increasing pain.
   • Persistent drainage from the arthroscopy wounds.
   • Fever greater that 101° after postoperative day #2.
   • Numbness/tingling of the fingers.

Please call this office immediately!

* Black and blue of the arm is normal and no cause for concern. Apply a heating pad to the arm to help diminish discoloration.

PAIN PUMP:

To remove pain pump:

1. Remove plastic patch over entry site.
2. Swab entry site with alcohol.
3. Pull pain pump catheter straight out.
4. Place catheter in bag and return to M.D.

Knee Arthroscopy, Menisectomy and Debridement

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POSTOPERATIVE INSTRUCTIONS

Upon hospital discharge the knee will be wrapped with an Ace bandage. Beneath the Ace bandage will be either Band-Aids or 4 x 4 dressings.

Once at home, begin icing of the knee 20-minutes on/20-minutes off until bedtime.

Take pain medication before pain becomes severe.

If the Ace bandage feels tight, it may be removed and re-wrapped more loosely. The Band-Aids or dressings can be changed by you if soiled.

You may weight bear to tolerance using crutches unless instructed otherwise by your surgeon.

Swelling and incision site discomfort is expected.  This resolves in the first several weeks.

Postoperative physical therapy will help in diminishing swelling and pain and restoring range of motion and strength.

On postoperative day #3, if the suture sites are clean and dry, you may shower getting the sutures wet. Dry the suture sites carefully and recover with a Band-Aid.

Postoperative visits are scheduled 7-10-days following procedure for suture removal.

WARNINGS:

1. If drainage from the portals.
2. Increasing pain.
3. Fevers (101°).
4. Spreading redness of the knee is noted

Please call this office immediately for early evaluation!

* Increasing swelling is a sign of TOO much activity! Elevate the leg and diminish activity.

Status/Post Injection Protocol

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1. Ice area surrounding injection region for 10-15-minutes an hour for *3-hours.



2. Do not place ice directly over skin.



3. Pain may suddenly increase 1-3-hours post injection as anesthetic wears off. When Cortisone starts to work, pain lessens in approximately 1-4-days.



4. Ice frequently to decrease pain.



5. Limit any necessary activity using injected extremity for 7-10-days.  This will allow Cortisone to exert maximal anti-inflammatory effect.  Additionally, Cortisone injection around tendons can lead to tendon rupture.  Limiting activity will lessen this risk.



6. Please call if after 2-days you see:
   • Temperature up to 101°.
   • Swelling, redness noted at injection site.

* Longer icing if more pain.