Laith M Jazrawi, MD Professor of Orthopedic Surgery Chief, Division of Sports Medicine T 646-501-7223 NYU Langone Orthopedic Center 333 E 38th St, New York, NY 10016 T 646-501-7223 F 646-754-9505 www.NewYorkOrtho.com Post-Operative Instructions Baker’s Cyst Removal Day of surgery A. Diet as tolerated B. Icing is important for the first 5-7 days post-op. While the post-op dressing is in place, icing should be done continuously. Once the dressing is removed on the first or second day, ice is applied for 20-minute periods 3-4 times per day. Care must be taken with icing to avoid frostbite. Alternatively, Cryocuff or Game-ready ice cuff can be used as per instructions. C. Pain medication as needed every 4-6 hours (refer to pain medication sheet). D. Make sure you have a physical therapy post-op appointment scheduled during the first week after surgery. First Post-Operative Day A. Continue ice pack every 1-2 hours while awake B. Pain medication as needed. C. You may remove surgical bandage and shower this evening. Apply regular bandages to these wounds prior to showering and when showering is complete apply fresh regular bandages. You will need to follow this routine for 2 weeks after surgery. Second Post-Operative Day Until Return Visit A. Continue ice pack as needed. B. Unless otherwise noted, you can bear as much weight on the affected leg as you can tolerate. Most patients use crutches or a cane for the first 1-3 days. The amount of pain you experience should be your guide for discontinuing crutch or cane use. C. If there is no brace on your leg, you may bend the knee as tolerated. D. If you have a brace or a splint on your leg, this must be worn for all walking activities. The brace may be removed for showering. It may also be removed for short periods of time while relaxing (while watching television, reading, etc.) as long as the leg is well supported. E. Call our office @ 646-501-7223 option 4, option 2 to confirm your first postoperative visit, which is usually about 1-2 weeks after surgery. If you are experiencing any problems, please call our office or contact us via the internet at www.newyorkortho.com.
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Laith M Jazrawi, MD
Professor of Orthopedic Surgery Chief, Division of Sports Medicine T 646-501-7223
NYU Langone Orthopedic Center 333 E 38th St, New York, NY 10016 T 646-501-7223 F 646-754-9505 www.NewYorkOrtho.com
Post-Operative Instructions Baker’s Cyst Removal
Dayofsurgery
A. DietastoleratedB. Icingisimportantforthefirst5-7dayspost-op.Whilethepost-opdressingisinplace,icingshouldbedone
continuously.Oncethedressingisremovedonthefirstorsecondday,iceisappliedfor20-minuteperiods3-4timesperday.Caremustbetakenwithicingtoavoidfrostbite.Alternatively,CryocufforGame-readyicecuffcanbeusedasperinstructions.
C. Painmedicationasneededevery4-6hours(refertopainmedicationsheet).D. Makesureyouhaveaphysicaltherapypost-opappointmentscheduledduringthefirstweekaftersurgery.
FirstPost-OperativeDay
A. Continueicepackevery1-2hourswhileawakeB. Painmedicationasneeded.C. Youmayremovesurgicalbandageandshowerthisevening.Applyregularbandagestothesewoundsprior
toshoweringandwhenshoweringiscompleteapplyfreshregularbandages.Youwillneedtofollowthisroutinefor2weeksaftersurgery.
SecondPost-OperativeDayUntilReturnVisit
A. Continueicepackasneeded.B. Unlessotherwisenoted,youcanbearasmuchweightontheaffectedlegasyoucantolerate.Mostpatients
usecrutchesoracaneforthefirst1-3days.Theamountofpainyouexperienceshouldbeyourguidefordiscontinuingcrutchorcaneuse.
C. Ifthereisnobraceonyourleg,youmaybendthekneeastolerated.D. Ifyouhaveabraceorasplintonyourleg,thismustbewornforallwalkingactivities.Thebracemaybe
removedforshowering.Itmayalsoberemovedforshortperiodsoftimewhilerelaxing(whilewatchingtelevision,reading,etc.)aslongasthelegiswellsupported.
E. Callouroffice@646-501-7223option4,option2toconfirmyourfirstpostoperativevisit,whichisusuallyabout1-2weeksaftersurgery.Ifyouareexperiencinganyproblems,pleasecallourofficeorcontactusviatheinternetatwww.newyorkortho.com.
Laith M Jazrawi, MD
Professor of Orthopedic Surgery Chief, Division of Sports Medicine T 646-501-7223
NYU Langone Orthopedic Center 333 E 38th St, New York, NY 10016 T 646-501-7223 F 646-754-9505 www.NewYorkOrtho.com
Rehabilitation Protocol: Baker’s Cyst Removal Name:____________________________________________________________Date:___________________________________Diagnosis:_______________________________________________________DateofSurgery:______________________PhaseI(Weeks0-2)
• Weightbearing:Astoleratedwithcrutches(forbalance)x24-48hours–progresstoWBAT• RangeofMotion–leginkneeimmobilizerforthefirst2weeks
o Goal:Immediatefullrangeofmotion• TherapeuticExercises
o QuadandHamstringsetso Heelslideso Co-contractionso Isometricadductionandabductionexerciseso Straight-legraiseso Patellarmobilization
PhaseII(Weeks2-4)• Weightbearing:Astolerated• RangeofMotion–AAROMàAROMastolerated• TherapeuticExercises
o QuadricepsandHamstringstrengtheningo Lungeso Wall-sitso Balanceexercises–Corework
PhaseIII(Weeks4-6)• Weightbearing:Fullweightbearing• RangeofMotion–Full/PainlessROM• TherapeuticExercises
o Legpresso Hamstringcurlso Squatso Plyometricexerciseso Enduranceworko Returntoathleticactivityastolerated
Comments:Frequency:______timesperweek Duration:________weeksSignature:_____________________________________________________Date:___________________________
Dr. Laith M. Jazrawi Chief, Division of Sports Medicine Associate Professor Department of Orthopaedic Surgery
Rehabilitation Guidelines for Knee Arthroscopy
333 38th St. ▪ New York, NY 10016 ▪ (646) 501 7047 ▪ newyorkortho.com!
Arthroscopyisacommonsurgicalprocedureinwhichajointisviewedusingasmallcamera.Thistechniqueallowsthesurgeontohaveaclearviewoftheinsideoftheknee,whichhelpsdiagnoseandtreatkneeproblems.Recentadvancesintechnologyhaveledtohighdefini@onmonitorsandhighresolu@oncameras.Theseandotherimprovementshavemadearthroscopyaveryeffec@vetoolfortrea@ngkneeproblems.AccordingtotheAmericanOrthopaedicSocietyforSportsMedicine,morethan4millionkneearthroscopiesareperformedworldwideeachyear.5Kneearthroscopycanbeusedtotreatmensicalandar@cularcar@lagetears,[email protected]@lageintheknee,ar@cularcar@[email protected]@cularcar@lageismadeupofcollagen,proteoglycansandwater,whichlinetheendofthebonesthatmeettoformajoint.Theprimaryfunc@onofthear@cularcar@[email protected]@cularcar@lageonar@cularcar@lageisapproximately5@mesmoresmooth(i.e.lessfric@on),thanrubbingiceonice.3Awiderangeofinjuriescanoccurtothear@cularcar@lageduringsportsinjuries,[email protected],par@althicknesstearsofthear@cularcar@lagecancausepain,swelling,orcatchingintheknee.Thesetypesoftearscanbetreatedwitharthroscopybyremovingthetornorfrayedar@[email protected]@cularcar@lagewhilepreservingtheremainingintactar@[email protected]@lageinthekneeincludesamedial(insidepartoftheknee)meniscusandalateral(outsidepartoftheknee)meniscus(Figures1and2).Togethertheyarereferredtoasmenisci.Themenisciarewedgeshapedandarethinnertowardthecenterofthekneeandthickertowardtheperipheryofthekneejoint(Figures1and3).Thisshapeisveryimportanttoitsfunc@onsincetheprimaryfunc@onofthemenisciistoimproveloadtransmission.Arela@velyroundfemursiOngonarela@velyflat@biaformsthekneejoint.Withoutthemeniscitheareaofcontactforcebetweenthesetwoboneswouldberela@velysmall,increasingthecontactstressby235-335%(Figure4).Themeniscialsoprovidesomeshockabsorp@on,[email protected],acutetrauma@[email protected]@vetearsoccurmostcommonlyinmiddle-agedpeopleasaresultofrepe@@vestressestothemenisciover@me,whichseverelyweakenthe@ssueandcauseanonacute,[email protected]@ssuedegenera@onmakesitveryunlikelythatasurgicalrepairwillhealorthatthesurroundingmeniscuswillbestrongenoughtoholdthesuturesusetorepairit.
Figure1LateralandmedialmeniscusoftheleVknee(shownherefromabovetheknee,withoutthefemur)
Figure2Medial(inside)viewoftheknee
Rehabilitation Protocol After Knee Arthroscopy
333 38th St. ▪ New York, NY 10016 ▪ (646) 501 7047 ▪ newyorkortho.com!
Onereportshowedthatlessthan10%ofmeniscaltearsoccurringinpa@entsmorethanfortyyearsofagewere
repairable.Symptomsofadegenera@vemeniscusmaytear
includeswelling,painalongthejointline,catching,andlocking.
Ifadegenera@[email protected]@almeniscectomy,whichistermed
par@albecausethesurgeonsonlyremovethesegmentof
meniscuscontainingthetearasopposedtoremovingtheen@re
meniscus.
Acutetrauma@ctearsoccurmostfrequentlyinthe
athle@cpopula@onasaresultofatwis@nginjurytothekneewhenthefootisplanted.Symptomsofanacutemeniscustear
includeswelling,painalongthejointline,catching,lockinganda
specificinjury.OVen@mesthesetearscanbediagnosedbythe
historyoftheproblemandagoodphysicalexamina@on.
Some@mesanMRIwillbeusedtoassistinmakingthediagnosis.ThearrowinFigure3showsanormalmeniscusonanMRI,but
thearrowsinFigure5showatornmeniscus.
Ifanathletesuffersameniscaltearthethreeop@onsfor
treatmentinclude:non-opera@verehabilita@on;surgerytotrim
outtheareaoftornmeniscus;orsurgerytorepair(s@tchtogether)thetornmeniscus.Thetreatmentchosenwilldepend
ontheloca@onofthetear;thesizeofthetear;thesportto
whichtheathleteisreturning;ligamentousstabilityoftheknee;
andanyassociatedinjury.2Theloca@onofthetearisimportant
becausetheouterpor@onofthemeniscushasagoodbloodsupplywhereastheinnerpor@onhasaverypoorbloodsupply.
Bloodvessels(theperimeniscularcapillaryplexus)enterthe
peripheralonethirdofthemeniscus,1thisbloodsupplyis
necessaryforatearorsurgicalrepairtoheal(Figure6).Withoutanadequatebloodsupply,usuallytheareaoftornmeniscushas
toberemoved.
Figure3NormalMRI(saggitalview)oftheknee,lateralside(outside)
Figure5MRI(saggitalview)ofalateralmeniscustear(yellowarrows)
Figure4Schema@crepresenta@onofthemeniscaleffectoncontactpressurein
theknee.Contactareaisincreasedby
reducescontactpressures.
withoutmeniscus
withmeniscus
Otherstructuresinthekneethatcancausepainandlimitfunc@onwheninjuredorchronicallyinflamedarethefatpad(Figure3)andtheplica.Theseproblemscanarisefromavarietyofcauses,butiftheydonotimprovewithnon-surgicalmeasuresitmaybenecessarytousekneearthroscopytoremovethe@ssue.Secondaryproblemsmayalsoarisefrominjury,suchasscar@ssueorcysts,whichneedtoberemoved.AVerkneearthroscopy,rehabilita@onwithaphysicaltherapistorathle@[email protected]@onwillfocusonrestoringrangeofmo@on,developingstrengthandmovementcontrol,andguidingtheathlete’sreturntosport.Therehabilita@onguidelinesarepresentedinacriterionbasedprogression.Specific@meframes,restric@onsandprecau@onsaregiventoprotecthealing@ssuesandthesurgicalrepair/[email protected]@meframesarealsogivenforreferencetotheaverage,butindividualpa@entswillprogressatdifferentratesdependingontheirage,associatedinjuries,pre-injuryhealthstatus,[email protected]@onofthemeniscaltearalsomayaffecttherateofpost-opera@veprogression.
Rehabilitation Protocol After Knee Arthroscopy
Femur
Meniscus
Tibia
Figure6Perimeniscularcapillaryplexus(thickarrow)providingbloodsupplytotheouterthirdofthemeniscus
References
1.ArnoczkySPandWarrenRF.Microvasculatureofthehumanmeniscus.AmJSportMed,19822.FowlerPJandPompanD.Rehabilita@onaVermensicalrepair.TechinOrtho,8(2):137-139,1993.3.UlrichGSandAronczykSP.Thebasicscienceofmeniscusrepair.TechinOrtho,8(2):56-62,1993.4.ZachariasJ.MensicalInjuries:Anatomy,DiagnosisandTreatment.UWSportsMedicineconference.September8,1999.5.AmericanAcademyofOrthopedicSurgeons:orthoinfo.aaos.org
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