Meniscal procedures

English

جراحة الغضاريف

Indications:

Done for patients with meniscal tears.

Description:

Torn meniscus causes severe pain and leads to progressive osteoarthritis. This necessitates operative intervention either by removing the torn part of the meniscus or by suturing it according to the size and site of tear.

Expected time of surgery:

15-30 minutes

Implants used:

With meniscal suturing, a suture might be used in some cases (Fast fix; Smith & nephew or miniscal viper Arthrex)

Type of anaesthesia:

Spinal/General

Hospital stay:

Same day discharge

Post operative plan:

With excision WB is allowed on the same day of surgery and return to work is in 7 days. With repair, WB is postponed for 4 weeks but ambulation is definetly allowed on a single limb with crutches instantly after surgery

meniscal_vert_sutures_sm

meniscal-cartilage-tears-image

Meniscal procedures 01Meniscal procedures 02Meniscal procedures 03

Post-Operative Instructions

MENISCAL RECOVERY PLAN

Its Normal to experience some sharp pain in the knee when working on moving your knee. You are not doing any damage by moving the knee and feeling this pain.

Diet

  • Begin with clear liquids and light foods (jellos, soups, etc.)
  • Progress to your normal diet if you are not nauseated
  • Take Zofran prescribed to you if you develop nausea

Stop smoking !!

Smoking slows the healing process. Smoking also increases the risk of infection and pneumonia after surgery by slowing your body’s white blood cells.

 

 Wound Care

  • Keep your post-operative dressing on for 48 hours after surgery.
  • It is normal for the knee to bleed and swell following surgery. If blood soaks the dressing , this is not significant cause for concern. You may simply reinforce the dressing with another wrap.
  • Remove your surgical dressing after 48 hours following surgery. Do not remove the sutures that are now visible. Make sure the wound is dry. Pat-dry if necessary with a clean towel. Cover with a waterproof band-aid.
  • You may shower 24 hours after surgery, but keep the dressing covered with plastic so that the dressing stays dry. Do not get the dressing wet. Make sure the waterproof band-aids cover the entire incision(s) once the dressing is off. While showering, if necessary cover the waterproof band-aids to make sure the incision stays dry. Do not immerse or soak the incision in water until 2 weeks after surgery.

 Pain and Swelling

  • Ice your knee as frequently as possible with the cooling device or an ice pack. Do not place ice or the cooling device directly on the skin as it may damage the skin. This should be done for 20 minutes 4-5 times per day. This will help with the pain and swelling. Icing the knee is very important the first couple of weeks following surgery.
  • Narcotic pain medication will be prescribed for use after you leave the hospital. Try to wean down as tolerated. These medications can cause constipation and you may want to use an over the counter stool softener. •Swelling to some degree is common after surgery. To reduce swelling, elevation is very helpful. Elevate the knee above the heart level (“toes above the nose”) for 30 minutes every 2 hours for the first 2-5 days after surgery. Moving your ankles up and down on a regular basis helps circulate blood from your legs to help reduce swelling. Excessive pain and swelling should be reported to your surgeon.

Knee Immobilizer:

Meniscal Repair patients are to wear the knee immobilizer full time for the first 3 weeks to protect the repair for the first phase of healing.

This includes while you are sleeping. It is to be removed only for physical therapy directed exercises and showers.
Note: Patients should not flex the knee past 90 degrees for the first 3 weeks. After 3 weeks, you will change from the immobilizer to a knee hinged brace.  Under guidance, you can then start bending the knee from 90 degrees to a maximum of 120 degrees. When first switching to the knee hinge brace, you may need to use two crutches again for a short time to help with balance if needed.

 

Crutches:

Patients are to use two crutches for the first week, putting light weight on the operative leg with each step with the immobilizer on. Remember to put the involved foot flat on the ground. Most patients can be fully weight bearing by the end of the first week while continuing to wear the immobilizer. After the first week, you may then increase weight as tolerated and advance to one crutch for a few days and then a cane if needed.

Meniscus (cartilage) Repair patients cannot do twisting, pivoting, squatting, deep knee bends or impact activities for four months. It is vital that meniscus repair patients do not squat for at least four months after the repair.

Return to Work:

People with light work (like desk or computer work with no squatting, lifting or kneeling) can return to work within a week to ten day with the brace on. The exception is for people who may have long commutes. By staying still with the leg down for long periods, increases the risk of a BLOOD CLOT in the leg. Patients with active office work or very light labor with variable tasks can sometimes go back to work at two or three weeks, depending on lifting requirements and if their employer will make accommodations for light duty. Heavy work, (lifting or unprotected heights) cannot usually return before 6 weeks. Most will need to be cleared by their physical therapist. The heaviest of labor, working in unprotected heights would naturally take longer.

 

Driving

Right knee patients and left knee patients with a standard transmission car cannot drive until out of the knee immobilizer, off all pain meds and can fully weight bear without pain. Left knee surgery patients can drive after 3 weeks if they have no pain and you are off pain all pain medications comfortable walking without crutches.

 

Blood Clots:

Those at higher risk of blood clots include those patients who have sedentary life styles, long car or train commutes, have a history of prior cancer, women on birth control pills, may be overweight or males over the age of 40. These patients should be taking an at least a baby aspirin per day (unless allergic or sensitive). Doing the exercises (ankle pumps below), using aspirin and at times compressive stockings will also reduce the risk of blood clots. Patients who have a history of clots in the past or three or more of the above risk factors should ask if they should be on a blood thinner post op for at least six weeks.

Post-Operative Exercises:

  • Begin exercises the day after surgery. These include straight leg raises with the brace on and off. Quad sets, ankle pumps, heel slides, and prone hangs should be performed with the brace off.
  • It is safe to bend your knee up to 90 degrees and straighten your knee while non weight-bearing
  • Ankle pumps may be performed all day long to help reduce risk of blood clots.
  • Discomfort and stiffness is common the first few times you try the exercises.
  • Complete the exercises 3-4 times daily until your sutures are removed.
  • Motion goals at the suture removal visit: Full extension and at least 90 degrees flexion.
  • Formal physical therapy (PT) begins within the first week after surgery. You will be given a prescription for PT.

 

Ankle Pumps:

Rehabilitation-ankle-pump

Pump your ankle up and down for at least 1 minute (like pressing on the gas pedal). This increases circulation and reduce the risk of developing a blood clot.

Straight Leg Raise:

Straight Leg Raise exerciseTighten your quads (muscle in the front of your thigh) with the knee immobilizer on and raise your leg 8 to 12 inches off the bed.

 

 

Add other exercises as your therapist gives them to you.

Knee bends/heel slides:

With your heel on the bed, bend your knee while sliding your heel toward you. Start with bending 30-45 degrees and work toward 90 degrees during the first week. If you are in bed for extended periods, move your arms regularly. Use light weights for upper arm exercises and keep muscle tone for using crutches.

 

Emergencies

Contact us if any of the following are present:

  • Unrelenting pain
  • Temperature greater than 37.5 C
  • Redness or drainage around the surgical incision
  • Color change in foot or ankle
  • Painful calf swelling or numbness in foot, ankle, or calf
  • Continuous bleeding or drainage from incision (a small amount is normal and expected)
  • Difficulty breathing
  • Nausea and vomiting

Frequently Asked Questions

What is a Meniscus?

There are two types of cartilage in the knee, articular cartilage and meniscus cartilage. Articular cartilage lines the end of the bones while meniscal cartilage act as cushion between the bones that acts as a shock absorber , lubricator and protector for the articular cartilage

meniscal_vert_sutures_smMeniscus-Repair-300x277Meniscus

meniscus-tears

The meniscus cartilage in the knee includes a medial (inside) meniscus and a lateral (outside) meniscus. Together they are referred to as menisci.

There are two categories of meniscal tears: acute traumatic tears and degenerative tears…

Degenerative tears;

Most commonly occur in middle-aged people that happen with or without trauma. This degenerated weakened tissue makes it very unlikely that a surgical repair will heal or that the surrounding meniscus will be strong enough to hold the sutures used to repair it. So partial removal of the torn part is the solution. Symptoms of a degenerative meniscus tear include swelling, pain along the joint line, catching and locking.

Acute traumatic tears

Occur most frequently in the young athletic population as a result of a twisting injury to the knee. this is where repair is possible under certain criteria

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Clinic Address

30 Mourad St. – Giza
2nd Floor – # 108
RadioShack building

Tel: 3578909
Mobile: 010 60906808

Clinic Schedule:

Saturday, Monday & Wednesday:
from 4 pm to 7 pm

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    عنوان العيادة

    30 شارع مراد – الجيزة
    الدور الثانى – عيادة رقم 108
    عمارة راديوشاك

    تليفون: 35738909
    محمول: 01060906808

    مواعيد العيادة

    السبت والأثنين والأربعاء
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