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
