Meniscus Surgery – Knee Arthroscopy

Preoperative Assessment and Postoperative Guidelines for Meniscus Surgery

What does the process look like leading up to arthroscopic meniscus surgery?

Dr. Ramkumar has a detailed process and checklist to ensure your safety prior to undergoing meniscus surgery. Arthroscopic meniscus surgery is a specialized operation that requires specialized attention. Once you have decided to proceed with surgery, we check the following:

• Brace: You must get this before surgery and bring it with you on the day of surgery. If you are struggling to acquire one in a timely fashion, you can purchase it through Amazon Prime HERE. 
• Physical therapy appointment: you should have an appointment for your first session in the third week after surgery
• Medications: you need to have these picked up well before you check in to the hospital, as it will be highly unlikely and unreasonable to expect to acquire these homegoing medications close to or on your surgical date. Pharmacies often struggle with receiving electronic prescriptions and, depending on your insurance plan or surgery, require prior authorization – causing delays that frustrate everyone involved. If you don’t have your medications within 48 hours of your preoperative visit, you are expected to email info@premramkumar.com so we may help reconcile this issue where possible.

What are my restrictions right after meniscus surgery?

Your post-operative protocol depends on what is done at the time of surgery. There is no way to know exactly what will be performed until after Dr. Ramkumar performs the minimally invasive surgery, as this depends on multiple factors beyond the physical exam and MRI – such as the nature and timing of the injury. There are three protocols for recovery after meniscus surgery: partial meniscectomy, non-displaced meniscus repair (the most common scenario), and meniscus root or displaced meniscus repair.

If you had a partial meniscectomy, less than 20% of your torn meniscus was removed because repair was impossible or likely to result in an unacceptably high failure or reoperation rate with repair. Although this is the most common scenario for the surgical treatment of meniscus tears globally, this is extremely uncommon for Dr. Ramkumar and occurs less than 10% of the time in his practice. However, this is the easiest recovery as: (1) No brace is required, (2) You can bend your knee right away, and (3) You will put very little to no weight on your leg the first week (toe-touch weight bearing status), but slowly progress to full weight by the end of the second week so you can fully normalize your gait by the first post-op appointment around two weeks.

In the most likely scenario that your meniscus was repaired and saved, Dr. Ramkumar will place you in a brace when you wake up from surgery. This brace should be picked up before surgery and brought with you to surgery; if for some reason your insurance has not authorized your brace in time, you may purchase one on Amazon here. You will not adjust or tinker with the settings on the brace after surgery. This brace is locked straight in extension (fully straight) the first two weeks after surgery and is critical to a successful outcome. You will sleep in the brace during the first two weeks. You must wear this brace at all times – except in one very important scenario: when you are actively working on motion! 

In order to work on motion, you need to fully remove the brace without touching the settings and simply bend your knee when you are in a safe setting to combat stiffness. If you were given the non-displaced repair protocol, you must achieve a bend of 90 degrees by the two week post-op appointment. If you were given the displaced repair protocol, you must achieve a bend of 70 degrees by the two week post-op appointment. You can work on motion right away, including the day of surgery.

With regards to weight bearing after your meniscus surgery, there are two key differences depending on which meniscus repair protocol you received. If you were given the non-displaced repair protocol, you will put very little to no weight on your leg the first week (toe-touch weight bearing status), but slowly progress to full weight by the end of the second week. However, you will not be able to normalize your gait by the first post-op appointment since your brace will still be on and locked straight. If you were given the meniscus root or displaced repair protocol, you will put very little to no weight on your leg for six long weeks to give your meniscus the best opportunity to heal.

What equipment do I need?

Dr. Ramkumar requires a brace for the highly likely scenario your meniscus is repaired. This brace should be picked up before surgery. Dr. Ramkumar’s office will help you receive authorization, should your plan need this. It is critical you remember to bring this to surgery.

Do I need physical therapy?

Dr. Ramkumar believes physical therapy is absolutely critical – but at the right time. There is no need for physical therapy during the first two weeks. You should secure an appointment for your first physical therapy appointment by the three-week mark. This will be important for you to learn how to move safely, regain your motion, and help normalize your gait. Physical therapy can be a 3-month process, but it is increasingly important in the earlier phases of your post-operative recovery to restore your motion, improve flexibility, and build strength in a safe manner.

What do I need to focus on immediately after surgery?

There are three elements Dr. Ramkumar needs you to focus on immediately after surgery but before your first postoperative visit two weeks later:

• Wearing the brace: If you had a repair, and not a partial meniscectomy, your knee needs to be locked in extension (fully straight) at all times (even when sleeping!) during the first 2 weeks after surgery. If you fail to do this, it becomes very difficult – and sometimes impossible – to get your knee fully straight ever again.
• Bending your knee: You need to work on your motion. Depending on your protocol, you need to bend it to 70 (root repair or displaced protocol) or 90 degrees (non-displaced protocol) by the time you see Dr. Ramkumar at 2 weeks postoperatively. When you are in a safe environment at home, you must remove your brace and gently bend your knee to work on regaining motion. If you do not take this seriously, you may need another surgery to break up scar tissue.
• Breaking up scar tissue: This sounds more painful and difficult than it actually is! All you need to do is take your kneecap (patella) and move it around so that it can freely move. Scar tissue can quickly build up under the kneecap during the early phases of recovery after ACL reconstruction. Your simple efforts to manually mobilize your patella can break up scar tissue and prevent the need for future surgery. Scar tissue is a common complaint even three months after surgery and feels like a snapping or cracking sounds over the front of the knee by the incision sites.

How do you address pain management and nausea after meniscus surgery?

Dr. Ramkumar prescribes you the following medications:

• Ondansetron (4-8mg) for the first week of surgery: anti-nausea
• Naproxen (500mg) twice daily for the first two weeks after surgery: anti-inflammatory medication to be used on the 5th postoperative day after completing the course of indomethacin; do not take naproxen and indomethacin on the same day
• Norco (Hydrocodone-Acetaminophen) (5-325mg) every 6 hours for the first week after surgery: medication for breakthrough pain; take this scheduled for the first two days after surgery
• Colace (100mg) twice a day while on narcotics (Norco): stool softener medication
• Aspirin 81 mg once daily: to prevent harmful blood clots for the first two weeks when you may be less mobile although you should up and moving immediately after surgery

When can I drive after meniscus surgery?

Patients usually feel comfortable to drive between 1-2 weeks after surgery. For patients with the root repair or displaced meniscus repair protocol, this can be up to 6 weeks. Dr. Ramkumar cannot formally know when you are safe to drive but he has the following criteria:

• No longer taking prescription narcotic medications such as Norco
• Walking without assist devices (crutches) for a week.
• You feel comfortable enough to slam on the brake.

When can I shower after meniscus surgery?

Patients can shower 48 hours after surgery. This first involves removing the tan ace wrap and cotton white soft roll – but leaving the sticky dressings adhered to the skin. The tan ace wrap is for swelling, and you can choose to put it back on if you desire. These sticky dressings should never peel off or be removed, as this can expose your fresh incision to bacteria and cause an infection. Although these sticky dressings are technically waterproof, Dr. Ramkumar does not want you testing the manufacturer. To reduce the risk of this sticky dressing coming off during a shower, Dr. Ramkumar prefers you keep the leg wrapped (trash bag, Saran wrap or Glad Press ‘n Seal) to avoid any incidental leaking.

This dressing will be removed at the first postoperative visit in the office for personal evaluation of the incision and the stitches will be removed. Come to the office during business hours at any time if you have any concerns with the integrity of the dressing, and one of our medical assistants will see you for a nursing visit the same day. After your first postoperative visit with Dr. Ramkumar, showering over the incision and their steri-strips with soap and water is fine, but do not directly scrub the surgical incision. You may pat the surgical area dry. The steri-strips will fall off on their own time, usually in 1-2 weeks after application. No submerging or bathing the incision until at least 6 weeks after surgery.