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Shane K. Woolf, MD Associate Professor of Arthroscopy, Sports Medicine, and Shoulder Reconstruction Chief, Sports Medicine Medical University of South Carolina Administrative Assistant: M. Annie Justiss Office: (843) 792-1081 Fax: (843) 792-3674 Patient Instructions After Outpatient Knee Surgery Return to Activity and Rehabilitation REMEMBER: After surgery your body, including your knee, may not respond as it has in the past. Be cautious and test your body and knee before you resume activity. Comply with the activity restrictions described below. Each patient’s recovery is different. If you have questions or concerns, check with your surgeon. Return to Driving after Knee Surgery: There are no medical rules with regard to when you may return to driving after knee surgery. There are, however, legal implications, and you may be held liable if a mishap occurs when you are driving in the weeks after surgery. Each patient must determine on an individual case-by-case basis when she/he feels it is safe for to drive. This may be done in consultation with the physician and/or physical therapist. In general, if you do not feel you can safely drive, then you should not drive. Your physician cannot recommend specifically when to return to driving but can offer the following guidelines: Do not drive home from the hospital after knee surgery Do not drive if impaired due to pain or due to the use of narcotic pain medications or other medications Do not drive if the knee brace limits her/his ability to safely operate the automobile Return to Work after Knee Surgery: There are no medical rules with regard to when you may return to work after knee surgery unless specifically instructed by your surgeon. Patients must determine on an individual basis when she/he feels able to return to work. This can be done in 1 consultation with the physician, case manager, and/or physical therapist. In general, a functional level of knee motion and strength is required before returning to work that involves standing, walking, or more strenuous activity. Patients with Workman’s Compensation Claims will be released for full or restricted duty work according to the surgeon’s assessment of her/his abilities, to a reasonable degree of medical probability, as required by law. Patients with weight-bearing restrictions or bracing requirements must comply with these requirements, even if this limits the ability to return to full or restricted duty work. Patients having meniscus repair or microfracture should not return to strenuous activities like heavy physical work for at least 10-12 weeks and only after obtaining the doctor’s clearance. Patients having ACL reconstruction, meniscus transplant, or patellar realignment should not return to moderate work activities (eg moderate physical work, walking, prolonged standing) for at least 10-12 weeks or to strenuous activities (eg heavy physical work, carrying, climbing) for at least 12 weeks and only after obtaining the doctor’s clearance. A functional knee brace may be prescribed and may be recommended for strenuous activities, as well as moderate activities that involve knee pivoting, for at least 4-6 months. Return to Sports Activity after Knee Surgery: In general, there are no medical rules with regard to when you may return to sports after knee surgery. You must determine on an individual basis when you feel able to return to sports. This should be done in consultation with the physician and/or physical therapist, as certain restrictions may apply. Patients with weight-bearing restrictions or bracing requirements must comply with these requirements, even if this limits the ability to return to sports. Patients having meniscus repair should not return to moderate activities like running or jogging for at least 10 weeks. In addition, patients having meniscus repair should not return to strenuous activities (eg golf, tennis), or to very strenuous activities involving jumping or pivoting (eg football, basketball, soccer, skiing), for at least 12 weeks. 2 Patients having microfracture should not return to moderate activities like running or jogging for at least 10-12 weeks. Strenuous activities may resume after 3-4 months. Patients having ACL reconstruction, meniscus transplant, or patellar realignment should not return to strenuous activities like (eg skiing, tennis) for at least 4 months and should not return to very strenuous activities involving jumping and pivoting (eg basketball, soccer) for 4-6 months. In some cases, a functional knee brace will be provided to patients and may be recommended for strenuous or very strenuous activities. Furthermore, return of complete knee motion and strength is required prior to safely returning to sports. Patients must be aware that recurrent injury and further damage are distinct possibilities despite appropriate treatment and rehabilitation. Rehabilitation after Knee Surgery: Knee Arthroscopy: Patients having knee arthroscopy, including partial medial and/or lateral meniscectomy (trimming a torn meniscus), loose body removal, synovectomy (removing painful inflamed joint lining), or chondroplasty (smoothing rough cartilage), must follow the post-operative instruction sheets and may gradually resume activities. At the first follow-up office visit, formal physical therapy may be recommended for patients with significant swelling, stiffness, weakness, or pain, but will not be prescribed in all cases. Meniscus Repair or Transplant (with or without ACL Reconstruction): Patients having meniscus repair or transplant (with or without ACL Reconstruction) may be instructed to start formal physical therapy prior to the first follow-up office visit and may be prescribed a Continuous Passive Motion (CPM) machine for 2-3 weeks. These patients may bear full weight but must do so with the knee brace locked in full extension for at least 6-8 weeks. The brace may be unlocked or removed when not bearing weight. Anterior Cruciate Ligament (ACL) Reconstruction: Patients having ACL reconstruction may be instructed to start formal physical therapy prior to the first follow-up office visit. 3 Microfracture: Patients having microfracture may be instructed to start formal physical therapy prior to the first follow-up office visit and may be prescribed use of a Continuous Passive Motion (CPM) machine for at least 2-3 weeks. Those having Patella (kneecap) microfracture may bear full weight but must do so with the knee in a brace locked to allow only 30 degrees of flexion for 7-8 weeks. The brace may be unlocked or removed when not bearing weight. Those having Femoral and/or Tibial (thigh bone and/or leg bone) microfracture may not bear weight on the operated leg for at least 8 weeks. Patellar Realignment Procedures: Patients having a patellar (kneecap) realignment procedure, including lateral retinacular release, may be instructed to begin physical therapy prior to the first follow-up office visit. Patients may be permitted to bear full weight but must do so with the knee in a brace locked to allow only 30 degrees of flexion for 6-8 weeks, unless instructed otherwise. The brace must be worn at all times except when cleaning the operated knee. Special Instructions: Please Call (843) 573-1550 or 792-2123 (after hours) for: Any Questions or Concerns o For medical emergencies call 911 Excessive redness of the incisions Drainage of more than 4 days Fever of more than 101.5° F 4 You should have a follow up appointment with your surgeon 7-10 days after surgery. If one is not already scheduled, call (843) 876-0111 for an appointment. 5