Knee > Kneecap Dislocation > Treatments

    Arthroscopy

Preparing for Surgery

If you and your physician have decided on surgery to address your dislocated kneecap, the decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in giving you the best possibility of a healthy recovery. Most insurance companies require a second opinion before agreeing to reimburse a patient for a surgical procedure. Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Prior to your return home from the hospital, make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, walker, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any new medications you are taking.

   If possible, practice walking with your crutches in case you need to use them after surgery.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

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Prior to surgery, you may be instructed to go to the hospital for pre-admission testing a few days before surgery. A nurse will review your medical history and provide you with all the preoperative instructions you need.You will be asked about your past medical history, given a complete physical exam and undergo the appropriate routine blood and urine tests and diagnostic studies (e.g. x-rays and electrocardiogram). If you are taking any medications, you will receive instructions about which medications to take and the appropriate dosing prior to your surgery. At most medical centers, you will go to "patient admissions" to check in for your surgery. There may be separate areas for ambulatory outpatients (patients who go home the same day after surgery) and for overnight inpatient surgery check-in. Be sure to ask your doctor or one of his assistants about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed and your knee area may be shaved (this is not always necessary). You will be asked to change into a hospital gown and, if necessary, to remove all of your jewelry, watches, dentures, and glasses. You will have the opportunity to speak with your orthopedic surgeon or one of his assistants, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Unless requested, most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.

   If your surgery is going to be an outpatient procedure, arrange for someone to drive you home when you are released, as the anesthetic and pain medications may make you drowsy.

   If your surgery is going to be an inpatient overnight stay procedure, pack a bag for yourself that contains toiletries, underwear, personal phone numbers you may need, and any other items you would like to have during your hospital stay.

   Wear a loose pair of pants or other clothing that will fit comfortably over your knee bandage when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

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Arthroscopic surgery for kneecap dislocations usually takes about an hour or less, depending on what your surgeon finds and does for your particular problem. Once the problem is identified, the appropriate procedures can be performed. These may include tightening, releasing, or a combination of procedures that will ultimately allow the kneecap to track properly so you can avoid future dislocations.

   General anesthesia is typically used for surgery, though in some cases a spinal or epidural anesthetic is used. You can expect to be given a sedative in theoperating room before the anesthesiologist administers the anesthesia to put you to sleep. After anesthesia is administered, the surgical team sterilizes the leg with antibacterial solution and places clean drapes around the site of the operation.

   One or two small incisions are used for the diagnostic portion of the operation. Any further incisions depend on what your surgeon will be required to do to help your kneecap track normally in its groove.

   With the arthroscope in your knee, the surgeon can see how the kneecap tracks in its groove and determine which knee structures attached to your kneecap are too tight, too loose, or torn.

   Once the problem is identified, the appropriate procedures can be performed. These may include tightening, releasing, or a combination of procedures that will ultimately allow the kneecap to track properly.

   The instruments are removed, the incisions are closed, local anesthetic is injected, a sterile dressing is applied, and you are awakened and transported to the recovery room.

After arthroscopic surgery, you will be transported to the recovery room where you will be closely observed for one to two hours while the immediate effects of the anesthesia wear off. After surgery, you will experience some pain. Adequate pain medications will be prescribed for you. You will be given oral, IV, and/orintramuscular pain medications when you ask for them. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. Your knee will be bandaged and may have ice on it. There will likely be pain, and you can expect to be given pain medication as needed. Be sure to ask for medication as soon as you feel pain coming on, because pain medication works best on pain that is building rather than on pain that is already present. The nurses will not give you more than your doctor has prescribed and what is considered to be safe. You should try to move your feet, hips, and ankles while you are in the recovery room to improve circulation. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. It is likely that you will be able to bear some weight on your leg, but your surgeon may suggest that you use crutches or a cane for a couple of days. For most people, crutches are used only until you feel steady on your feet. Your physician may prescribe a brace to help support your knee and keep it from bending too far. As soon as you are fully awakened, you usually are allowed to go home. You will probably be unable to drive a car, so be sure to have arranged a ride home.

You will likely feel pain or discomfort for one to two weeks, and you will be given oral pain medications as needed. A prescription-strength pain medication is usually prescribed and should be taken as directed on the bottle. There may be some minor drainage on the dressing since fluid may have accumulated during the surgery. Do not be alarmed to see some bloody drainage on your dressing over the first 24 hours. Here is what you can expect and how you can cope after arthroscopy:

   You should usually continue with the ice for at least 24 to 72 hours and remove the dressing as instructed by your physician. Icing your knee as much as possible during the first two days after arthroscopy will help reduce pain and swelling. Ice therapy is most effective in the first 24 to 48 hours.

   As much as possible, you should keep your knee elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows or blankets under your ankle.
   Sponge bathe and keep your wounds dry. Do not shower or take a bath until your surgeon tells you it is safe to do so.

   Crutches or a cane may be needed for a few days following arthroscopy, but you can usually put your weight on your knee and begin walking soon after surgery. The pain typically feels like you bumped into a table. However, it is difficult to predict the amount of pain any given patient will experience.

   For two or three days after surgery, you may experience a low-grade fever of up to 101. Your physician may suggest acetaminophen, coughing, and deep breathing to get over this. This is common and should not alarm you.

   You may return to work a few days after arthroscopy, depending on the severity of your pain.

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Usually, you will be asked to try a well-supervised rehabilitation program for between six weeks for a subluxation and up to six months for a dislocation. In most cases, you will need to continue the exercises you learn in physical therapy for your entire life. After a dislocation, the knee is immobilized for four to six weeks. After a subluxation, motion is resumed when the pain decreases enough to make it tolerable. Generally, most people can begin range of motion and strengthening exercises within a week after a subluxation. Your physician and physical therapist can help design a customized rehabilitation program that is best for you. You will start slowly with range of motion exercises and proceed to stretching exercises. In most cases, patients respond to non-operative treatment. Most people can begin stretching the muscles and tendons around the kneecap within a week. Physical therapy after a kneecap dislocation follows a general pattern. It often involves an elaborate daily stretching routine that helps ensure muscles pull evenly on your kneecap. When stretching, try to avoid bending your knee past 90 degrees, which is roughly the knee angle when sitting in a chair with your feet flat on the floor. Rehab progresses into strengthening exercises that focus on the quadriceps and hamstrings ­ the main stabilizing muscles for your knee. Physicians suggest you gradually increase the amount of weight as your leg muscles get stronger. Strengthening exercises require dedication because results often take weeks and pain may recur. After about six to 12 weeks of rehab, physical therapy can become activity-oriented as you regain the ability to perform complicated movements, using stationary bikes, elliptical machines, and cross-country skiing machines. Coordination exercises continue for months until your kneecap is fully rehabilitated. Physicians usually suggest that you continue strength training even after your kneecap has been rehabilitated. Have your physician periodically check your kneecap for strength and proper tracking.

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Your main prevention goal following kneecap dislocation should be to strengthen your quadriceps and hamstring muscles so they are stronger than before the dislocation. You should try to feel comfortable that your leg muscles are powerful enough to snugly keep your kneecap in a normal alignment. Physicians usually suggest that you wear your knee sleeve during any activities that may stress your knee. The knee sleeve by itself may improve the tracking of your kneecap, however, to prevent kneecap dislocations, your rehab exercises are ultimately more important than bracing. Making the strengthening exercises you learned in rehab part of your regular conditioning routine is the best way to prevent future kneecap dislocations. Like any dislocated joint, once the first dislocation occurs, less force may provoke subsequent dislocations. You will have to rely much more on muscle strength to hold your kneecap in a normal position after a dislocation. Depending on the severity of your dislocation and the success of your rehab program, your physician may recommend that you avoid contact sports or risky, high-speed activities. In general, your kneecap can become healthy and stable after a dislocation, but you may need to be cautious of activities that could result in accidental collisions or falls. Besides the knee sleeve, consider wearing sturdy kneepads designed for crashes during activities like in-line skating and padded knee braces during contact sports. Your physician can recommend the best types of protective gear for your knees. You may know some people who seem able to pop their joint in and out of place painlessly. This should be avoided at all costs. The more your kneecap is popped out of place, the greater your chances of arthritis and the higher your risk of re-injury during activities.