Knee > Osteochondral Defect > Treatments

   Arthroscopic Reduction and Fixation

The decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Make sure you have received any equipment you will need when you get home from the hospital. This may include a knee brace, crutches, ice packs or coolers, or a continuous passive motion (CPM) machine. You should receive prescriptions for any of these from your doctor when your surgery is scheduled.

   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, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

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

   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.

   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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   What to ask the doctor

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At most medical centers, you will go to "patient admissions" to check in for your arthroscopic surgery for osteochondral defect. If your surgery is going to be inpatient, there may be a separate department, so be sure to ask your doctor. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will 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. 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.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts or sweat pants with a zipper or buttons on the side that will fit comfortably over a knee brace 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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   ABC’s of anesthesia

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Arthroscopic repair of an osteochondral defect usually takes between 30 to 45 minutes to perform. The procedure is generally outpatient and you can leave the hospital about two hours after the surgery.

   Regional anesthesia is usually used to numb you from the waist down, but you may have some choice about the type of anesthesia depending on the advice of your anesthesiologist.

   Physicians look at the osteochondral defect through an arthroscope, using a tiny camera and microsurgery instruments inserted through three- to four-millimeter incisions.

   A tiny drill is used to prepare the area on the bone that will have the fragment attached to it.

   The fragment of bone and cartilage is fixed in place by special screws or pins.

   The incisions are stitched and the patient is taken to the recovery room.

Though every patient is different, arthroscopic reduction and fixation of osteochondral defects is not a painful procedure. About 99 percent of patients are able to leave within a few hours after surgery. In rare circumstances, some patients may stay overnight in the hospital to control their pain. Your knee is generally wrapped with gauze and an ice pack in the recovery room. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and spinal anesthesia may take up to two hours. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return and a prescription for pain medicine. 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 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. However, depending on the size and location of the osteochondral defect, you may be instructed to only put partial weight on your leg for up to four to six weeks and your knee may be immobilized in a stiff brace. As soon as you are fully awakened, you are usually allowed to go home. You will probably be unable to drive a car, so be sure to have arranged a ride home.

Many people spend seven to 10 days at home before returning to work after surgery for osteochondral defect. You may be partially incapacitated, but physicians generally recommend you start gentle leg motion as soon as possible after surgery. Here is what you can expect and how you can cope after arthroscopy:

   You will likely feel pain or discomfort for the first few days, and you will be given a combination of pain medications as needed. Usually you are given both a narcotic painkiller and an anti-inflammatory.

   There may be some minor drainage on the bandage since fluid may have accumulated during the surgery. Expect some blood to show through the bandage during the first 24 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 under your ankle. Icing your knee for 20 or 30 minutes a few times a day during the first two days after arthroscopy also will reduce pain.

   Wait until you can stand comfortably for 10 or 15 minutes at a time before you take a shower. You can probably shower and swim the day after arthroscopy.

   The dressing on your knee is usually removed one day after arthroscopy, during the first follow-up visit.

   Crutches or a cane may be needed for six to eight weeks. Depending on the size and location of the lesion, patients can usually start bearing some weight on their leg immediately after surgery.

   If the fragment is stable in its proper position, you should begin doing exercises using a continuous passive motion (CPM) machine while in bed. Your doctor can arrange to get you a CPM machine for use at home, which helps flex and extend the leg and prevents the joint from becoming stiff due to inactivity.

   For two or three weeks after surgery, you may experience night sweats and a 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.

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Physicians generally suggest that you progress through rehabilitation slowly after undergoing arthroscopic reduction and fixation of fragment to correct osteochondral defect. The newly attached fragment of cartilage and bone needs time to heal. After surgery, your physical therapist can help you learn the proper combination of rest, gentle movement to stimulate blood flow and healing, and light exercises. It is important not to twist or bend in ways that may grind cartilage together until your physician is certain the osteochondral defect has healed. You can usually begin gentle exercises within 72 hours after surgery. After the fragment has healed, physical therapy generally helps return healthy young athletes to sports at full strength. Arthritis may complicate the rehab process, especially for older athletes, but the physical therapy program generally recommended by physicians can be broken into three basic phases for everyone:

NON WEIGHT BEARING - TWO TO FOUR WEEKS

To restore movement and basic coordination, your physical therapist will help you begin moving your knee and teach you an exercise program to perform on your own. Physicians usually recommend that you put only partial weight on your knee for up to six weeks.

RESTORING RANGE OF MOTION - ONE TO THREE MONTHS

Rehab progresses into stretching and strengthening exercises that focus on the quadriceps and hamstrings Ð 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.

RETURNING TO ACTIVITIES - THREE TO SIX MONTHS

The focus of rehab turns to increasing your coordination. After a few months 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. Once the muscles of your injured leg are about 90 percent as strong as the uninjured leg, you can usually return to activities.

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   Knee strengthening exercises: Cartilage injuries

Physicians usually suggest that you continue strength training even after your knee has been rehabilitated. Adequate leg muscle strength is the best way to prevent the recurrence of osteochondral defect. Have your physician periodically check your knee. Weight control is also important. One extra pound of body weight translates into three or four pounds of weight across your knee every time you take a step. Lightening the load on your knees helps them to last longer. After an osteochondral defect, you may be at risk of suffering arthritis later in life. Depending on how well your knee heals, you may want to consider cutting back or avoiding repetitive-impact activities, like long-distance running, and contact sports, like football. Many of the exercises and activities that are popular for fitness put stress on your knees. To prevent osteochondral defects it is important to learn knee-sparing exercise techniques by dividing your activities into three components:

   Daily living - the average person takes between 12,000 and 15,000 steps a day, with each step exerting a force between two and five times your body weight on your knees. After a knee injury, take it easy on your knees during the day whenever possible to save them for activities and exercise. Avoid stairs when there is an elevator, take the shortest path when walking, and consider wearing athletic shoes designed to absorb shock rather than hard-soled shoes.

   Muscle strengthening and conditioning - Activities themselves are not a substitute for conditioning. Your need for special conditioning to prepare for activities increases with age. The best strengthening programs are low-impact and non-weight-bearing, like stationary bikes and certain weightlifting programs, so that the knees do not have to absorb shock.

   Recreation - Sports that require twisting and quick direction changes put great strain on your knee. To prevent injury, stick to light, non-impact activities for your recreation after arthroscopic fragment fixation. If you decide to return to sports like football and basketball, a physician should carefully examine your knee to make sure you have a proper coating of cartilage over your bones.

If pain recurs after rehab, physicians usually suggest you stop your activities and return for a check-up. Pain could be a sign that the fragment has not healed properly. Large osteochondral defects may make it difficult for some people to return to competitive athletic activity.