instructions for surgery · baker’s cyst removal day of surgery a. diet as tolerated b. icing is...

CenterforMusculoskeletalCare333E.38thSt,NewYork,NY10016Tel:(646)501-7223/Fax:(646)754-9505/www.NewYorkOrtho.com

Laith M. Jazrawi, MD AssociateProfessorofOrthopaedics Chief-DivisionofSportsMedicineTel:(646)501-7223

INSTRUCTIONS FOR SURGERY Inordertomakeyouradmissionandhospitalstaysmoothandmorepleasant,pleasecomplywiththefollowinginstructions:

c IfyoursurgeryisonMONDAY,pleasereportto:

NYUHospitalforJointDiseases301East17thStreetNewYork,NY10003

Ifindicatedbyyourphysician,scheduleyourpre-surgicaltesting,locatedat

3032ndAvenue,1stFloorSuite16

NewYork,NY10003

c IfyoursurgeryisonFRIDAY,pleasereportto:

NYULangoneOutpatientSurgeryCenter339East38thStreetNewYork,NY10016

Ifindicatedbyyourphysician,pleasecall212-263-5985toscheduleyourpre-surgicaltesting,locatedat

240East38thSt.

NewYork,NY10016MezzanineLevel

*Onebusinessdaypriortoyoursurgery,hospitalstaffwillcontactyoutofinalizeyoursurgerytime.

A. Bringjogging/warm-uppants,shorts/skirtifhavingkneesurgery.

B. Bringashirt/blousethatbuttonsopeninfrontinsteadofapulloverifhavingshoulder/elbowsurgery.

C. Ifyouowncrutches,bringthemwithyou,ifhavingknee,ankleorhipsurgery.

D. Bringallmedicationsoralistofcurrentmedicationsyouaretakingwithyou.Alsobringalistofany

allergies.

E. Bloodpressuremedicationshouldbetakenasusualwithasipofwaterthemorningofsurgery.DONOTtakeadiureticorfluidpill.Seizuremedicationsmaybetakenbeforesurgery.

F. DONOTtakeoraldiabetesmedications(pills)thenightbeforeorthedayofsurgery.Ifyouareoninsulin,

DONOTuseinsulinthemorningofsurgeryunlessyouarea"problemdiabetic"inwhichcaseyouneedtoconsultyourphysicianregardingtheproperinsulindoseforyoutousepriortosurgery.

CenterforMusculoskeletalCare333E.38thSt,NewYork,NY10016Tel:(646)501-7223/Fax:(646)754-9505/www.NewYorkOrtho.com

Laith M. Jazrawi, MD AssociateProfessorofOrthopaedics Chief-DivisionofSportsMedicineTel:(646)501-7223

G. PleaseDONOTwearmakeupornailpolishthedayofsurgery.Youwillneedtoremovecontactlens(includingextendedwear),denture,orbridgespriortosurgery.Pleasebringyourowncontainersforstorage.

H. Leavealljewelryandvaluablesathome.Thehospitalwillnottakeresponsibilityforlostormissingitems.

I. Youneedtoreportanyskinirritation,fever,cold,etc.,toDr.Jazrawi.

J. Youwillneedtobringyourinsurancecard/informationwithyou.

K. DONOTeat,drink(includingwater),chewgum,candy,smokecigarettes,cigars,usesmokelesstobacco,etc.,aftermidnightthenightbeforesurgeryorthemorningofyoursurgery.Theonlyexceptionisasipofwatertotakenecessarymedicationsthemorningofsurgery.

L. Youmustarrangesomeonetodriveyouhomewhenreadytoleavethehospital.Youwillnotbeallowedto

driveyourselfhomeaftersurgery.Wecanassistyouifyouneedtransportationtotheairportorhotel,however,youneedtoletusknowinadvance(ifpossible)sowecanmakethearrangement.

M. NOTE:DONOTtakeanyaspirin,aspirinproducts,anti-inflammatories,CoumadinorPlavixatleast5days

priortosurgery.YouareallowedtotakeCelebrexuptoyourdayofsurgery.Ifyourmedicaldoctororcardiologisthasyouonanyoftheabovemedications.Pleasecheckwithhim/herbeforediscontinuingthemedication.YoumayalsotakeTylenolorExtra-StrengthTylenolifneeded.

NonsteroidalAnti-Inflammatory(Arthritis)Medications:

SomeofthemostcommonnamesforfrequentlyusedNSAID'sinclude:Motrin,Indocin,Nalfon,Naprosyn,Naprelan,Arthrotec,Tolectin,Feledene,Voltaren,Clinoril,Dolobid,Lodine,Relafen,Daypro,Advil,Aleve,Ibuprofen.Yourfirstfollowupappointmentisusuallyscheduledforapproximately2weeksafteryoursurgeryatthe333

East38thstreetoffice.Thedateandtimeofyourfollow-upis__________________________.

Ifyoucannotmakethisappointmentorneedtochangethetime,pleasecontacttheoffice.Ifyouhaveanyquestionsregardingyoursurgery,pleasecontacttheofficeat646-501-7223option4,option2orviatheinternetatwww.newyorkortho.com

Laith M. Jazrawi, MD Associate Professor of Orthopaedics Chief - Division of Sports Medicine Tel: (646) 501-7223

Home Supplies For Your Surgery Laith M. Jazrawi M.D.

Open Surgery

A. Open knee surgery (ACL reconstructions, ALL (Anterolateral ligament) reconstructions, Autologous

Chondrocyte Implantation, PCL reconstructions, High tibial osteotomy, Distal femoral osteotomy,

Posterolateral corner reconstruction, MCL reconstruction, OATS (osteochondral autograft), Osteochondral

allograft,)

a. You will need 4x4 (or similar size) waterproof bandages for fourteen days. Bandage changes for

open knee surgery done post-op day #3.

B. Open shoulder surgery , (Biceps Tenodeis, Latarjet, Open capsulorrhaphy, Glenoid reconstruction using

Distal tibial allograft):

a. You will need 4x4 (or similar size) waterproof bandages for fourteen days. Also, a box of Bandage

changes for open shoulder surgery are done post-op day #3.

C. Open Ankle Surgery (Achilles Tendon Repair, Os Trigonum Excision, Ankle OCD, Modified Brostrom-

Gould Procedure, Peroneus Longus/Brevis Repair)- You do not have to worry about dressing changes as

your leg will be in splint/cast for the first two weeks

D. Open Elbow surgery (Distal Biceps Repair, LCL Reconstruction, Radial Head or Capitellum ORIF, Radial

Head Replacement/Resection, Triceps Repair, UCL Reconstruction – Tommy John Surgery)- You do not

have to worry about dressing changes as your arm will be in splint/cast for the first two weeks. For Tennis

Elbow surgery (lateral epicondylitis) and Golfer’s Elbow Surgery (medial epicondylitis), dressing

changes are are started on post-op day #3. You will need 4x4 (or similar size) waterproof bandages for

fourteen days.

E. Hamstring repair You will have a special dressing placed on at the time of surgery that will be kept

on for the first 2 weeks after surgery. You will then need 4x4 (or similar size) Tegaderm or Telfa

waterproof dressings. Also, a box of 4" by 4" gauze sponges if there is bleeding at the incision site.

Arthroscopic Surgery

A. For Arthroscopic shoulder, elbow, knee, or ankle surgery:

a. Regular adhesive bandages (“Band-aids”) can be used for arthroscopic portals x 2 weeks.

b. If biceps tenodesis was performed, use 4x4 (or similar size) waterproof bandages on

wounds.

c. In general, dressing changes for arthroscopy are done on post operative day 3

Center for Musculoskeletal Care 333 E. 38th St, New York, NY 10016

Tel: (646) 501-7223/ Fax: (646) 754-9505 / www.NewYorkOrtho.com

Post-OperativeMedicationAdministration

KneeArthroscopy

• Pain-Motrin800mg.1tabthreetimesdaily,asneeded

• Adjunctivepain:Percocet(Oxycodone/Acetaminophen)10/325;Onetabevery6hoursas

neededforadjunctivepain

• Antibiotic–Keflex500mg;Onetab4timesdailyx4days

o Keflexallergy–Clindamycin300mg;Onetabtwicedailyx7days.

KneeLigamentReconstruction

• Pain-Percocet(Oxycodone/Acetaminophen)10/325;Onetabevery6hoursasneeded.

• BreakthroughPain–Dilaudid(Hydromorphone)2mg;2-3tabsevery8hoursasneededfor

adjunctivepain.

• Antibiotic–Keflex500mg;Onetab4timesdailyx4days

o Keflexallergy–Clindamycin300mg;Onetabtwicedailyx7days.

• Constipation–Docusate(Colace)100mg;1tabtwicedailyasneeded.

• DVTprophylaxis-Aspirin81mg;2tabsdailyx14days

• ****AntibioticsandAspirinstartpost-operativeday#1

Non-weightbearingLowerExtremitySurgery(MeniscalRepair,MeniscalRootRepair,DistalFemoral

Osteotomy,HighTibialOsteotomy,TibialTubercleOsteotomy,CartilageTransplant)

• Antibiotic–Keflex500mg;Onetab4timesdailyx4days

o Keflexallergy–Clindamycin300mg;Onetabtwicedailyx7days.

• Pain-Percocet(Oxycodone/Acetaminophen)10/325;Onetabevery6hoursasneeded.

• AdjunctivePain–Dilaudid(Hydromorphone)2mg;2-3tabsevery8hoursasneededfor

adjunctivepain.

• Constipation–Docusate(Colace)100mg;1tabtwicedailyasneeded.

• DVTprophylaxis-Aspirin81mg;2tabsdailyx14days

• ******AntibioticsandAspirinstartpost-operativeday#1

Shoulder/ElbowSurgery

• Antibiotic–Keflex500mg;Onetab4timesdailyx4days

o Keflexallergy–Clindamycin300mg;Onetabtwicedailyx7days.

• Pain-Percocet(Oxycodone/Acetaminophen)10/325;Onetabevery6hoursasneeded.

• AdjunctivePain–Dilaudid(Hydromorphone)2mg;2-3tabsevery8hoursasneededfor

adjunctivepain.

• Constipation–Docusate(Colace)100mg;1tabtwicedailyasneeded.

• DVTProphylaxis-Aspirin81mg;2tabsdailyx14days

Anklefracturesurgery&AchillesTendonSurgery

• Antibiotic–Keflex500mg;Onetab4timesdailyx4days

o Keflexallergy–Clindamycin300mg;Onetabtwicedailyx7days.

• Pain-Percocet(Oxycodone/Acetaminophen)10/325;Onetabevery6hoursasneeded.

• AdjunctivePain–Dilaudid(Hydromorphone)2mg;2-3tabsevery8hoursasneededfor

adjunctivepain.

• Constipation–Docusate(Colace)100mg;1tabtwicedailyasneeded.

• DVTProphylaxis-Aspirin81mg;2tabsdailyx14days

• ****AntibioticsandAspirinstartPOD#1

Anklearthroscopy+/-MicrofractureandAchillesrepair

• Pain-Percocet(Oxycodone/Acetaminophen)10/325;Onetabevery6hoursasneeded.

• DVTProphylaxis-Aspirin81mg;2tabsdailyx14days

• ****Aspirinstartspost-operativeday#1

Hamstringrepair

• Antibiotic–Keflex500mg;Onetab4timesdailyx4days

o Keflexallergy–Clindamycin300mg;Onetabtwicedailyx7days.

• Pain-Percocet(Oxycodone/Acetaminophen)10/325;Onetabevery6hoursasneeded.

• AdjunctivePain–Dilaudid(Hydromorphone)2mg;2-3tabsevery8hoursasneededfor

adjunctivepain.

• Constipation–Docusate(Colace)100mg;1tabtwicedailyasneeded.

• DVTProphylaxis-Aspirin81mg;2tabsdailyx14days

• ****AntibioticsandAspirinstartPOD#1

CenterforMusculoskeletalCare333E.38thSt,NewYork,NY10016Tel:(646)501-7223/Fax:(646)754-9505/www.NewYorkOrtho.com

Laith M. Jazrawi, MD AssociateProfessorofOrthopaedics Chief,DivisionofSportsMedicineTel:(646)501-7223

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 AssociateProfessorofOrthopaedics Chief-DivisionofSportsMedicineTel:(212)598-6784

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,fatpadimpingementandchronicplicairrita@on.Therearetwotypesofcar@lageintheknee,ar@cularcar@lageandmeniscuscar@lage.Ar@cularcar@lageismadeupofcollagen,proteoglycansandwater,whichlinetheendofthebonesthatmeettoformajoint.Theprimaryfunc@onofthear@cularcar@lageistoprovideasmoothglidingsurfaceforjointmo@on.Rubbingar@cularcar@lageonar@cularcar@lageisapproximately5@mesmoresmooth(i.e.lessfric@on),thanrubbingiceonice.3Awiderangeofinjuriescanoccurtothear@cularcar@lageduringsportsinjuries,traumaanddegenera@veprocesses.Smaller,par@althicknesstearsofthear@cularcar@lagecancausepain,swelling,orcatchingintheknee.Thesetypesoftearscanbetreatedwitharthroscopybyremovingthetornorfrayedar@cularcar@lagewithashaver.Thegoalofthisistoremovethedamagedar@cularcar@lagewhilepreservingtheremainingintactar@cularcar@lage.Themeniscuscar@lageinthekneeincludesamedial(insidepartoftheknee)meniscusandalateral(outsidepartoftheknee)meniscus(Figures1and2).Togethertheyarereferredtoasmenisci.Themenisciarewedgeshapedandarethinnertowardthecenterofthekneeandthickertowardtheperipheryofthekneejoint(Figures1and3).Thisshapeisveryimportanttoitsfunc@onsincetheprimaryfunc@onofthemenisciistoimproveloadtransmission.Arela@velyroundfemursiOngonarela@velyflat@biaformsthekneejoint.Withoutthemeniscitheareaofcontactforcebetweenthesetwoboneswouldberela@velysmall,increasingthecontactstressby235-335%(Figure4).Themeniscialsoprovidesomeshockabsorp@on,lubrica@onandjointstability.Therearetwocategoriesofmeniscaltears,acutetrauma@ctearsanddegenera@vetears.Degenera@vetearsoccurmostcommonlyinmiddle-agedpeopleasaresultofrepe@@vestressestothemenisciover@me,whichseverelyweakenthe@ssueandcauseanonacute,degenera@vetear.Thisprocessof@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%ofmeniscaltears

occurringinpa@entsmorethanfortyyearsofagewere

repairable.Symptomsofadegenera@vemeniscusmaytear

includeswelling,painalongthejointline,catching,andlocking.

Ifadegenera@vetearissymptoma@citisusuallysurgically

removed.Thisiscalledapar@almeniscectomy,whichistermed

par@albecausethesurgeonsonlyremovethesegmentof

meniscuscontainingthetearasopposedtoremovingtheen@re

meniscus.

Acutetrauma@ctearsoccurmostfrequentlyinthe

athle@cpopula@onasaresultofatwis@nginjurytotheknee

whenthefootisplanted.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@tch

together)thetornmeniscus.Thetreatmentchosenwilldepend

ontheloca@onofthetear;thesizeofthetear;thesportto

whichtheathleteisreturning;ligamentousstabilityoftheknee;

andanyassociatedinjury.2Theloca@onofthetearisimportant

becausetheouterpor@onofthemeniscushasagoodblood

supplywhereastheinnerpor@onhasaverypoorbloodsupply.

Bloodvessels(theperimeniscularcapillaryplexus)enterthe

peripheralonethirdofthemeniscus,1thisbloodsupplyis

necessaryforatearorsurgicalrepairtoheal(Figure6).Without

anadequatebloodsupply,usuallytheareaoftornmeniscushas

toberemoved.

Figure3NormalMRI(saggitalview)ofthe

knee,lateralside(outside)

Figure5MRI(saggitalview)ofalateral

meniscustear(yellowarrows)

Figure4Schema@crepresenta@onofthe

meniscaleffectoncontactpressurein

theknee.Contactareaisincreasedby

50%withaddi@onofmenisci.This

reducescontactpressures.

withoutmeniscus

withmeniscus

Otherstructuresinthekneethatcancausepainandlimitfunc@onwheninjuredorchronicallyinflamedarethefatpad(Figure3)andtheplica.Theseproblemscanarisefromavarietyofcauses,butiftheydonotimprovewithnon-surgicalmeasuresitmaybenecessarytousekneearthroscopytoremovethe@ssue.Secondaryproblemsmayalsoarisefrominjury,suchasscar@ssueorcysts,whichneedtoberemoved.AVerkneearthroscopy,rehabilita@onwithaphysicaltherapistorathle@ctrainerisusuallyrequiredtoop@mizetheoutcome.Rehabilita@onwillfocusonrestoringrangeofmo@on,developingstrengthandmovementcontrol,andguidingtheathlete’sreturntosport.Therehabilita@onguidelinesarepresentedinacriterionbasedprogression.Specific@meframes,restric@onsandprecau@onsaregiventoprotecthealing@ssuesandthesurgicalrepair/reconstruc@on.General@meframesarealsogivenforreferencetotheaverage,butindividualpa@entswillprogressatdifferentratesdependingontheirage,associatedinjuries,pre-injuryhealthstatus,rehabilita@oncomplianceandinjuryseverity.Thesizeandloca@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

Laith M. Jazrawi, MD AssociateProfessorofOrthopaedics Chief-DivisionofSportsMedicineTel:(646)501-7223

PHYSICALTHERAPYLOCATIONS**Pleasescheduleyourpost-operativephysicaltherapyappointmentsBEFOREyoursurgery**

ManhattanSportsandManualPhysicalTherapy

10East33rdStreet,2ndFloorNewYork,NY10016(646)487-2495www.msmpt.com

CenterforMusculoskeletalCarePT

333E38thSt,5thFloorNewYork,NY10016(646)501-7077

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RUSKPhysicalTherapy� 240E.38thStreet NewYork

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STARPhysicalTherapy� 160E.56thStreet NewYork 10022 (212)355-7827

Laith M. Jazrawi, MD AssociateProfessorofOrthopaedics Chief-DivisionofSportsMedicineTel:(646)501-7223

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Laith M. Jazrawi, MD AssociateProfessorofOrthopaedics Chief-DivisionofSportsMedicineTel:(646)501-7223

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