Defect > Treatments
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.
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
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.
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.
possible, practice walking with your crutches in case
you need to use them after surgery.
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.
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.
to ask the doctor
to take to the hospital
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:
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
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.
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.
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.
to take to the hospital
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.
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.
look at the osteochondral defect through an arthroscope,
using a tiny camera and microsurgery instruments inserted
through three- to four-millimeter incisions.
tiny drill is used to prepare the area on the bone that
will have the fragment attached to it.
fragment of bone and cartilage is fixed in place by
special screws or pins.
incisions are stitched and the patient is taken to the
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
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.
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
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
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.
dressing on your knee is usually removed one day after
arthroscopy, during the first follow-up visit.
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
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.
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
to call the doctor after surgery
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
NON WEIGHT BEARING - TWO TO FOUR
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
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
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
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:
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
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.
- 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
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.