Defect > Treatments
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
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 sweatpants 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
microfracture usually takes about 30 to 45 minutes to
perform and is normally done on an outpatient basis.
will either be put under general anesthesia or be numbed
from the waist down with a spinal anesthesia. Physicians
insert an arthroscopic awl through tiny incisions. The
awl looks like a screwdriver with a pointed end.
frayed cartilage is smoothed over and ground down. To
stimulate blood blow, tiny perforations are made in
the bone beneath the osteochondral defect, about four
to five millimeters apart.
are stitched and you are sent to the recovery room.
After surgery for osteochondral defect, 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 about
two hours to wear off. When you awaken in the recovery
room, your knee is usually wrapped in gauze, bandaged,
and covered with an ice pack. Patients generally feel
a moderate amount of pain, depending on the size of
their osteochondral defect. 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. You may have significant pain initially and
you should take the pain medicine as directed. Remember
that it is easier to keep pain suppressed than it is
to treat pain once it becomes present. When you feel
the pain coming on, take another pill, as long as it
is within the time limit on the bottle. 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. Physicians generally
suggest that you walk with crutches, keeping all weight
off your injured leg, for about six to eight weeks.
Your knee is usually immobilized in a stiff brace for
a short period of time, which varies based on the size
of the osteochondral defect. Most patients leave the
hospital after two or three hours. 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.
Most people spend about seven days at home after their
knees are drilled to repair osteochondral defect. Your
knee may be partially immobilized in a removable, hinged
brace, which may be locked to allow the knee to only
bend and straighten a few degrees. This can make movement
around the house difficult. Doctors strongly recommend
that you avoid any movement that twists your knee. For
example, getting your foot stuck under a table leg and
twisting around can cause severe pain. Here is what
you can expect:
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
as needed. Many patients may be given 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 the day after arthroscopy.
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.
generally recommend that you avoid putting all your
weight on the injured knee for about six weeks.
soon as possible after surgery, you should begin passive
motion exercises either with a physical therapist or
using a 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 surgery for osteochondral
defect. A blood clot that forms around the osteochondral
defect needs to stay intact. Too much movement after
surgery may hinder the healing process. 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. After the osteochondral defect 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
ON WEIGHT BEARING - UP TO SIX WEEKS
Let the osteochondral defect heal. 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.
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
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.
strengthening exercises: Cartilage injuries
Adequate leg muscle strength is the best way to keep
the bones in your knees from grinding into each other
and prevent recurrence of osteochondral defect. Physicians
usually suggest that you continue strength training
even after your knee has been rehabilitated. 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.