Pain Syndrome > Treatments
Preparing for Surgery
is a useful surgical tool for diagnosing and treating
patellofemoral pain problems. 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. 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 nurse
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 pants or other clothing that will fit
comfortably over your knee bandage when you leave the
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
surgery for patellofemoral pain usually takes about
an hour or less, depending on what your surgeon needs
to do and if there are other associated injuries to
ligaments or tendons. After anesthesia is administered,
which may be local, regional, or general, the surgical
team sterilizes the leg with antibacterial solution.
The instruments are then set up and the television monitors
are turned on.
to three small, four-millimeter incisions are used for
the diagnostic portion of the operation. Any further
incisions depend on what your surgeon will do to fix
your particular problem.
the arthroscope in your knee, the surgeon can see exactly
how the kneecap tracks in its groove and any instability
or tendency to dislocate can be seen easily. Your surgeon
can also determine whether some of the tendons and structures
that are attached to your kneecap are too tight, too
loose, or torn.
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.
incisions are stitched and you are awakened and taken
to the recovery room.
surgery, you usually stay in the recovery room for at
least two hours while the anesthetic wears off. 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. You may have significant pain early
on 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. 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. 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.
Here is what you can expect after
to correct patellofemoral pain syndrome:
will likely feel pain or discomfort for the first few
days, and you will be given a combination of pain medications
as needed. A prescription-strength painkiller is usually
prescribed and should be taken as directed on the bottle.
Taking one every four to six hours as directed is a
good idea in the first 24 hours to suppress pain.
may be some minor drainage on the dressing since fluid
may have accumulated during surgery. Expect some blood
to show through the bandage during the first 24 hours.
should usually continue with the ice for at least 24
hours and remove the dressing within the first 48 hours.
Icing your knee for 20 or 30 minutes a few times a day
during the first two days after arthroscopy will help
reduce pain. Ice therapy is most effective in the first
24 to 48 hours.
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.
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. If you have
access to a pool, many physicians suggest swimming for
a half-hour a day.
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. The pain typically feels like you bumped
into a table.
soon as possible after surgery, you should begin doing
physical therapy as directed by your surgeon.
two or three days 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
may return to work the next day after arthroscopy, depending
on the severity of your pain.
to call the doctor after surgery
Your physician may prescribe visits
to a physical therapist to begin supervised strengthening
exercises as soon as possible after arthroscopic
surgery. You can begin therapy immediately after surgery
in most cases. Patients should do stretching and strengthening
exercises for a minimum of four days a week. The workouts
should focus on the knee for at least thirty minutes
and be combined with a knee-friendly cardiovascular
workout. Despite your dedication to the rehab program,
you may not feel any improvement for up to six weeks
or longer and your kneecap pain may recur. Though everyone's
rehab program is slightly different, physical therapy
after arthroscopy for kneecap pain follows a general
pattern. Most people can begin stretching the muscles
and tendons around the kneecap within a week. Though
your knee may be weak, it is generally strong enough
to handle mild stretching and slow movements. Working
to restore early range of motion may help reduce swelling
and stiffness, and increase your healing time. Rehab
progresses into 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.
Once the muscles of your injured leg are about as strong
as the uninjured leg, the focus of rehab turns to increasing
your coordination. After about six 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. 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.
strengthening exercises: Kneecap (patella) injuries
Physicians may suggest that you wear
a neoprene knee sleeve with a hole around the kneecap
during any activities that may stress your knee. The
knee sleeve by itself may improve the tracking of your
kneecap; however, to prevent patellofemoral pain, your
rehab exercises are ultimately more important than bracing.
Physicians generally recommend that you make the stretching
and strengthening exercises you learned in rehab part
of your everyday routine as soon as your doctor diagnoses
you with patellofemoral pain. Many of the exercises
and activities that are popular for fitness put stress
on your knees. To prevent further kneecap pain 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. Any climbing
or jumping activity where the knee is bent beyond 90
degrees puts undue pressure on the cartilage surfaces
under the kneecap. To prevent injury, stick to light,
non-impact activities for your recreation after suffering
patellofemoral pain. If you decide to return to sports
like football and basketball, a physician should carefully
examine your kneecap and test it for proper alignment.
If you plan on participating in sports, remember to
take it easy during daily activities and to keep your
kneecap tracking properly with stretching and strengthening
A small amount of pain is normal during physical activity,
but if you feel so much pain in your knee to warrant
taking a painkiller before an activity, you should consider
cutting back or stopping.