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Arthroscopy in Children and Teenagers (Ages 8 to 18)
Edited By: Gregory A. Schmale, M.D.
Last updated Friday, July 22, 2005
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Recovering from surgeryPain and pain management
Pain is relieved in part by oral pain medications, usually a
combination of mild narcotics such as Tylenol with codeine or
hydrocodone and a non-steroidal anti-inflammatory such as ibuprofen.
In addition, the use of cold therapy may also greatly reduce
discomfort. Plastic bags of ice placed over the dressings for 15
minutes out of every hour provide fair cooling of the knee, though more
controlled and less labor intensive cooling may be achieved with the
use of a cooling cuff placed by the surgeon under the dressing. The
cooling cuff attaches to a thermos mixed with ice and water.
Use of medications
Most patients who have had a meniscal tear repaired arthroscopically
will stay overnight in the hospital. Pain medications may be
administered orally with intravenous supplementation of more powerful
medicines if necessary. Usually oral medicines and cold therapy
together provide adequate pain relief within 12-24 hours, and narcotic
pain medicines can often be stopped within a week.
Patients who
have had their meniscus trimmed often feel well enough to go home later
that same day. In this case, oral pain medicines and cold therapy
together provide adequate relief within 1-2 hours of surgery, and
narcotic pain medicines can often be stopped within a week.
Effectiveness of medications
Oral pain medicines and cold therapy may greatly reduce discomfort,
though if a patient does not elevate their foot above their knee and
their knee above their heart for the first three to five days after
surgery, the pain experienced may not be well controlled.
Important side effects
Nausea and vomiting may occur early after surgery, though these side
effects of the general anesthesia and potent intravenous narcotics
often wear off within 12 to 24 hours. Post-operatively, any nausea may
be lessened when pain medicines are not taken on an empty stomach.
Should a patient experience these symptoms with the oral pain medicines
despite taking the medicines on a full stomach, a change in medicines
may be necessary. Using oral or rectal anti-nausea medicines may help
break the cycle of nausea and vomiting that can accompany use of oral
narcotic pain medicines.
Hospital stay
For patients whose meniscus is repaired, an overnight stay is often recommended to ensure adequate pain control.
Patients
are often discharged from the hospital the same day if the meniscus is
only trimmed, should their level of discomfort be tolerable with oral
pain medications.
Recovery and rehabilitation in the hospital
For those who have undergone repair, patient should use crutches and
keep the weight off their knee for six weeks. Motion is encouraged
during this period of time, as well as isometric quadriceps and
hamstring strengthening exercises. These exercises are usually taught
to the patient at the pre-operative visit and reviewed at an early
post-operative visit. At six weeks, the patient is allowed to stand
fully on the leg, though no squatting is permitted for six months.
This approach often precludes any participation in contact sports for
six months. Though this seems like a long period of time to stay out of
sports, such a delay increases the chances of the torn meniscus
healing, decreasing the likelihood of early arthritis in the knee.
If
the patient has had only a trimming of the meniscus without repair,
then he or she may put as much weight on the limb as they can tolerate.
However, this procedure is somewhat less desirable than a repair, as
early arthritis in the knee may occur after removal of portions of the
meniscus.
After a trimming, the patient is usually cleared for
return to contact sports within three weeks, allowing time for the
small incisions to heal.
Hospital discharge
For those who have undergone meniscal repair, crutches are required for
six weeks and longer if inadequate quadriceps strength is noted at that
time.
Crutches are used for comfort for those who have had a
trimming of the meniscus. The crutches may be discarded when the
patient desires.
Convalescent assistance
Patients do not ordinarily need any convalescent stay after arthroscopic treatment of meniscal tears.
Surgery for Meniscal tears in the knee of adolescents and children at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-987-3700 to make an appointment. Our clinical center is located in Seattle Washington, USA
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