MACI Cartilage Transplant, MPFL Reconstruction and Tibial Tubercle Transfer

First 10 days

Activity

1. Elevate your knee and leg above your heart as much as possible, especially the first few days to minimize swelling. Avoid pillows under the knee. Place pillows under the calf or ankle.
2. Ice the knee at least 4 times per day (try breakfast, lunch, dinner, bedtime) for 20 minutes each time. Alternatively, use an ice machine such as a Cryo-Cuff as directed.
3. You may walk using crutches but NO WEIGHT bearing on operated leg. Keep the knee immobilizer in place with your knee in full extension at all times.
4. You can remove the dressings on postop day 3, and then shower and get the incisions wet.
5. If you have a TED hose stockting on and experience numbness, tingling, pain in your foot or toes, you can roll down your TED hose stocking. Do not remove the TED hose stocking completely – it is there to control swelling. You DO NOT have to wear on opposite leg
6. Do not place any weight on the leg for at least 2 weeks, we will direct you when you may begin increasing your weight bearing.
7. Start your continuous passive motion machine (CPM) for your knee 8 hours a day, 0-30 degrees. After 7 days, increase the CPM 30° each week until full range of motion. Please contact our office every 3 weeks so we can renew your CPM which will be used for 3 months.

Medications

1. Resume all your regular medicines as prescribed.
2. Drink plenty of water.
3. Take the pain medications as prescribed and as needed for pain. Please wean off of using the narcotics.
4. Do not take any anti-inflammatories for 6 weeks (Ibuprofen, motrin, aleve) as this slows the bone healing.

Wound Care

1. Please keep dressings clean dry and intact for the next three days. On postop day three after surgery, you may remove the TED hose stocking and dressings on your knee. Do not remove the tapes on your knee called Steri-Strips. You may shower and get your knee wet. However, do not soak your wounds, no baths, no pools, no spas. After showering, please dry your wound and replace the TED hose stocking. If there is any using from your wound, please place some dry dressings over the incision site.
2. Expect some bloody drainage on your surgical dressing. This is normal. You may change the gauze under the TED Hose stocking if necessary, then re-wrap your knee.

IMPORTANT

CPM – continuous passive motion machine

Use every day 2-3 hours at a time for 8 hours a day. Start at 0-30 degrees for 1 weeks.

After week 1, then increase to 60 degrees from weeks 2-3

Weeks 3-4: 0-90 degrees

Week 4-6: 0-120 degrees.

Early Rehabilitation Exercises

Dedicate 30 minutes 3 times per day to the following exercises:

1. Quad sets – Contract quads for 30 secions then relax. Start the 10, then 20, etc.
2. Straight leg raises in the brace.
3. Towel Roll – Place a rolled towel about 3 inches thick under your ankle. Allow knee to fully extend and contract leg muscles to straighten the knee.
4. Bending your knee too early can do significant damage to your knee.

Call my office at 916-732-3005 or 916-732-3000 (during the day) or the advice nurse after hours for the following:

1. Increasing pain or pain not controlled by ice or medications prescribed.
2. Large amounts of bloody drainage.
3. Foul smelling drainage from the surgical site.
4. Swelling.
5. Rash.
6. Fever (over 101F) or chills.
7. Increasing redness/warmth/hardness around wounds.
8. Inability to eat or urinate.
9. Persistent numbness and/or tingling not present before surgery, or by loosening the ACE bandage.
10. Cold or blue toes.
11. Any other signs that concern you.

Follow Up Appointment Information

Call to schedule follow up appointment for 10-12 days, 916-732-3005. You will require xrays before each follow-up appointment, so please allow extra time to obtain them on the day of your appointment.

Please obtain the postop range of motion brace from Pacific Medical.

Physical therapy appointment: start immediately -please bring the yellow Vericel rehabilitation but to the 1st physical therapy visit.

Questions and Concerns

Please call our office at 916-732-3005 for any questions or concerns. You may also contact our office via the Klara texting application. We may not be able to answer your text immediately due to working with other patients. Please also use this text the application during normal business hours. If you text our office after hours or on the weekends, we may not answer the text message until Monday or when our office is open next.

Greg Takenishi, MD
Sacramento Orthopedic Sports & Shoulder
Sacramento River Cats Head Team physician
San Francisco Giants Team physician
www.sacorthosports.com