Knee Arthroscopic Capsular Release with Manipulation

Pain Medications

In most cases local or regional nerve blocks will provide 8-12 hours of numbness. As soon as you start to feel the numbness wearing off, begin taking oral pain medication.
Take Tylenol 500mg one tab every 8 hours.
Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.
If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).
If you still have pain after all of the above, take a second Norco tab.
Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.DO NOT exceed 3500mg of Tylenol over 24 hours.
It is illegal to drive or operate machinery with narcotic medications.
Do not combine alcohol or other sedatives with narcotic medications.
You do not need to take pain medications once you no longer have pain. You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.

Other Medications

Take Aspirin 325mg one tab once a day for the first 4 weeks to prevent blood clots.
Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).
Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.

Activity

You may progress to putting all of your weight on your operative leg as tolerated.
You can stop using crutches once you are walking normally with no limp. Do NOT use only one crutch.
Elevate your operative extremity above the heart as much as possible to decrease swelling.
Avoid prolonged periods standing to prevent excessive pain and swelling.

Recovery Equipment

Keep your ACE wrap on for compression to help with swelling during the first 3 days after surgery.
Use your continuous passive motion (CPM) machine as instructed beginning the day after surgery.

Cold Therapy

We recommend cold therapy use as much as possible in the first two weeks.
Cold therapy units may be used continuously as instructed.
Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.
Do not apply ice directly to the skin to avoid burning.

Recovery Exercises

You may perform leg bridges, heel slides (0-90 degrees), quad sets, and ankle exercises as instructed in your preoperative packet.
Your motion goal should be to have as much knee motion as possible at your initial postoperative visit.
You should initiate physical therapy immediately after surgery.

Diet: Please refer to your preoperative packet instructions.

Incision Care: Please refer to your preoperative packet instructions.

Emergencies: Please refer to your preoperative packet instructions.

Therapy Plan: Twice per week for 0-2 months, once per week for 2-4 months

ROM Progression

Progress ROM as tolerated with the goal of symmetric full motion at 6-8 weeks.

Weight Bearing Progression

Full weight bearing as tolerated utilizing crutches initially for assistance.

Progress weight bearing with the goal of removing crutches at 1-2 weeks
Do NOT progress to one crutch - gait must be pain free and non-compensatory to remove both crutches

Initial Post-Operative Physical Therapy Visit

Correctly perform weight bearing with crutches or wean off of crutches if gait is normal
Instruct on leg bridge for extension, heel slides for flexion, quad sets, ankle pumps
Isometric exercises for core, glutes, quadriceps, hamstrings

Phase 1 Physical Therapy (0-4 weeks): protect the joint, progress ambulation

NO open-chain exercises
Aggressive progression of ROM
Progress ROM as tolerated with passive, active-assist, and active stretching
Soft tissue mobilization, patellar mobilization, isometric exercises, core strengthening
Tactile and verbal cueing to enable non-compensatory gait patterning

Phase 2 Physical Therapy (4-8 weeks): progressive stretching and strengthening

Continue progressive ROM
Initiate closed-chain strengthening and planks advancing as tolerated when full ROM is achieved
Proprioceptive training
Soft tissue mobilization, patellar mobilization, isometric exercises, core strengthening
Plyometrics and agility drills as tolerated after full ROM and strength are achieved
Elliptical and pool running may start at 6 weeks as tolerated

Phase 3 Physical Therapy (8-12 weeks): return to pre-injury level and sport

Focus on functional exercises in all planes, advance only when fully controlled
Advance closed-chain and core strengthening
Proprioceptive training
Straight treadmill running may start at 8 weeks
Sport-specific drills as tolerated
Full return may take a full 3-6 months or more depending on surgery and recovery