Patellar Tendon / Quad Tendon Repair Surgery Discharge Instructions

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1 Matthew T. Mantell, MD 128 Medical Circle Winchester, VA Phone: Web: Patellar Tendon / Quad Tendon Repair Surgery Discharge Instructions What to Expect after surgery It is perfectly normal within the first few days to start to experience slightly increased pain and swelling. During the surgery, local medications or a nerve block are injected to help reduce pain after surgery. This medication begins to wear off 1-2 days after surgery. Some patients remain in the hospital for 1-2 days after surgery. The majority of patients transition to home while others may require a stay at a rehabilitation facility prior to discharge home. This will be arranged by the hospital after surgery. You will be placed in a hinged knee brace that will initially be locked in full extension. This needs to stay on at all times. This will gradually be unlocked during your follow-up visits. It is ok to put weight on your leg after surgery as long as the brace is on and locked. You will need crutches after the surgery, which will be provided to you by the office or the hospital. You will not be allowed to drive until cleared by Dr. Mantell. You must be off all pain medications before returning to operate a vehicle. Bandages and Incision Care As long as the initial dressing is not soiled it should stay on for one week prior to changing. Please replace the dressing with clean gauze and tape until your follow-up appointment. You can use the ACE wrap from surgery as well. You can shower with the dressing from surgery. Do not rub the incision area. You may pat the area dry with a towel. If the dressing is soaked or moist, please change it with clean gauze covered with tape. One month after surgery you may begin to use Vitamin E lotion or Mederma to lessen the appearance of the scar Most times the incision is closed with absorbable sutures and glue. There should be no stiches to remove in the office.

2 Activities Icing You are allowed to put weight on your operative leg as long as the brace is on and locked in full extension. You should use a walker or two crutches initially. Everybody heals at different rates so it can sometimes not be helpful to compare yourself to others that had the same surgery. Please continue to do the exercises from the therapists and the instructions. It is important to get back your motion after surgery but only do what is allowed based on the rehab protocol. Part of the success of the surgery is based on how well the rehab goes afterwards. You may walk as much as you can. There are no restrictions. If you are experiencing worsening pain please let Dr. Mantell know. Sleeping if you are having trouble with sleep you may want to try an over the counter Benadryl before bed. It is helpful to use ice around the incision area for up to one to two weeks after the surgery. Please do not place the ice directly on the skin Ice for 20 minutes at a time up to 8-10 times per day Please try to prevent the wound and dressing from getting wet Medications There are a number of different pain medications (Oxycodone, Percocet, Norco, Vicodin, Dilaudid, or Tramadol) that may be prescribed after surgery. Please take as prescribed from the hospital. o Often times you will be able to take 1-2 tabs every 4-6 hours as needed for pain o If you are prescribed tramadol, oxycodone or dilaudid please take additional over the counter Tylenol 650 mg by mouth every 6 hours as needed for pain. o If you are prescribed Percocet, Norco, or Vicodin these medications already have Tylenol in them and it is not advised to take additional Tylenol. Try to decrease the amount of pain medications you take by mouth each day. Narcotics can be addicting medication so it is best to stop using them as soon as possible. For more information please see

3 You will be prescribed a medication to help prevent blood clots as well. This may be aspirin, lovenox, Coumadin, or xarelto. Please take as instructed for up to three weeks. If you are prescribed aspirin please take with food and consider an over the counter medication for you stomach such as Pepcid, Prilosec, protonix, or nexium. This will help to prevent ulcers. Please take an over the counter Colace/Senna twice a day to help prevent constipation that may occur with the pain medicines. Getting up and walking also helps to prevent constipation after surgery. Please make sure to drink plenty of water as well. If you have an allergy to any of the medicines prescribed please notify Dr. Mantell or the physician who prescribed the medication. Preventing Blood Clots You will be prescribed a medication from the hospital that you will need to take for 3 weeks after surgery. Most often this will be Aspirin 325 mg by mouth twice a day. Please wear your compression stocking as much as possible for the first month after surgery. Daily exercises such as getting up, walking, and other sitting exercises such as ankle pumps help to reduce the risk of blood clots. If you have a predisposition to blood clots or a previous history of blood clots in your family please make sure that Dr. Mantell is aware as this may change your medications. Swelling It is important to use the compression stockings on your legs to help decrease swelling. These should be worn almost the entire day. They can be removed for showers, changing clothes, and to give the skin a break if necessary for a few hours each day. You should wear them for one month after your surgery. They help to decrease swelling and also decrease your risk of getting a blood clot in your leg. Elevating the leg above the level of your heart, particularly while sleeping, can also help to reduce swelling. You may put a few pillows underneath your foot and ankle while sleeping. Physical Therapy You will likely be given a script for physical therapy at your first or second office visit. The prescription is usually for 2-3 times per week and will focus on motion and strengthening.

4 Follow-up Please call the office at to schedule a follow-up appointment for two weeks after surgery. You may also visit to schedule an appointment online via . At your office visit the wound will be examined and medications will be discussed. Your second follow-up visit will be scheduled at that time, usually for 4-6 weeks after surgery. When to call the doctor: Sudden increase in pain Uncontrolled nausea or vomiting Inability to bear weight or walk Fever greater than 101 degrees Shortness of breath or chest pain Any dizziness Redness or swelling around your incision A large amount of drainage or bleeding around the incision site

5 REHABILITATION GUIDELINES AFTER: Patella or Quad Tendon Repair The intent of this protocol is to provide the therapist with guidelines of the post-operative rehabilitation course after a patellar or quad tendon repair. It should not be a substitute for one s clinical decision making regarding the progression of a patient s post-operative course based on their physical exam findings, individual progress, and/or the presence of post-operative complications. The therapist should consult the referring physician with any questions or concerns. INDIVIDUAL CONSIDERATIONS: I will tailor your therapy to your repair type. If it is more stable, I may advance your therapy more quickly than this protocol dictates. PHASE I (0-4 weeks) Control pain and inflammation Ice 4-6 times per day Brace locked in full extension at all times except for hygiene WBAT with brace locked with crutches o Quad sets o Patellar mobilization o Calf pumps PHASE II (4-8 weeks) Weeks 4-5: WBAT IN BRACE, normalize gait pattern, discontinue crutches BRACE o Locked in extension during day and night, ok to be unlocked during exercises o Can unlock from 0-60 degrees o Continue with swelling control o Heel slides

6 o Patellar mobility exercises o Side lying hip/core/glut exercises Weeks 5-6: WBAT IN BRACE, normalize gait pattern BRACE o Locked in extension during day and night, ok to be unlocked during exercises o Can unlock from 0-90 degrees o Continue with swelling control o Heel slides o Patellar mobility exercises o Side lying hip/core/glut exercises o Weight bearing calf raises Weeks 6-8: WBAT IN BRACE, normalize gait pattern, No weight bearing with flexion past 90 degrees BRACE o Locked in extension during day, ok to be unlocked during exercises o Can unlock during ambulation at week 6 from 0-45 degrees o Can unlock from 0-90 degrees for exercises o Discontinue brace at week 8 o Continue with swelling control o Heel slides o Patellar mobility exercises o Side lying hip/core/glut exercises o Weight bearing calf raises

7 PHASE III (8-12 weeks) WBAT BRACE - discontinue o Progress closed chain activities o Begin hamstring work o Lungers and leg press with knee flexion restriction to 0-90 o Proprioception exercises o Begin stationary bike when able o Patellar mobility exercises o Hip/core/glut exercises PHASE IV (12-20 weeks) Progress Phase II exercises and functional activities Single leg balance Core, glutes Eccentric hamstring Ok to start elliptical and bike Swimming ok at 12 weeks Advance to sport specific drills and running and jumping at 20 weeks once cleared