Wound Care

• Remove dressing in 2 days
• Keep steri-strips or glue in place until they fall off; after your steri-strips have fallen off, you do not need to cover your incisions with any bandage.
• You can shower 3 days after your surgery; do not scrub the area, pat dry.
• Do not bathe or swim until approved by surgeon.
• Continue to wear your TEDS stockings for one week after surgery to help decrease the swelling. You may remove for showering, etc.

Ice

• We recommend that you use ice on a consistent basis for the first 24–48 hours. This will help reduce post-operative swelling. After that, use as necessary.
• Use a cloth between the ice and your skin. DO NOT place ice directly on skin as this may cause frostbite. Do not leave ice wrap or cold therapy on for more than 20 minutes.

Braces/Devices

• With a Patellar Fracture Fixation you will wear your hinged Bledsoe Brace for approximately 9 weeks after surgery, per Dr. Pettit.
• If you are given a Bledsoe Brace, it should be kept locked in extension until advised by your orthopedic surgeon to unlock it. You should wear your brace at all times, unless showering.

Crutches & Weight bearing status

• Following a Patellar Fracture Fixation, you will be weight bearing as tolerated from day 1 using crutches, with the hinged knee brace locked in full extension.

Physical Therapy

• You will also receive a therapy protocol form. Following a Patellar Fracture Fixation, you should start formal physical therapy when you are four weeks post op.
• The prescription and protocol should be given to a physical therapist of your choice so you can begin your program as directed under close supervision of your surgeon.
• You should also start the following exercise the day after your surgery:

Pain Control and Medications

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. DVT prophylaxis: Please take one 81 mg baby Aspirin twice daily for 30 days following surgery to help minimize the risk of blood clot (extremely rare). If you are under age 16, unable to take aspirin for other medical reasons, or currently on anticoagulation, you do not need to take aspirin after surgery.
5. Muscle relaxer: Flexeril (Cyclobenzaprine) for muscle spasms in quadriceps muscle. Take this as needed, it will make you drowsy.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

Oral Contraceptive medication:

• If you are currently taking oral contraceptive medication, you may be at a higher risk for a blood clot after surgery. Speak with your primary care physician about potential temporary discontinuation.

Driving

• You may drive once you have full control of your arms and legs. Do NOT drive if you are taking narcotics! If you have had surgery on your RIGHT knee, please wait 2-4 weeks after your surgery and are able to unlock your brace. If you drive a manual transmission vehicle and have had surgery on your LEFT knee, please also wait 2-4 weeks to prevent irritation from operating the clutch. We recommend you practice driving in an open parking lot before returning to the road. If you have to drive for long periods of time within 2 – 4 weeks after surgery, we recommend taking frequent breaks to walk and stretch, to decrease the risk of a blood clot.

Return to Work

• You may return to work as soon as you are comfortable and able to safely weight bear using crutches. This typically occurs 1–4 weeks post-op. Return to work notes can be obtained at your first post-op appointment.

Follow-up Appointment

• Your first post-operative appointment will be scheduled within 7 days following your surgical procedure. Your first post-operative appointment will be scheduled 5-7 days following your surgical procedure. Typically dissolvable sutures are used during surgery, and do not need to be removed. If you do have sutures that need to be removed, this will occur at your first post-operative visit. If you do not have a post-operative appointment scheduled when you leave following surgery, please call 513-441-5639 (Direct Line to Dr. Pettit’s office) to make the appointment

****Signs & Symptoms to Immediately Report****

Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing.

Week 1-4

No active ROM knee extension.

• PROM knee ext to 0 degrees
• AROM/AAROM knee flexion – very gently – start with 60 degrees and work to 90 degrees by 6 weeks
• Gradually unlock brace for sitting as PROM knee flexion improves

Exercises:

• Ankle pumps
• Patellar mobilizations
• Hamstring stretch sitting
• Gastroc stretch with towel
• Heelslides
• Quad sets – may add E-stim for re-education at 2-3 weeks upon MD approval
• Patellar mobilization – all directions.
• SLR all directions, active assistive flexion- start at 3rd post-op week – do not allow lag – use e-stim as needed after 2-3 weeks. If unable to achieve full extension, perform SLR in knee immobilizer

Week 5

Gradually increase A/AAROM knee flexion

Exercises:

• Submaximal multi-angle isometrics (30-50% only)
• Continue knee flexion ROM – rocking chair at home
• Active SLR 4 way – no weight for flexion – watch for extensor lag – increase resistance for hip abduction, adduction, and extension.

Add aquatic therapy if available. Move slowly so water is assistive and not resistive

Aquatic therapy exercises:

• With knee submerged in water, knee dangling at 80-90 degrees – slowly actively extend knee to 0 degrees.
• Water walking in chest deep water
• SLR 4 way in the water with knee straight
• Knee flexion in water

Week 6-8

Brace – unlock for sitting to 90 degrees at 6 weeks. If quad control sufficient at 8 weeks unlock brace 0-90 degrees for ambulation with bilateral axillary crutches and gradually open brace as ROM improves. Progress to ambulation at 8 weeks with no crutches as quadriceps strength allows. D/C crutches and brace at 8-12 weeks depending on patient’s quadriceps control. Emphasize frequent ROM exercises

Goals – Gradually increase P/A/AAROM during weeks 6-8

Exercises:

• Total gym semi squats level 3-4
• Gradually increase weight on all SLR, if no lag present
• Week 6 – bike (begin with rocking and progress to full revolutions)
• Week 6 – Closed chain terminal knee extension with theraband
• Week 6 – SAQ (AROM)
• Week 7 – LAQ (AROM)
• Week 8 – SAQ (gradually increase resistance)
• Week 8 – LAQ (gradually increase resistance)
• Week 8 – weight shifts
• Week 8 – balance master and/or BAPS – with bilateral LE weight bearing
• Week 8 – cones

Week 9-10

Exercises:

• Total gym level 5-6
• Bilateral leg press – concentric only – no significant load work until 12 weeks.
• Weight shift on minitramp
• Toe rises
• Treadmill – Concentrate on pattern with eccentric knee control

Week 11-16

Exercises:

• Leg press – Gradually increase weight and begin unilateral leg press at week 12
• Wall squats
• Balance activities: unilateral stance eyes open and closed, balance master
• Standing minisquats
• Step-ups – start concentrically, 2” to start and progress as tolerated
• Week 16 – lunges
• Week 16 – stairclimber/elliptical machine

CRITERIA TO START RUNNING PROGRAM

• Patient is able to walk with a normal gait pattern for at least 20 minutes without symptoms and performs ADL’s painfree
• ROM is equal to uninvolved side, or at least 0-125 degrees
• Hamstring and quadriceps strength is 70% of the uninvolved side isokinetically
• Patient without pain, edema, crepitus, or giving-way