ACL Reconstruction
Post-operative Instructions During the First Week
George L. Caldwell, Jr., M.D
The arthroscopic ACL reconstruction is generally done as a outpatient procedure.
This means that patients may go home several hours after the surgery as long as they are
feeling relatively well. Many questions arise during the first week after surgery. There are
many different sensations occurring in the body, especially the operative knee/leg. The
following information may answer many of your questions and relieve normal post
operative anxiety.
Pre-operative Check list
___ Pain medicine prescriptions filled out.
___ Any remaining questions discussed with
physician.
___ Transportation arranged for drive home from
hospital as well as initial office and
therapy visits.
___ Therapy appointments set up for the second
day after surgery.
___ Direction to the hospital. Bring suitable
reading materials on the day of surgery to
occupy potential waiting time.
Patient's Signature_________________
Nurse's Signature____________________
Responsible Adult________________
Physician
_____________________
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1. PAIN CONTROL
At the end of surgery, an anesthetic (numbing type of medicine similar to novacaine) is placed into
the knee. This effect will last at least several hours. With time, the medicine will wear off and the pain may
increase. This is a normal course of events. The prescriptions for pain medicine will be given to you
preoperatively in the office or upon discharge from the hospital.
Pain medication should then be taken as prescribed until your pain is under control. Generally, two
prescriptions will be given. One is a narcotic (often Vicodin) and the other may be an anti-inflammatory
(often Toradol is used). They may be taken together (within the guidelines on the bottle) to increase the pain
relief. Either medicine may cause stomach upset. If this occurs, stop taking the medication until this
resolves. If it does not improve, call the office.
In general, pain on the day after surgery is worse than the pain on the day of surgery (because the
anesthetic wears off) and the night is often worse than daytime. In general, the second night after surgery is
the toughest. If you are experiencing a lot of pain while doing your exercises, take your pain medicine thirty
minutes prior to performing these exercises.
Once your prescription is finished, extra strength Tylenol or Motrin/Advil (over the counter) can be
used to control any discomfort you may be experiencing. If adequate pain relief is not achieved after taking
one of these medicines, in conjunction with elevation and ice to the knee, notify our office.
NOTE: ADDICTION TO NARCOTICS (PAIN MEDICATION) GENERALLY TAKES MONTHS OF
USE. ADDICTION WILL NOT OCCUR DURING THE FIRST WEEKS AFTER YOUR SURGERY.
Apply the cryotherapy (cooling) device to the knee and elevate your leg (above the level of your
heart) as much as possible. This device (often called Polar Care) will help decrease the amount of swelling to
the knee, which in turn will decrease your pain. The icing may be used as much as possible especially for the
first 3 days after surgery. After 4-5 days use the cryocuff for 20-30 minutes after therapy or activity. If
overcooling occurs, such as increasing pain or numbness down the leg, then turn the device off until normal
again.
2. DRESSING CHANGE
The original operative dressing will be removed at 1 to 2 days after surgery at the physician's office
or while in physical therapy. The next dressing will be lighter and consist of gauze and an ace bandage. This
is removed by the patient on the following day. Examine the incision daily. After this, the incision may be
left open to the air or covered loosely with an ace bandage. The small tape strips over the incision may fall
off on their own as healing occurs.
3. SHOWER
Keep the initial operative dressing dry. You should resume regular showers after the dressing is
removed at your first postoperative appointment. Use a chair in the shower to prevent accidents. Go into the
shower, sit in the chair, and remove the brace and dressing. Water (even soapy water) should run over the
incision. Clean the entire leg. When complete, pat the incision dry, reapply brace, and exit shower carefully.
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4. REHABILITATION KNEE BRACE
The knee brace is to be locked at all times during ambulation (walking). Also during this first three
to four weeks, the brace must be worn while sleeping, in the locked position. This is to prevent a flexion
contracture (stiff, bent knee) that can occur during the night if one slept with their knees bent. This brace will
usually be discontinued between three to four weeks after surgery depending upon your return of motion and
strength as determined by the surgeon. The brace straps should be snug when walking, but looser while
sleeping. The brace should be off when lying awake on a couch with the leg elevated or when doing
exercises, unless otherwise directed by the office. Having the brace and dressing off with the leg elevated
above the level of the heart (i.e. lying down) is encouraged as much as possible during the first few weeks.
5. ACTIVITY / CRUTCH WALKING
Both crutches are to be used during the first four weeks after surgery until discontinued by the
physician. Generally, you can put as much weight on the operative leg as instructed by the physician, but
you must be in your brace with it locked while using crutches. Try to walk while keeping your body upright.
Your pair of crutches should move synchronously with your operated leg. You will use the crutches until
you are able to walk without a limp as determined by the physician.
You should plan on being relatively sedentary during the first week after surgery. Concentrate on
exercises, therapy and elevation rather than going out. This will reduce your swelling and greatly enhance
your recovery.
6. PHYSICAL THERAPY
Prior to surgery you must determine, with the surgeon, where you will have therapy and set up your
initial appointments ahead of time. The first session must take place one to two days after the surgery,
generally after you have seen the physician in the office for the first dressing change.
7. HOME EXCERCISES
There are also some exercises that you are expected to begin later in the day of surgery. Continue to
perform your exercises after discharge for 10 minutes every hour while awake. These important exercises for
the fist several weeks include, straight leg raises, calf pumps, and heel props. After surgery, your knee would
tend to get stiff in the bent position if no exercises were done. Heel props are extension exercises (ones that
help the straightening of the knee to match the other side). The flexion (bending) exercises will begin in
therapy and continue while at home. You will need to attend physical therapy within two days following
discharge from the hospital.
NOTE: THE MOST IMPORTANT ASPECT OF YOUR RECOVERY IS TO ACHIEVE FULL
KNEE EXTENSION. WHILE LAYING DOWN WITH YOUR LEG ELEVATED ON THE BED
OR SOFA, PLACE A ROLLED TOWEL OR TWO PILLOWS UNDER YOUR HEEL. THERE
SHOULD BE A SMALL GAP BETWEEN THE BACK OF YOUR KNEE AND THE FLAT
SURFACE. WORK ON ACHIEVING FULL EXTENSION WITH GRAVITY OR GENTLE
ASSISTED PRESSURE DIRECTING THE KNEE BACKWARD TOWARD THE BED. THIS IS
CALLED "HEEL PROPS"
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8. SUTURE REMOVAL
Keep your sutures and/or staples clean and dry between showers. You should shower and clean the
knee with soap and water like regular skin daily. The stitches will be removed approximately 7-10 days after
surgery.
9. DRIVING
No driving during the first week after surgery regardless of the operative knee. Driving an
automatic may begin at about two weeks if the operative knee is the left. If the operative knee is the right,
driving usually begins 4-6 weeks after surgery unless instructed otherwise by your doctor. Driving a
standard transmission usually begins at 6 weeks post surgery regardless of the operative knee. No driving is
permitted until you are confident of return of adequate strength, motion, and reflexes of the operated leg to
maintain safe operation of your vehicle.
10. ELASTIC HOSES (SUPPORT STOCKINGS)
Elastic hoses should be worn on the operative leg when out of bed for greater that fifteen minutes
during the first two weeks to promote circulation and decrease swelling. These stockings can be removed for
sleep of during elevation during the day.
11. PREVENTION OF THROMBOEMBOLISM
Thromboembolism (clots in the veins of the leg) rarely occurs after any arthroscopic surgery on a
limb. Prevention of thromboembolism is achieved by elevation, exercises, stockings and aspirin. We
recommend aspirin (one tablet twice daily with breakfast and dinner) for four weeks after surgery after
completion of the Toradol unless otherwise contraindicated (i.e. ulcers, bleeding disorders, or allergy).
12. RETURNING TO WORK OR SCHOOL
You may return to work (sedentary) or school 5-7 days after surgery if pain is tolerable. You must
make the time in your work/school schedule to continue with your exercise program. The leg will tend to
swell, however, the longer it rests below the level of your heart. Returning to heavy labor work will be
determined by your doctor.
13. BRUISING
Bruising is common after surgery. Some blood from the surgery tracks underneath the skin and
along the thigh and calf. It will work its way to the surface over time and gradually resolve.
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NORMAL SENSATIONS AND FINDINGS AFTER SURGERY
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Skin pain
Knee swelling and slight warmth up to 3-4 weeks
Small amount of bloody drainage
Numbness to incision area
Soreness to Achilles tendon area (area above the heel)
Soreness and swelling to back of the knee
Bruising to lower leg (i.e. black and blue appearance)
Lower leg swelling i(mild) ncluding the ankle - if this occurs,
elevate the leg above the heart and apply ice to swollen area
Low grade temperature less than 100 degrees - if this occurs;
1) drink plenty of fluids, 2) take Tylenol, 3) cough and deep breath (every 2 hrs
while awake) to expel any mucus present in the lungs, (take 10 deep breathes, then
forcefully cough a few times).
temperature should be checked with a thermometer if a fever is suspected
Small amount of redness to the suture area
Sore throat: this may be related to the intubation tube placed while you were sleeping
during surgery. If you experience this, gargle with warm salt water 3-4 times a
day to help relieve the discomfort.
NOTIFY OUR OFFICE IMMEDIATELY FOR ANY OF THE
FOLLOWING SIGNS OR SYMPTOMS
a.
b.
c.
d.
e.
f.
g.
h.
Change is noted in your incision, e.g. no redness or drainage from the incision today,
tomorrow redness and/or drainage is present.
Pain to the calf (the middle part of the back of the lower leg) especially if
sharp pains are occurring when you pull your toes back toward your nose.
Temperatures greater than 100 degrees
Fever, chills, nausea, vomiting or diarrhea
Sutures became loose or fall out and then incision becomes open
Drainage becomes yellow, puss like or foul smelling
Increased pain unrelieved by medication or measures
mentioned above.
Increased pain at rest after postoperative day 2
Contact our office if you have any questions.
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