Advice following Anterior Cruciate Ligament (ACL) reconstruction
Information for patients
Mobilisation
As soon as you feel well enough after the operation you will be able
to get up and mobilise. You will have a large bulky dressing on it that
will make the knee feel stiffer. Your physiotherapist will provide you
with elbow crutches to assist you with your walking. You can take
your full weight through the operated knee and should only require
walking aids initially due to pain. You can stop using elbow crutches
as advised by your physiotherapist. You should gradually increase
your walking as you feel comfortable to do so. You may be required
to wear a brace for the first few weeks to protect the graft. This
is dependent on your consultant and you will be informed of this
before the operation.
Weight bearing status:
Walking Aid required:
Use for:………….days / weeks / discard as soon as comfortable
Hinge: Yes / No
Use for:…………..days / weeks / discard as
soon as comfortable
Precautions
Your Anterior Crucite Ligament (ACL) has many functions. Its main
function is to stop the forward movement of the tibia on the femur
(i.e. shin bone moving forward on the thigh bone). It also contributes
to the stability of the knee and therefore it is important that the
new ACL graft is not over stretched or stressed after surgery. To
avoid over stressing or stretching the graft certain movements and
exercise are avoided for the first few weeks and months.
• Open Chain Movements – exercises where the foot is in open
space i.e. in the air, off the floor or bed. Only one specific muscle
group is used. The new ACL graft is placed under tension and
shearing forces which can lead to it loosening or failing.
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• Closed Chain Movements – exercises with the foot in contact
with a surface, e.g. floor or bed. All muscle groups are used to
support the leg. The new ACL graft is protected.
You should only use CLOSED chain movements until advised
otherwise by your physiotherapist. It is very important to protect the
new graft.
• Getting out of bed – to support the graft all muscle groups must
be activated. With the leg straight tighten the knee by pressing
the back of the knee into the bed. This activates the muscle
above your knee (quadriceps muscle). Then dig your heel into
the bed to tighten the hamstring muscles. Your knee and graft
is then supported whilst you move your leg on and off the bed.
Maintain these contractions until the foot is in contact with either
the bed or the floor. You may use your hands or the other leg to
support the leg below the knee if you struggle with this.
• Do NOT lift your heel off the floor when sitting in the chair (open
chain movement)
• Mobilising and stairs – it is important that you put your full
weight through the leg when mobilising. This is a closed chain
movement so the graft is protected. Hopping is an open chain
movement and places undue tension on the graft.
Swelling
Most patients will experience some swelling around the knee after
the operation and this can increase over the following 24-48hrs. To
minimise swelling we recommend you elevate your leg. Ideally the
knee should be higher than the hip to allow the swelling to drain
up the leg. If your knee is swollen and/or painful, putting ice on will
help. Please follow these instructions:
o Take a bag of crushed ice or frozen peas.
o Give the bag a knock to loosen the ice/peas.
o Place a cold damp cloth/towel over the knee, place the peas on top.
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o Leave in place for 15 – 20 minutes.
o Repeat up to every 2 hours.
o Check skin colour regularly, it should be pink not blue.
If your knee is particularly hot and swollen and painful, you should
contact the ward or A&E.
Exercises
You will be provided with some exercises to carry out. These should
be started as soon as you feel able to, and should be carried out
3-4 times a day. These exercises are designed to return your
range of movement and strength after your operation. It is your
responsibility to continue with the exercises independently to aid
your rehabilitation.
Outpatient Physiotherapy
Out-patient physiotherapy will be organised for you after discharge
from the ward. Your first appointment should be within the first two
weeks of the operation. This first appointment may only be to check
the exercises are being done correctly and to ensure there are no
post-operative complications. You should not begin new exercises
or activities without your Physiotherapist / Surgeon’s advice.
Return to Work
Returning to work depends on the type of work you do. Generally
you will not be advised to return to work until you are off elbow
crutches and have functional range of movement and strength
in you leg. If your job is sedentary you may be able to return to
work earlier, usually 2-4 weeks post operatively. If your job is
physically demanding i.e. you stand for long periods of time and
involves heavy manual work, you may be able to return to work
after 6 weeks. You can seek further advice from your surgeon or
physiotherapist.
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Driving
You will not be able to return to driving until you are off elbow
crutches and have functional range of movement and strength in
your leg. You must be able to be in complete control of the car and
it is advised that you discuss this with your car insurance company.
You can seek further advice from your surgeon or physiotherapist.
Return to Sport
Returning to sport is dependent on the activity you wish to return
to. Some non-impact closed chain gym work can be returned to
after 2-4 weeks. Running and other impact exercise can not be
started for at least 3 months. Full contact sports can be up to 6-9
months post operation. Please seek advice from your surgeon or
physiotherapist before starting any new activities or exercises.
Wound and Dressing
You will usually have a large bulky dressing on your knee after the
operation. If you still have the pressure bandage on when you leave
hospital, it should be removed after 24 – 48 hours. The nursing staff
will provide you with advice regarding your wound and dressing.
Pain Relief
It is important that you do not stop taking pain medications too
quickly. By continuing to take your pain medication you will be able
to carryout your physiotherapy exercises effectively. You should
reduce medications gradually prior to stopping.
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For any queries or further information please contact
the Physiotherapy Department at:
Pontefract Hospital
Tel: 01977 747280
Pinderfields Hospital
Tel: 01924 541493
We are committed to providing high quality care. If you have
a suggestion, comment, complaint or appreciation about the
care you have received, or if you need this leaflet in another
format please contact the Patient Advice and Liaison Service
on: 01924 543686 or email: [email protected]
To contact any of our hospitals call: 0844 811 8110
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1522a
Published Oct 2011
Review Date 2014
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