Post Operative Instructions
Arthroscopic Anterior Cruciate Ligament Reconstruction
SURGERY AND ANESTHESIA
The surgical procedure takes approximately 60-90 minutes and is done under general anesthesia. Two small incisions are made around the kneejoint to accommodate the instruments. A third incision is made just below the knee to harvest the hamstring tendon and/or pull the new ACL graft into the knee.The arthroscope is attached to a camera to visualize and magnify the knee structures. During the procedure, theentire knee is examined including all the ligaments, bones, and cartilage. Repairs and corrections are performed as necessary.
- Autograft vs. Allograft: There are several options for ACL grafts. The most common graft used is a hamstring autograft (the patient's own tissue). This graft requires a smaller incision and is less painful to harvest than the patellarautograft. Patients typically do better in the initial post-operative phase using a hamstring autograft. The anterior tibialis allograft (cadaver tissue) is used for patients who require revision surgeries or are not a candidate for an autograft.
- Meniscal Repair vs. Removal:The meniscus is a semi-lunar shaped piece of cartilage that acts as a "shock absorber" in the knee. Treatment options for a torn meniscus depend on the location of the tear, age and health of the patient, and activity level. The meniscus is repaired by stitching the torn edges together using suture material attached to a very small anchor. In order for a meniscal repair to heal, the tear must be near the outer edge of the meniscus where the blood supply is located. This is called the red-red or red-white zone. Patients undergoing meniscal repairs will be required to remain non-weightbearing for 4-6 weeks following surgery to allow the cartilage to heal. Meniscal tears in the central portion of the meniscus will not heal if a repair is performed due to the lack of an adequate blood supply. In these cases, a meniscetomy (removal of the torn segment) is performed. These patients are able to bear full weight on the operative leg immediately following surgery.
Following surgery, the leg will be wrapped in a dressing from mid-thigh to the foot. A T-scope brace is fitted on top of the dressing and is locked in the extended position. A small amount of bloody drainage on the dressing is not unusual in the first day or two. If this occurs, the dressing can be reinforced with clean 4X4 gauze and an ACE wrap. The dressing is to remain in place for 48 hours and must stay completely dry. You may shower; however, the knee must be covered with plastic wrap before doing so. After 48 hours, you may remove the dressing down to the white tape strips that stick to the skin. These are Steri-strips and must remain in place. If the Steri-strips fall off before your first post-operative appointment, place Band-Aids over the incision sites and remaining Steri-strips. No baths, hot tubs, or swimming for 3 weeks following surgery to allow the incisions to fully close. After removing the dressing, place the brace back on the leg and tighten the straps, if necessary.
REST, ICE AND ELEVATION
Elevate your leg under the heel, not the knee, to prevent a flexion contracture or stiffness in the knee.The Cold Therapy unit is helpful in reducing swelling which minimizes the requirements for narcotics. Follow the instructions given at the time of discharge and use the cooling system a minimum of 12 hours/day for the first few days. Continuous use is allowed and encouraged as long as it is not uncomfortable. Do not let the cooling pad touch the skin. There should always be a dressing or cloth between the skin and the cooling pad.
CRUTCHES AND BRACE
Full weight bearing on the operative leg with the brace in the locked position is allowed unless otherwise instructed following surgery. Crutches may be helpful for the first several days for stability and help with getting around.
Begin the following exercises the night of surgery. Repeat the exercises 3-5 times per day and complete 10-15 repetitions.
- Quad sets: Push the back of the knee into bed and hold for the count of 10.
- Straight leg raises:Sitting in a seated position with the leg out straight in front of you, liftthe leg off the bed a few inches and hold for a count of 10.
- Ankle pumps:Move the ankle up and down multiple times to encourage blood flow in the leg.
- Flexion exercises: With the leg in a fully straightened position, bend the knee to pain tolerance. Try to bend the knee a little more each time you complete the exercise.
You will be prescribed three medications following surgery: A pain medication, an anti-nausea medication, and Aspirin.
- Do not drive or drink alcohol beverages while taking pain medications.
- Pain medication should be taken with food to help prevent any stomach upset. You may also take the prescribed anti-nausea medication.
- Often pain medications will cause constipation. Eat high fiber foods and increase your water intake. You may also purchase a stool softener at any pharmacy and follow the recommended directions on the bottle.
- You should resume taking your normally prescribed medications unless otherwise directed.
- Aspirin 325 mg has been prescribed to help prevent a blood clot in your lower leg. This medication should be taken twice daily (once in the morning and once in the evening) for 2 weeks following surgery.
POST-OP APPOINTMENT AND PHYSICAL THERAPY
Your first post-operative appointment will be 7-10 days following surgery. At this appointment, we will check your incision sites to be sure they are healing properly as well as your range of motion and your overall post-operative progress. You will also be given a prescription for physical therapy to begin as soon as possible. Appointments for physical therapy should be twice a week for 2-3 months. We recommend that you call to schedule those appointments prior to surgery since physical therapy offices fill quickly.
You may resume driving a vehicle when you have stopped your narcotic pain medication and you can comfortably bend and straighten your operative knee.
Please contact the office by calling 703-810-5223 for any of the following symptoms:
- Fever greater than 101.5 degrees F for 24 hours.
- Severe pain unresponsive to narcotic medication.
- Excessive bleeding or vomiting.
- Numbness, loss of color, or coolness to touch in the foot.
- Redness or swelling in the calf that does not resolve overnight.
- Difficulty breathing or shortness of breath, CALL 911.