Post-Operative Instructions for ACL Reconstruction

Congratulations! You have just completed the surgical phase and entered the recovery/ rehabilitation
phase of your operative experience. In order to achieve the best possible result, active patient
participation is extremely important during this period of time. The following instructions are designed
to help you achieve the best possible outcome following your surgery.
ACTIVITY: Your weight bearing status is __________________________________________. Crutches should
be used to assist ambulation during the immediate post-operative period. You should continue using
your crutches until instructed otherwise by your physician. In general, you may discontinue using
your crutches when you can perform 10 straight leg raises without difficulty and you can ambulate
without a limp. Your brace is to be worn AT ALL TIMES WHEN WEIGHT BEARING during the FIRST 6
WEEKS after surgery. A CPM (constant passive motion) machine will be used for approximately one
week after surgery. You should spend a total of 8-10 hours/day in the CPM with the time divided into
several 2-3 hour sessions.
DRESSING/BRACE/COLD THERAPY: You will have a large dressing covering your surgical sites when
you are discharged from the hospital. You may not remove this dressing. A small amount of bloody
drainage on the dressing is not unusual and this can be covered with a clean 4x4 gauze and ACE
wrap.
Additionally, you will have a brace and cold therapy unit in place on the outside of your dressing. The
brace should be locked in extension at all times except when you are in the CPM machine and when
you are performing your home exercise program. You may remove the brace while using the CPM
machine, however you must wear the brace when performing the home exercise program (you must
unlock the brace in order to do this).
BATHING/SHOWERING: You may not get your surgical incisions wet during the first week after
surgery. During the period of time that you must keep your incisions dry, you will need to place a
large plastic bag or Saran Wrap over the operative sites and firmly secure the edges with tape.
COLD THERAPY UNIT: A cold therapy unit or ice should be applied to the outside of your dressing at
all times during the first 48 hours after surgery, and frequently during the first week following surgery.
After the first week, you may consider using your cold therapy unit or ice after rehabilitation sessions
or when swelling occurs. Do not apply ice directly to the skin.
POST-OPERATIVE SWELLING: Post-operative swelling can significantly slow your recovery time
from surgery. Swelling is markedly worsened when you stand or walk for a prolonged period of time.
For that reason, please limit standing and/or walking to 15-20 minutes out of every hour. This will help
to minimize swelling and speed your recovery. If you experience significant swelling, elevate your leg
and apply your cold therapy unit or ice.
EXERCISE:You should perform your initial post-operative exercises exactly as instructed. Dont start
anything new, and dont leave anything out. This is extremely important! Failure to perform these
exercises may result in stiffness, atrophy, and ultimately a poor outcome. On the other hand, you
could potentially cause damage if you do too much too soon. Please perform your exercises exactly
as you were instructed!
You may begin the following home exercises the day after surgery. These should be performed 5-10
times every hour when you are not in the CPM machine or sleeping.
1.
2.
3.

Quad sets: push the back of your knee into the bed and hold for a count of 10.
Straight leg raises: lift leg in knee brace off the bed for a count of 10.
Hamstring sets: push heel into bed for count of 10.

4.

Heel slides: sit on a firm surface with your leg straight in front of you. Slowly slide the heel of
your operative leg toward your buttock by pulling your knee to your chest when you slide.
5.
Ankle pumps: push back of ankle up and down multiple times to encourage blood flow.
MEDICATIONS: Your post-operative regimen consists of several medications.
For pain, you may take _________________________________________________________________
Pain Medication Tips:

Do not drive while taking pain medications.

Do not drink alcoholic beverages while taking pain medications.

Pain medication should be taken with food as this will help prevent any stomach upset.

Often pain medications will cause constipation. Eat high fiber foods and increase your fluid
intake if possible. To alleviate constipation, 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. In
addition, you have been prescribed the following medications
______________________________________________________________________________________
______________________________________________________________________________________
SPECIAL INSTRUCTIONS: Please contact my office for further instruction if you develop fevers
greater than 101.5 degrees Fahrenheit, persistent drainage from your surgical incisions, intractable
pain, or persistent numbness/tingling in your leg.

Before ACL Surgery

Physical Therapy
As soon as you have your ACL surgery date scheduled, call to schedule both your pre-surgery and post-surgery
physical therapy visits. Your PT schedule will include a pre-operative evaluation, a visit five to seven days after
your surgery and then two to three times each week for up two months following surgery.
During your pre-operative evaluation, the physical therapist will check your physical limits and teach you some
exercises to better prepare you for surgery and to help your recovery go more smoothly. It is important that you
do the exercises daily so you do not lose any knee motion or strength. In particular, you want to keep your thigh
muscle working when you squeeze it, the muscle should move the kneecap up.

Medication and Supplements

Before your surgery, tell your doctor about any medicines you take, including vitamins and supplements. Keep
these points in mind:

Do not take non-steroidal anti-inflammatory drugs (NSAIDs) for seven to 10 days before surgery,
including naproxen (i.e., Aleve) and ibuprofen (i.e., Advil or Motrin).

If you take any medicine to thin your blood or to prevent blood clots, make sure to discuss with
both your surgeon and your prescribing physician whether you should stop your medication prior to
the surgery.

If you take medicine for diabetes, you may need to stop or change your dose before surgery. Talk to
the doctor who manages your diabetes to see how you should adjust your insulin the day of surgery.

Also, you will need to check your blood sugar the morning of your surgery. If it is above 250 or less
than 70, call your doctor for more instructions. High or low blood sugar may result in a delay or
cancellation of your surgery.

Other Care
Manage any knee swelling with ice, wraps and elevation, and use crutches or a brace if you have been
instructed to do so.
If you are a smoker or use other tobacco products, quit at least four weeks before and for as long as eight weeks
after surgery to help your wounds heal and to reduce your risk of infection.
Line up a family member(s), friend(s) or roommate(s) for their help on the day of your surgery. You will need
them to take you to and from the hospital on your surgery date (you will not be allowed to drive home), to help
access essentials at home and to assist with your immobilization brace and cold therapy.

Surgery Preparation
We will call you the weekday before your surgery to give you your surgery and arrival times. If you do not
receive this call, please contact us at 614-293-3600.
Before you arrive for surgery:

Do not shave anywhere below your neck within 48 hours of surgery.

Do not eat, drink or smoke after midnight the night before your surgery. This includes no gum,
breath mints or candy. Brush your teeth and rinse your mouth, but do not swallow anything.

Take a shower the evening prior and the morning of surgery using the anti-microbial (CHG) soap
provided to you by the office staff.

Do not put anything on your skin such as makeup, lotions, deodorant, perfume or cologne.

Do not wear contact lenses, jewelry/body piercings or nail polish.

You should wear comfortable, loose-fitting clothing. Leave your valuables at home, including jewelry and
money. Bring only these essentials to the hospital: photo ID; insurance card; your co-pay; a list of medications
and dosages; crutches or walker, if needed; and cases for dentures, glasses and hearing aids, if worn.

The Surgery
Plan to be at the hospital for at least six hours.
Upon arrival, you will be taken to the preoperative holding area. The nurse will have you change
into a hospital gown and will take you to your assigned bed. An intravenous line (IV) will be
placed in your arm to deliver fluids and medications during and after the surgery.

After a review of your health history, an anesthesiologist will meet with you. Most patients
undergo a general anesthetic (i.e., go to sleep). The anesthesiologist may discuss the option of
a postoperative pain block or catheter where a local anesthetic is injected to numb the top of
your thigh.
Your surgeon will recheck your surgical consent, mark your operative site and see if you have any
last minute questions before your procedure.

What To Expect During The Surgery

The Operating Room
The anesthesiology team and your circulating nurse will take you to the operating room. You and your care team will
complete a sign-in procedure to verify the correct patient, consent, surgical site marking, medication allergies and the
surgery to be performed.
Once those steps have been completed, anesthesia is administered through your IV. Heart and brain wave electrodes
monitor how you are responding to anesthesia. Once you are fully asleep, your legs are positioned and padded. The
skin on the operative knee is prepped with a sterile surgical cleansing scrub from the mid-thigh to the ankle. Sterile
drapes are applied.
Before beginning, the surgeon verifies your name, on which side your surgery is being done, the type of surgical
procedure(s), your medical allergies and any other special considerations or needs for your case.

Obtaining the graft

The first step in ACL reconstruction is obtaining the graft that will be used to reconstruct the torn ACL. An autograft
is a graft that is harvested from your own body. In most cases, a portion of hamstring tendon (autograft) is harvested
from the same knee or, in some cases, the opposite knee. A 4-centimeter incision is made just below the knee on the
inside and top portion of the shin bone or sometimes on the back side of the knee, depending on surgeon preference.
A special instrument is used to harvest one or two hamstring tendons (the semitendinosus and the gracilis).

Preparation of the graft

After it has been harvested, the surgeon prepares the hamstring graft by trimming and cleaning the tissue and tagging
the ends with suture. The graft is then folded over to determine its diameter and length. If the graft is too small in
diameter, the surgeon may elect to add to the hamstring with a donor/cadaver graft (allograft).The use of allograft
tissue is patient-specific and depends on several factors, such as the patients age and condition of the knee. The
allograft is stored in a designated tissue freezer and has been screened and sterilized. The preparation of the allograft
is the same as the hamstring autograft. If you receive an allograft for your knee, you will NOT need to take antirejection medications.

Arthroscopic evaluation

After the graft has been prepared and sized, the surgeon performs an arthroscopic evaluation of your knee. Two or
three small incisions (portals) are made around the knee. Sterile fluid is pumped into the joint to help the surgeon see
inside the knee and to control bleeding. A small camera is introduced into one portal and the instruments through the
other(s) to fully evaluate the knee, looking at the meniscus (cartilage pads), ligaments, bony surfaces and other soft
tissues. It will be used to photograph the anatomy and conditions of the knee.

Addressing the injury

The surgeon will address any meniscus tears and other injuries and then turn his or her attention to the ACL
reconstruction. The torn ACL stump is removed with a motorized shaver. The torn stump of the ACL is removed to
allow room for the new graft. Using specific guides, two tunnels are created: one in the femur (thighbone) and the
other in the tibia (shin bone). These tunnels are in the anatomic footprint of the old ACL. The bone marrow at the
end of both bones provides nutrients and helps with healing of the new graft.

Wrapping up the surgery

Once satisfactory bone tunnels have been created, the graft is passed through the femur and tibia tunnels and
secured. The devices used to secure the graft can be a metallic button, bio-absorbable screw or other device. The
surgeon then bends and straightens the knee several times to check for the correct amount of tension and graft
placement and stability and to look for any impingement (pressure) on the graft. After final inspection, the
instruments are removed from the knee and the incisions closed. A sterile dressing is applied with a compression
wrap and a cold pack.
After surgery, you will be brought out of anesthesia and transported to the post-anesthesia care unit (PACU). Your
family will be allowed back to the recovery room. The nurse will review instructions regarding weight bearing,
activities and medications with you and the person driving you home. A physical therapist will meet with you
regarding crutch training and home exercises. Once you have recovered enough and are stable, you will be
discharged.
The effects of anesthesia may remain for 24 hours or longer. Do not drive, operate equipment or make important
decisions during this time.

Post-Surgical Care
Ensure that you have follow-up physician and physical therapy appointments scheduled. Follow these
instructions for your care at home:

Protect your knee

You are encouraged to bear as much weight as you are able on your surgery leg. Since your thigh may
be numb for a day or two, you may be at risk of falling. Use crutches as needed for support and
balance.

Do not bend your knee more than 90 degrees if you have had a meniscus repair.

Elevate your leg for comfort and to limit swelling.

Cold therapy

Use your cold therapy unit (Cryocuff) for the first 48 hours after surgery. After that, use it for 20 minutes
four to six times during the day. After the bulky dressing is removed (three days after surgery), do not
apply the cold pad directly to the skin place a soft cloth between your skin and the pad.

Do not leave the temperature set to maximal coldness. If the temperature reads into the red area,
unplug and restart it.

If blisters or redness appears, discontinue cold therapy on the affected area.

Incision care

Keep the dressing clean and dry for 72 hours. Remove the bulky dressing after 72 hours. Leave the
tape strips (called Steri-Strips) in place, even if they are bloody. You may want to use small gauze pads
or adhesive bandages over the incisions to keep the stitches from catching on your Ace wrap.

Use an Ace wrap to control swelling or for comfort. Start the wrap at the lower leg and work your way
up above the knee. Do not wear the Ace wrap at night unless you are told otherwise.

Do not apply any ointment or cream to the incisions.

Bathing

Keep the incisions dry for three days. You may sponge bathe around the incisions.

After three days, you may shower, but do not let the water spray hit your incisions. Only let the water
gently run over the incisions. Gently pat the incisions dry with a clean towel or gauze pad.

Do not soak the incisions in a tub bath, pool or hot tub until 24 hours after your stitches are removed.

Medicine

If you were given a prescription for an anti-inflammatory medicine, be sure to take it as directed until it
is gone.

Your prescription pain medication may cause constipation. You may take an over-the-counter stool
softener.

Exercise

Complete all exercises as you are instructed, even if it feels uncomfortable. You should start your
exercises the day of surgery if you are able. You will not cause any damage to your knee.

Do 200 leg raises each day. Do not put a pillow under the knee, but use a towel roll under your heel.

Work on both getting your leg straight and bending your knee to 90 degrees.

Your surgeon will determine if you will need a knee brace or continuous passive motion (CPM) machine
after ACL reconstruction.

You will be given more exercises at the first physical therapy appointment five to 10 days after surgery.

Call your doctor right away

If you have signs of infection at the incisions:

o

Redness, swelling or warmth of the skin

Pus or changes in the amount or color of the drainage

Fever or temperature over 101 degrees F

Signs of blood clot (which could indicate deep vein thrombosis):

o

Pale/cool or red/swollen extremity

Chest pain

Shortness of breath

Uncontrolled pain, swelling, nausea or vomiting

Bleeding that is not controlled with direct pressure. Some oozing is normal during the first two days
after surgery.

Returning to Activity
If you are an athlete who is returning to sport after ACL reconstruction surgery, here are important
considerations:
Stay involved with your team; you can still be learning, observing or maintaining fitness on the sideline even
though you are injured. Helping track team stats and/or documenting the practice plans can help you achieve
mental engagement with the team.

Core work, stationary cycling, upper extremity strengthening and rehab exercises are all options to discuss
with your physical therapist or athletic trainer. Be certain that you are protected from any plays, passes or
equipment that could cause injury to your knee. If your knee begins to bother you at any time, stop activity and
apply ice.
Every athlete recovers at a different pace. You might feel fit and ready to return (starting with sideline/weight
room activity) around 4-6 weeks after surgery, but you should verify the plan with your physician, physical
therapist or athletic trainer. Be sure to keep your coach involved in the rehabilitation process as well.