ACL Reconstruction 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.

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:
  • 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):
  • 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.

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.