ACL Tears Post-Op Instructions

ACL: Anterior Cruciate Ligament Tears

The Anterior Cruciate Ligament or ACL is a ligament that connects the femur (thighbone) to the tibia (shinbone) it is located in the center of the knee. Located in the center of the knee, the ACL provides stability and keeps the tibia from moving too far forward relative to the femur. Most ACL tears are the result of a twisting injury. After an ACL injury, your knee buckles more easily letting the tibia shift forward.

Treatment: ACL Repair

Surgery to reconstruct the ACL ligament is done on an out-patient basis (avoiding a hospital stay and allowing the patient to recover in the comfort of their own home.) It requires placing a tendon graft obtained from your patella tendon and tibia or a donor graft from a cadaver. Bone tunnels are drilled into the tibia (shinbone), and the femur (thighbone). The graft is guided through the tunnels and anchored in place with titanium screws. Once the graft is in place the small incisions are closed.

Figure 1 ACL tear	Figure 2 ACL guide in place	Figure 3 ACL Tunnel	Figure 4 ACL graft in place

Post Surgery Instructions:  

When you wake up in the recovery room, a long leg immobilizer and a cold pad wrapped in with an Ace bandage will be on the surgical leg connected to an ice machine. Using the ice machine will help you remain comfortable and will also aid in reducing the swelling. You should follow this schedule:

Day 1 and 2: Use continuously (including throughout the night). Disconnect from the machine only to go to the bathroom. After 48 hours you may remove your immobilizer and bandages and take a shower. It is recommended to use an antibacterial soap. Do not remove the small white "steri-strips"; they will be removed at your post-op visit as well as any stitches or staples. Gently bend your knee a few times while in the shower. After your shower place a small bandage over the front kneecap incision and Band-Aids over the other two incisions. When replacing the ice machine pad do not place directly on skin as this can cause frostbite. Wrap in a cloth or place between Ace bandages.

Day 3 and 4: At least 2 hours on and 1/2 hour off. You may find that the combination of 3 hours on and 3 hours off also works well. Start physical therapy.

Day 5 and after: Use as needed for comfort and swelling.

**Change the ice and water when you are unable to maintain a temperature of 50-52 degrees

ACL Recovery Plan

Diet: You may resume a regular diet when you return home. Start with tea or broth and advance slowly with crackers or toast, then a sandwich. If you become nauseated, return to clear liquids.

Lungs: After surgery you are encouraged to deep breath and cough frequently (at least 3-4 times per day). This will reduce mucous from building up in your lungs, and will reduce the risk of developing pneumonia.

Pain Control:  Take pain medication as prescribed by Dr. Reznik. Please call our office with any questions regarding your medication.  Ice as directed above. Elevate leg above heart level using 2-3 pillows. This will also decrease swelling.

Stop smoking: Smoking slows the healing process by interfering with the making of new DNA. Smoking also increases the risk of infection and pneumonia after surgery by slowing your body's white blood cells.

Deep Breathing: Be sure to regularly take a deep breath and blow it out. This helps to clear the lungs after anesthesia.

Immobilizer: You will wear this for 2 - 3 weeks and then change into the custom knee brace.

Crutches:  Use 2 crutches for 7-10 days putting light weight on the foot with each step.  Increase the weight as tolerated.  When you are able to bear weight comfortably, you may then advance to one crutch for the next few days and then to no crutch. Most patients can be full weight bearing after 2 weeks while wearing the ACL brace.

Driving:  Right knee patients and left knee patients with a standard transmission car cannot drive until off all pain meds and can fully weight bear without pain.

Return to Work:  People with light work (desk work with no squatting, kneeling or lifting can return to work within 2 weeks. The exception is for people who may have long commutes.  By staying still with the leg down for long periods, THEY ARE AT RISK FOR BLOOD CLOTS.  Patients with active office work or very light labor with variable tasks can sometimes go back by 6 weeks.  Heavy work, lifting or unprotected heights usually need at least 6 weeks and clearance from their physical therapist and will return with the ACL brace on.

Blood Clots:  Those at high risk of blood clots include patients who have long car or train commutes, may be overweight, have a history of cancer, women on birth control pills and males over the age of 40. These patients should be taking an aspirin per day for 6 weeks after surgery.

 **Dental Work: You cannot have any routine dental work (including cleaning) for at least 3 months after your surgery, or you risk infecting the tendon graft. After 3 months, you may see the dentist, but for one year from date of surgery, you will need to take antibiotics before and after dental work. Dr. Reznik will give you a prescription.

Post-Op Exercises

Vital to your recovery of good knee function is a graduated activity and exercise program to increase muscle strength and knee motion. Your physical therapy will begin 3-4 days after surgery. The physical therapist will guide you in your knee rehabilitation program. It is VERY important for you to start therapy when recommended. To avoid complications, post-operative follow up appointments with your physician are also required to monitor your progress.

You will begin simple exercises the day of surgery.

They should be done every day for the first week post-op, to maintain blood flow in the surgical leg and help prevent blood clots. Formal physical therapy will begin between three to five days after surgery.

	• Ankle Pumps: Pump your ankle up and down (like pressing the gas pedal). Do this 10 times per hour while awake.
	•  Straight Leg Raises: Tighten your quads muscle (the front of your thigh), and raise your leg 8 to 12 inches off the bed. Do this 10 to 15 times, 4 or 5 times per day.
	•  Range of motion: Sit on a chair. Place your foot on the floor, remove your immobilizer and set aside. Place the uninjured foot under the ankle of the surgical leg. Letting the uninjured side do the work, bring your leg into a straight position. Then, from a straight position, gently bring the foot down, bending at the knee. Do this 5 times, 4 or 5 times per day.

Revised 1/2/09