The following are post-operative instructions for patients who have undergone arthroscopic ACL surgery to their knee. Please refer to this reference sheet, which should probably answer most of the questions you might have. If you have further questions that need immediate answering, contact our office.
On your post op directions, the exact amount of weight bearing will be specified. Usually, this will be weight bearing as tolerated. Even if it states full weight bearing we prefer that you unload the leg by using a pair of crutches and for several weeks. If you are allowed full weight bearing advance with your therapist’s guidance.
You will be in a knee brace with hinge joints locked at 0 degrees. You should use it at all times to protect the knee. Your physical therapist or doctor will open the hinges when good muscle control returns. You may open the brace when awake for comfort. If the brace is not comfortable it may need to be adjusted and let us know. I recommend the brace for the first 6 weeks after surgery.
Dressings and Sutures
You will have a bulky dressing over your knee. Although it is very unlikely, you may notice some bloody spotting coming through the outer Ace wrap. It is important for you to watch this area, and contact us if it continues to spread. Otherwise, any small area of spotting will dry and can be ignored until we remove the dressings. The sutures utilized in closing any wounds are usually an absorbable type buried under the skin, and will not need to be removed unless you are told otherwise.
Ice and elevation will help minimize the pain and swelling after surgery, especially during the first few days. Elevation, to be effective, involves keeping your knee and lower leg above the level of your heart. You can keep ice packs on the knee continually during the first few days without risk of frostbite injury to the underlying skin as long as the original dressings are in place. The initial post-operative wrap involves multiple layers of cotton gauze and padding, therefore insulating the skin surface reasonably well. When the original dressing has been removed only the Ace compressive wrap and a lite dressing will be used. I would then recommend ice applications to the knee region for 20 minutes at a time, multiple times each day.
Once your dressing has been changed, and no wound drainage is noted, showering is permitted. If there is any noticeable or persistent drainage from the incision sites or any surrounding red areas, please contact us immediately.
You will be provided a prescription for formal physical therapy when you leave the hospital. All of the different therapy firms in our area are excellent with knee rehabilitation, so you are free to select your therapist. Please schedule your therapy to begin within a week following surgery. Here are a few simple exercises that everyone can begin immediately. A knee block put in by the anesthetist may interfere initially with quadriceps function.
Isometric Quadriceps Setting: Hold your knee straight and tighten your thigh as much as possible. Hold for three to five seconds, and repeat several sets. You can do this frequently throughout the day, whether sitting, standing, or lying down.
Straight Leg Raising: While lying on your back, hold your knee straight with the opposite knee bent and tighten your thigh. Then lift your leg a few inches off the floor and hold for several seconds. You should be given a stockinette to assist with this exercise.
Range of motion: Your knee will initially be in the brace locked out until good leg control is achieved. Motion exercises will begin in Physical therapy.
Please call our office within a few days following surgery to schedule your first follow-up visit for 1-2 weeks after surgery. This can vary plus or minus several days depending on your schedule and ours, as there are no sutures to be removed.
You will be provided with a prescription for a pain medication when you are ready to leave the hospital. Usually, we will prescribe hydrocodone, hydromorphone, or oxycodone. These are generic names for three different narcotic pain relievers. If you are aware of a certain pain medication that you have previously had problems with or one that you normally respond favorably to, please inform us so that we can give you the appropriate prescription. You may have the prescription prior to surgery to avoid filling it the day of surgery.
Normally we will avoid using anti-inflammatory medication (i.e. ibuprofen, Advil, Aleve, etc.) as this may interfere with bone or tendon healing. If you are intolerant to most pain medications the short term use of anti-inflammatory medication is OK. In this case, you might be given a prescription for an anti-inflammatory medication Toradol (ketorolac) that will help lessen pain and swelling. If not, you are welcome to use an over-the-counter anti-inflammatory such as Ibuprofen (Advil, Nuprin, etc.). These come in 200-mg tablets. The usual maximum adult prescription dosage is 600-800 mg three times per day, usually taken with food. This would amount to taking 9-12 store tabs per day. The anti-inflammatory medicine can be taken on a regular basis along with the prescription pain medication, which is utilized on an as needed basis. You will find that the combination will lessen your need for the prescription pain pill. If you have a history of ulcers or of stomach irritation with aspirin or anti-inflammatory drugs, then you should avoid taking these medications. If you have high blood pressure you should check your blood pressure to be sure these medications do not cause an elevation in your pressure. If you have kidney problems you should avoid these medications.
Plain Tylenol is OK if you have no liver disease. Remember, the short acting pain pills often have acetaminophen (Tylenol) in them. The maximum daily dose of Tylenol if you have a normal liver is 3500-4000 mg. If your narcotic pain medicine is not lasting long enough you can use a little more or use if less often as long as you do not overuse the maximum daily acetaminophen dose.
If you have a history of nausea with surgery we can prescribe an antinausea medication (Phenergan or Zofran). Try to take this medication regularly at first and prior to taking the narcotic pain pills to allow it to be most effective.
Please try to anticipate the need for any refills on your pain medication, and contact our office early in the day the day before running out completely. I cannot provide prescription refills after business hours or on weekends.
The incidence of an infection deep within the joint is literally one out of thousands. The onset of symptoms would be approximately 5-7 days following surgery and would consist of a significant increase in pain, swelling, warmth, and redness of the extremity, fever, chills or night sweats. More common, but still quite rare, would be a small superficial infection or irritation at one of the skin incisions. There can also be a very small incidence of a blood clot developing deep within your arm veins or leg veins. If you have had a previous blood clot, use estrogen, or have a family history of blood clots in the legs, arms or lungs you should probably be protected with TED hose and a blood thinner. If we did not start this let us know. If we recommended aspirin for blood clot protection you should use a single aspirin twice a day for 2 weeks or as long as the leg is immobilized. A blood clot would be characterized by a sudden onset of new pain (usually different from your surgical lower extremity pain) or tightness in the upper arm or more commonly the leg. This usually begins about 5-7 days from the day of surgery. The presence or absence of a clot can usually be determined by a simple non-invasive ultrasound test at the hospital. Contact our office for any concerns.
Bryan Bomberg, MD