Anterior Cruciate Ligament Reconstruction

Operation:
The interior of your knee joint was visualized using a small telescope, and the diagnosis was confirmed. The remnant of your torn ligament was removed and your ACL was reconstructed using biologic tissue from one of several sources- patellar tendon or hamstring tendons (called “autografts”), or tissue from tissue banks (called “allograft”). Additional surgery involving the removal or repair of damaged, torn, degenerative or abnormal cartilage may also have been performed using special micro-instruments.

Pain:
Upon discharge, you will be given one or two prescriptions for pain medication that can be filled at either the hospital or a local pharmacy. The pain medication can be taken every 3 to 6 hours as needed (please follow instructions). The medicine will help decrease the level of pain, but it is not meant to completely eliminate the pain. Some pain is expected. If you develop itching, skin rash, nausea or vomiting, please discontinue the medicine and call the office. Additionally, narcotics can cause constipation if used for an extended period of time. If this occurs, you should decrease the use of the prescribed medicine, and increase fluid, roughage and fruit intake in your diet. Please do not use Aspirin unless you have OK;d it with your surgeon.

The use of ice or cold therapy decreases both swelling and pain. The safest and most effective way to apply cold is to use a cold therapy wrap/unit which applies both uniform pressure and cold. Alternatively, you may place a bag of ice in a towel over your knee dressing. Ice should never be placed directly on the skin but used in conjunction with a towel or dressing next to the skin. We suggest using cold therapy 20 minutes every one to two hours while awake. Once you are ready for sleep, discontinue cold therapy treatment. Cold therapy is most effective for two to five days after surgery. If you were given a cold therapy unit, additional instructions will be provided. Elevate your leg above the level of your heart while at rest. This will help decrease swelling, and secondarily decrease pain.

Pain Pump:
You may have been sent home with a continuous infusion apparatus for pain management. The pump works automatically. Please do not pull or push on the pump or its tubing. One of the doctors at Valley Bone & Joint Clinic will remove this apparatus in approximately 48 hours to 72 hours.

Dressings:
Your surgery was performed arthroscopically, and therefore you may notice pink fluid or bloody drainage soaking your dressing for the first 24-36 hours after surgery. If this occurs and is bothersome, simply reinforce the dressing with additional sterile gauze. The incision on the front of your knee, as well as the small arthroscopic puncture wounds, have been closed with suture and skin tapes/steri-strips. These are covered by sterile gauze pads and held in place with either a compressive Ace wrap or Tubigrip elastic stocking. This bulky dressing will be removed and replaced with a smaller dressing at your first post-operative visit one to three days after surgery. You should change this new dressing daily until the gauze pads are free of drainage. Do not remove the suture or skin tapes as they are largely responsible for maintaining the integrity of your skin incisions. The skin tapes will fall off on their own in 7-14 days.

Anti-Embolism Stockings:
You will be placed in long TED stockings post-operatively. Please leave in place until your first post-op appointment.

Wounds:
The incisions and small puncture wounds may be sore and you may develop bruising in the area of the surgery as well as down your leg over the next several days. This will go away, and no special care if needed.


Bathing:
It is safe to shower or bathe 72 hours after surgery. Your incision sites should be kept dry for one week to minimize the risk of infection or delayed wound healing. You may try covering the incisions with saran wrap or a plastic bag. When showering, make sure you are well supported so as not to slip and fall. You may sit down on something if you are unsteady and extend the leg in the shower. After one week, you may wash – but do not scrub – the incisions with regular soap and water, dry them, and cover them with a dressing or Bandaids, if needed. Try not to remove the skin tapes as they will fall off on their own. You should not immerse your knee under water, and should avoid hot tubs or pools for two weeks.

Activity:
You should rest, relax and make arrangements to have someone stay with you for at least 24 hours after your discharge. Following surgery, your knee was placed into a hinged brace locked in extension. During the first week, you should wear your brace at all times except while exercising or showering. Because there is a tendency to curl your leg while sleeping, we strongly recommend that you sleep with the brace on until you have achieved full extension of your knee and can adequately perform straight leg raises (usually 2-4 weeks). You may loosen the velcro straps to sleep but do not remove the brace. While standing or walking, you may place as much weight as tolerated through your operative leg, unless otherwise instructed. It typically takes 3-7 days to feel comfortable placing full weight through your operative leg. All weight-bearing should initially be done with crutches and your brace locked in extension. The brace helps to maintain the knee in full extension while walking and prevents it from buckling. As your leg strength improves, we will unlock your knee brace to allow a more normal gait pattern. Next, you may discontinue your crutches when you have achieved a relatively smooth, even-paced heel-toe gait pattern. It is expected that the brace and crutches will be necessary only for 2 to 3 weeks while you develop strength to keep the knee fully extended while bearing weight. Remember, do not walk on your toes or with a bent knee, and do not limp. You should remove your brace several times a day to work on your range of motion. You are permitted to bend your knee as much as you like. When doing these exercises, there should be no pillows or bumps under your knee. You should, instead, place a pillow under your heel to allow the knee to sag and stretch into full extension. This maneuver is a very important element of your knee rehab, and should not be overlooked. Frequent ankle motion (ankle pumps) is encouraged to minimize the risk of developing blood clots following surgery.

Do not drive any vehicle or operate mechanical equipment for several days following your surgery. Even though you feel normal, your reaction time and strength have been affected by your surgery. Return to driving depends on which leg is operated upon and whether your car has an automatic or manual transmission. It often takes 1-3 weeks to be able to safely return to the road.

You may resume basic daily activities in 3 to 5 days, unless otherwise instructed. Return to employment depends greatly on working conditions and requirements.

If more extensive surgery was undertaken, special instructions will be provided, including prolonged immobilization and/or protected weight-bearing.

Diet:
Drink clear liquids (apple juice, ginger ale, broth, 7-Up, etc.). Progress to your regular diet as you feel able. Do not drink alcoholic beverages for at least 24 hours following your surgery.

Precautions:
A common occurrence after general anesthesia is a low-grade fever during the first 24-48 hours post-operatively. The fever is usually below 101° and slowly abates. Tylenol works well to keep it in check. If you develop a high fever (temperature over 101 degrees), shaking, chills, unexpected/severe pain, redness, or swelling, please contact the office for consultation or examination. Occasionally, there is minor swelling of the foot. This can usually be relieved by elevation of the leg, and loosely reapplying a compressive wrap (Ace wrap) around the knee region. If you develop pain, tenderness, warmth, or swelling in your calf, please contact the office immediately.

Follow-up:
A post-operative visit with your surgeon or assistant will be made 1 to 3 days following surgery to check your wounds and discuss your case. Formal physical therapy should begin 3 to 5 days after surgery – this appointment may have been made at the time of your pre-operative visit. Probably the most important thing to remember about your knee surgery is that the post-operative rehabilitation is more important than the surgery itself. Your surgeon and therapists will monitor your rehab program, and if you have any questions or concerns, please feel free to discuss the situation with either of them.

Emergency Calls:
If you have a problem of an emergency nature and are unable to reach your doctor, go to the Altru Hospital Emergency Room (phone: 701-780-5280); or your nearest hospital or emergency facility.


Contact Your Physician (Or His Alternate) If You Have Any Problems:

  • Fever greater than 101 degrees orally or if at all questionable.
  • Chills
  • Excessive bleeding
  • Separation of the incision
  • Excessive swelling or tenderness
  • Unusual drainage: pus-like drainage (white, yellow, or greenish in color); any excessive drainage
    from the area; foul odor from the incision or dressing.
  • Change in color around the area; excessive redness may indicate infection
  • Change in temperature around the area: unusual warmth
  • Increased pain in operative area