ACL reconstruction is an outpatient procedure.

The torn ACL is removed and replaced by new ligament tissue - a graft.. The work inside the knee is done arthroscopically. A small incision is made on the front of the knee to create a tunnel and to obtain the graft.

The graft is positioned in the tibial and femoral tunnels and fixed in place.

Goal

Stabilize knee. Prevent giving way episodes. Prevent further injury.

Surgical Time

Approximately 1 hour

Anesthesia

General anesthesia is most common. Spinal may be used in some cases.

Pre Op Preparation

Don't eat or drink anything after midnight. Most medications should be taken with a sip of water. You will be called one day prior to your surgery date with directions and the time of surgery. You be asked to arrive about and hour ahead of time. You can plan on going home about 4 hours later. You will need a ride home and someone who will stay with you overnight.

CPM

A continuous passive motion machine will be rented for you - for one week. This machine allows you to rest in bed with your leg supported. The machine moves gently and continuously - preventing stiffness and reducing pain.

Crutches

You will need crutches for three weeks. Let us know if you need to buy or rent some.

Post Op Instructions: ACL

Week 1 - 3

Ice 20 - 30 min twice daily

Ice reduces swelling and pain. Icing should be limited to 20 minutes - if directly on the skin.(3 to 4 session per day). You may use ice continuously if applied against a protective layer of towel or ace wrap.

Medication

Start with ice, elevation, and Tylenol or Ibuprophen.

Anti-inflammatory medication helps reduce pain and swelling. Over the counter:

Ibuprophen Take 3 with food three times a day or

Aleve Take two with food twice a day.

You will be given a narcotic pain reliever (hydrocodone or oxycodone) - use it if you need it. A little bland food on your stomach is a good idea. Take 1 or 2 as needed (at least three hours between doses).

Crutches

Toe touch weight bearing - enough to balance while brushing your teeth.

CPM at least 6 hours per day

Start with 0 - 45 degrees. Use the machine at least 4 hours per day. Advance your flexion by 5 degrees several times each day. Most people increase about 10 degrees per day. The gains are often erratic - 5 degrees some days, 20 degrees on others.

Warning Signs - Call our office at 425-899-6060 if you have:

• Marked swelling.
• Elevated temperature.
• Severe nausea.
• Marked pain.

Return visit

usually @ 2 days and 2-3 weeks, 6 weeks

Early Rehabilitation / conditioning

Ice for two days with minimal stress for knee. Avoid prolonged standing or walking.

Week 1 - CPM Start CPM on day 1. Advance several times per day.

Week 2,3 - stationary bike. Set the seat high, low resistance. Start by rocking you feet "to and fro". Eventually, work up to spinning.30 min per day - minimum.

Swimming is another good choice. Swim laps, walk or "run" in chest high water. Avoid breast stroke or whip kicking at first.

Start quarter squats - 100 per day (hold a table edge, squat approx 45 degrees, straighten into full extension)

Spend two sessions daily gently encouraging range of motion - flexion and extension - 5 minutes each.

Week 4 - intensify cycling, elliptical trainers, health riders

Week 4 advance to all activity - walking

Incisions and Dressings

Keep your bandage dry. You may shower, but cover the area with plastic. DO NOT soak in tub.The dressing will be changed at your first postoperative visit.

Return to work /sports

Sedentary (sitting) 1 week

Standing 4 - 6 weeks

Sports / Mod. Labor 2 - 5 months

Driving

Must be off pain medication, confident in using brake usually 3 days to 2 weeks.

Rehabilitation ACL

Month 1 - See above (weeks 1 - 3)

Month 2 - Linear Training, Low Intensity

Advance to full weight bearing

Range of motion - should be full by 6 weeks

Gait - normal by 6 weeks

Stair climber, elliptical trainer, real cycle, rowing

At six weeks,start strength training 3 days per week;

• squats 3 sets of 20 reps or leg press 3 sets of 20 reps
• lunges 3 sets of 20 reps
• calf raises 3 sets of 20 reps

No jumping, cutting

No quad. extensions

Month 3 - Linear Training, High intensity

Continue linear training daily and weight training 3 times per week.

Start Jogging 9 - 10 weeks Start with a treadmill, uphill grades, slow pace advance every other day.

Month 4 - Low impact, strength, lateral agility

Plyometrics program or step aerobics - lateral agility training. Continue linear strength building 3 * per week. Court sport ground stokes OK.

Month 5 - High Velocity

Start running

Month 6 - Return to Sports

Full return requires normal range of motion, normal strength,normal stability, and ability to run without a limp.

Sports brace

For high velocity sports between months 5 and 12.