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ACL Tears

Recovery After ACL Reconstruction

Monday, July 9, 2012 - 14:39

Patients generally stay in the recovery room following surgery. Depending on the type of anesthetic that was used, it takes about one to two hours to recover enough to be able to sit up, eat some light food, use the bathroom (with crutches), and feel ready to go home.

Some surgeons prefer their patients remain in the hospital overnight. Other surgeons are happy for their patients to return home four to six hours after surgery. The nursing staff will educate patients about home medications and will give instructions about when to change the surgical dressing.

Your physical therapist

Going home

Keeping comfortable

Precautions following surgery

Early post-surgical exercises

Your Physical Therapist

The physical therapist becomes an important part of the rehabilitation program. Rehabilitation begins immediately after surgery, which involves walking with crutches, contracting the thigh muscles, and attempting to lift the leg independently.

By working with the physical therapist, most patients are able to walk quite easily with crutches by one week after surgery. They are also able to lift their leg without assistance from a position lying on their back, and by the end of the second week after surgery can walk without crutches. The length a patient needs to wear a knee immobilizer following surgery will depend on the surgery and the preference of the surgeon.

Going Home

Even though many ACL surgeries are now done as outpatient procedures, the individual will not be able to drive home from the surgical center.

  • Prior to leaving, education will be given by the nursing staff regarding pain control as well as care of the incisions.
  • Crutch training (how to use crutches) will be done at that time or may have already been done before the surgery.
  • Depending on the preference of the surgeon, weight bearing will usually be allowed.
  • Crutches are usually needed for at least a week or two, with gradual progression to one crutch and finally to independent walking.
  • Also depending on the surgeon's preference, a brace may or may not be used. Some surgeons prescribe a rehabilitation brace that is adjustable and can be locked in a straight position or set to allow a certain amount of movement. Sometimes, a brace that prevents all bending movements may be used. However in either case, the brace will normally be taken off for certain exercises.

Keeping Comfortable

Once at home, the treatment of RICE as discussed earlier, three to five times a day for 20 minutes each time, is recommended.

  • Rest - Getting off the leg periodically throughout the day and resting the knee on pillows is recommended, to avoid excess postoperative swelling and pain.
  • Ice - Placing a cold compress or ice pack around the knee controls pain and swelling.
  • Compression - Carefully placing an ace wrap for compression around the knee is beneficial to control the swelling. Be careful that the wrap is not too tight to interfere with circulation to the lower leg.
  • Elevation - Lying down with the knee in a cold compress and elevated higher than the level of the chest is helpful in controlling and reducing swelling.

Need To Know:

Precautions Following Surgery

  • Keep the incisions dry for the first seven to 10 days.
  • Some fluid on the knee is normal following the reconstruction. However, the physician needs to be contacted if any of the following are present:
    • Increased redness
    • Increased swelling
    • Bleeding in the joint or from the arthroscopic incisions
    • Increased pain
  • Depending on the preference of the surgeon, the amount of weight placed on the operated leg after surgery will vary, as will the decision of whether or not to brace the knee.
  • Some surgeons prefer to have the brace locked straight while walking for the first few weeks, but allow the brace to bend from being straight to 90 degrees. Other surgeons encourage bending of the knee immediately. As the patient progresses with strength, range of motion, and confidence, the brace may be allowed to bend during walking.

Early Post-Surgical Exercises

The following exercises are recommended early in the rehabilitation phase even before any significant amount of weight is placed on the leg.

How To Information:

Ankle Pumps

With each foot separately or at the same time, point and flex the toes as if pumping the gas pedal of a car repeatedly, 25-50 times every five to 10 minutes.

Ankle Circles

With each ankle separately or at the same time, rotate the ankles in a large circle about 10 times each direction, 25-50 times every five to 10 minutes.

Heel Slides (Knee Flexion)

This exercise will promote muscle activity of the hamstrings as well as help increase the amount of knee flexion.

  • Lie on the bed on your back, with legs straight and together and arms at the side.
  • Bring the heel of the operated leg toward your buttock to a point where a mild stretch is felt.
  • This position is held to a count of ten. Slowly return to the starting position.
  • This is repeated five to 10 times, two-three sets (one set described as when the exercise has been performed five-10 times) twice daily.

Quadriceps Setting

This is a good beginning exercise, as it not only initiates the needed muscle contraction, but is also helpful in increasing extension of the knee.

  • Lie on the bed on your back, with legs straight and together and arms at the side.
  • Push the back of the knee downward onto a flat surface.
  • Hold for five to 10 seconds, followed by relaxing for a short period of time.
  • Repeat five to 10 times, two-three sets (one set described as when the exercise has been performed five-10 times) twice daily. (The amount of discomfort will determine how many each individual can perform.)

Straight Leg Raising

This is another excellent exercise to promote strength to the quadriceps and the flexor muscles important in walking.

  • Keeping the operated leg as straight as tolerated, raise it approximately six to ten inches upward.
  • Hold for five-10 seconds, and then lower slowly to the start position.
  • Repeat five to 10 times progressing to 20 times, two-three sets twice daily (one set described as when the exercise has been performed five-10 times).

Once this exercise can be done without any difficulty, gradual resistance at the ankle (such as the use of ankle weights) can be used to further strengthen the muscles. The amount of weight used should be increased in no more than one-pound increments. The individual bends the uninvolved leg by raising the knee and keeping the foot flat on a flat surface. This will help decrease or avoid unwanted strain on the lower back region.

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