AFTER YOUR ACL SURGERY
Peter Dewire, M.D.
Assistant Professor of Orthopaedic Surgery
Boston Medical Center
850 Harrison Avenue
Boston, MA 02118
(617) 414-5214
You have just undergone reconstruction of your anterior cruciate ligament (ACL). These
post-operative instructions should answer most of your questions about caring for your
knee from the time of discharge to your first follow-up appointment with me (10-14 days
after surgery in most cases).
1. Prescribed Medications:
a. For a pain:
1.
________________________________________________
2. ___________________________________________________
3. Tylenol (2 extra strength tables every 3 to 4 hours) or Advil (2 every 4
hours) can be taken for mild discomfort.
b. Antibiotics: (for same day discharges):____________________________
c. Although the incidence of phlebitis (blood clots in the leg) after ACL surgery is
very low, I recommend taking 2 enteric coated or baby aspirins a day starting the
day after surgery for 3 weeks, unless there is an allergy or medical
contraindication (e.g. history of ulcer disease). This is particularly important in
high-risk patients: patients over the age of 40 or females taking oral
contraceptives.
d. Other medications: _________________________________________________
2. Brace Instructions:
a. The brace is initially locked in extension (your leg straight). It is to be
worn this way for walking and sleeping for at least the first 2 weeks
after surgery. It is taken off your exercises as well as for CPM use. It
can be unlocked for sitting. The length of time it is worn locked for
walking depends on the individual case. In cases of meniscal repair it
may be locked for walking up to 4 to 6 weeks. Further instructions
will be given at your first follow-up appointment.
b. In most cases, a cryocuff device, which supplies compression as well
as ice to your knee, has been applied under your brace. You will be
instructed in its use before discharge. It should be used regularly for
the first three days after surgery. Before walking, it should be drained
and the brace straps tightened. After three days, you should still use
the cryocuff for icing the knee, but you do not have to wear it at all
times.
c. The snug white stocking on your leg is called a TED stocking and
keeps the swelling down in your lower leg and foot as well as your
knee. It also helps prevent phlebitis. It is to be worn for the first 2
weeks after surgery. After this, an ace bandage just around the knee
under the brace is sufficient.
d. If you get swelling in your lower leg below the knee and/or in the
foot, lay down, elevate your leg on some pillow above the level of
your heart and remove the brace and cryocuff. The welling should go
down within a couple of hours. This can occur from being on your
feel for longer periods of time in the immediate post-operative period
or from the brace straps and/or cryocuff being too tight and
constricting.
3. Dressing Instructions:
a. Expect some bloody staining through your dressing, especially in the
first couple of days. If mild, just leave the dressing intact for the first
5 days after surgery. If moderate, the dressing can be changed sooner.
If excessive, contact me or the ambulatory care nurse immediately.
b. In routine cases, the dressing can be changed at five days after surgery.
Pull the stocking down and remove the wrap and bandage around your
knee. The incision site will be covered with steri-strips (thin tape like
strips). Do not remove the steri-strips. The doctor should do this at
your follow-up visit. You will also have one to three tiny “nick”
incisions, which were the arthroscopy portals closed with 1 or 2
stitches. You can clean these sites with alcohol or peroxide and apply
a sterile gauze pad or Band-Aids. Apply sterile gauze pads to the
incision site and wrap the knee loosely with a kerlex or kling bandage.
Only change the bandage as necessary after this until your follow-up
appointment.
c. The dressing and wound are to be kept dry until at least your follow-up
appointment. Sponge baths or shower bags are necessary during this
healing period.
d. Report any pus or unusual drainage immediately, especially if it is
associated with increased pain, redness, warmth, and a temperature
of over 101 degrees. A temperature for the first couple of days after
surgery is common however.
4. CPM Instructions:
The CPM (constant passive motion) machine is to be used at home starting
the day after surgery. The brace should be removed for its use. The initial
setting should be from 0 (knee straight) to 40 degrees. I recommend using
the machine in two-hour sessions, 3 times a day. Set the machine at a
slow speed. Try to increase 10 degrees per day, although this is not
always possible. The machine has been prescribed for two weeks at which
time the CPM representative should be called to pick it up. If you pause
the machine for a period of time, stop it at 0 (with the knee straight) so
your knee doesn’t get stiff in a bent position.
5. Exercises
You will be given home exercises by the physical therapist. These are
very important in addition to the CPM. In particular, the exercises to
straighten your knee completely (“towel extensions”) are critical during
the first couple of weeks.
A written physical therapy protocol has been supplied to you and your
therapist. This is a rough “guideline” and there will be a lot of individual
variations.
If possible, formal physical therapy should start within 2 or 3 days after
surgery, with sessions initially 3 times per week.
6. Crutches and weight bearing:
a. In standard cases, you can weight bear as tolerated with 2 crutches,
meaning you can apply as much weight as you feel comfortable as
time progresses. You will use 2 crutches for as least the first three
weeks and given further instructions at your follow up visit.
b. If you have a “meniscal repair” you will have more restrictions in
terms of weight bearing and how long you will be on crutches. You
may be instructed not to put weight on your leg up to 4 to 6 weeks
after surgery. Usually the brace will be worn in a locked position for a
longer period of time as well.
7. Follow-up appointment:
Call 617-414-5214 to schedule your follow-up appointment, if you
have not already been notified previously that one has been made for
you.