ACL (anterior cruciate ligament)

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Message from your doctor…

Dr. Eric K. Bartel, foot and ankle orthopedic surgeon

Dr. Eric K. Bartel, foot and ankle orthopedic surgeon

Whether you or one of your family members or friends is considering ACL reconstructive surgery, or are scheduled for surgery, I understand this can be a stressful time. And you may have forgotten some of the information we discussed during our last visit, or forgot to ask me a specific question about what to expect. This site is designed to help us stay connected, and to answer some of the most common questions patients ask me about ACL reconstructive surgery. If you’re scheduled for surgery, please sign up to the right to receive pertinent post surgical and recovery information from me via text message or email. I want to make sure that both you and your family members have timely information at your fingertips during the days, weeks, and months following your surgery…so you can get back to enjoying the activities you love.

RecoverWell — Post Surgical ACL Reconstruction

Pertinent Recovery Information

ACL Reconstruction – Post-Operative Instructions

Day After Surgery

You will be receiving a post-operative phone call from the surgical staff within a few days after surgery to check on you and assist you with any concerns.

When To Call

Please call our office at (630) 584-1400 if you develop a fever greater than 101°F, increasing pain that is not responding to pain medication, redness, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours, the answering service will contact the physician assistant on call.

Driving

Please do not attempt driving until you are off the pain medications. You should wait to drive until you can comfortably and safely operate the vehicle (get from gas to brake). PLEASE DO NOT DRIVE WITH KNEE BRACE ON. If the brace were to lock up or get stuck, this could be dangerous. If you had a Right ACL reconstruction, it may be about 1 month before you can safely drive. If you had a Left ACL reconstruction, you may drive once you’re off pain medication and can comfortably and safely operate the vehicle.

Bathing/Dressing Change

You may remove your dressing 48 hours after your surgery to take a shower. You may have steri-strips over your incisions (small white strips of tape). If so, leave them in place until they fall off on their own or until they are removed at your first post-op appointment. You may let soap and water gently wash over your incisions, but do not scrub them. Pat them dry with a towel, then you may leave the steri-strips uncovered if you’d like. Or, you may cover each of the steri-strips with band-aids if there is still any drainage. Please reapply the large ace wrap to protect the incisions. The ace wrap is also helpful underneath the knee brace (stops the brace from rubbing on skin). You may not soak in a bathtub or go in a pool until your incisions are healed (usually 2-4 weeks).

Weight Bearing

You may put full weight on your operative leg immediately after surgery (with the knee brace on, locked in extension). You will be given crutches to use for comfort, but they are not required. Wean off the crutches whenever you are comfortable walking without them.

Knee Brace

The hinged knee brace should remain on, locked in extension, anytime you are up walking. If you are sitting or laying down resting, the brace may be removed. Please try to sleep with the brace on, at least for a few nights. This will help to better stabilize the knee and prevent any twisting type motions. The brace will typically remain locked for 2 weeks, then will be unlocked (allowing bending) for an additional 2 weeks. Your Physical Therapist will help determine when the brace may be unlocked. This is dependent on quadriceps strength and other factors. After 4 weeks total, your brace can usually be removed.

Dressings

Underneath your knee brace, you will have a soft dressing and ace wrap applied over your incisions. It is meant to absorb any leaking blood or fluid from the joint, and to protect from infection. Leakage immediately after surgery is normal and actually helps to drain some of the fluid that accumulates in the joint during surgery. The dressings may become slightly moist or blood-stained; this is normal and usually not a cause for alarm.

Mild Pain

If you are having minimal pain and would like to switch to a milder medication, please take Tylenol/acetaminophen (extra strength or regular). Do not take Tylenol and norco together (this would be too much acetaminophen). Do not exceed more than 4000mg of Tylenol/acetaminophen in a 24 hour period. If you are taking an aspirin per day (for blood clot prevention), you should be cautious combining aspirin with anti-inflammatories (NSAIDS) such as Advil, Aleve, Motrin, or Ibuprofen. These medications together can increase risk of GI bleeding. Please contact your medical doctor with questions about taking aspirin together with NSAIDS

Ice

It is helpful to use ice or a cold therapy unit to decrease pain and swelling. For the first few days after surgery, please try to ice at least 5 times daily, for 20 min each time. If you have an ice therapy unit, you are encouraged to keep the ice unit on as much as possible for the first 48 hours. You may also elevate your leg on a few pillows while laying down to decrease pain and swelling.

Pain Medication

Your prescription for pain medication will be called into the pharmacy of your choice before you leave the surgery center. After the first day or two, as the pain lessens, you may decrease the frequency with which you take the medication. Remember, the medications are not necessarily meant to completely eliminate your pain, only to make it more bearable. Narcotic pain medications can cause constipation; you may wish to use an over-the-counter stool softener to help prevent this.

Physical Therapy

You will start physical therapy within 1 week after surgery. Most patients will go 2-3 times/week for about 12 weeks. We recommend starting physical therapy prior to your first post-operative visit.

Return To Work

This will vary, based on the nature of your job. If you have a desk job, you may return to work as soon as you are off the pain medication, comfortable driving, and feel that you may perform your job. Most patients with desk jobs take at least 1 week off work to rest and focus on therapy. If you have a labor-intense job that may require more walking, squatting or heavy lifting, you may need a few months off work. We can discuss this in more detail during your 1st post-operative visit and we can give you work status notes (including light duty if this is an option for your job).

Prevention Of Blood Clots

Although the risk is very low, there is a small chance of developing blood clots into the leg after a surgery. A blood clot in the leg is called a DVT or deep vein thrombosis. Most patients will be asked to take a 325mg aspirin daily for 1 month after surgery to prevent blood clots. Some patients at higher risk of blood clots will require another form of anticoagulation such as lovenox injections or coumadin. Those at higher risk include patients who have had prior DVT, are on birth control pills, patients that smoke, or have clotting disorders.

Sport Specific Guidelines

We know you are eager to return to your sports and hobbies. We want to guide you safely through that process. Please use the following as a guide to slowly resume normal workouts.

STATIONARY BIKE

Within 1-2 weeks after surgery. It is best to start doing a stationary bike during physical therapy.

WEIGHT TRAINING

You may do upper-body weights and core strengthening within 1-2 weeks post op. For lower-body strengthening, please rely on your physical therapist to outline a program for you.

LIGHT JOGGING

3 months post-op, but start on an even-surface/treadmill to make sure your knee feels comfortable. Your physical therapist may have you first attempt jogging on a treadmill in therapy to make sure your knee is comfortable and ready.

SWIMMING

1 month post-op. Specifically, a gentle free-style or flutter kick. No frog kick or whip kick for 3 months post-op.

GOLF

Putting within 1-2 weeks after surgery (with your brace on) 3 months post-op: Chipping, pitching, and half-swings with your short irons 4 months post-op: Full but gentle swings with irons 5-6 months post-op: Full play with no restrictions *The reason for golf restrictions is because you must avoid excessive pivoting/twisting of the knee, to protect the ACL.

OTHER SPORTS

For contact sports, such as basketball, football, and hockey… You will be fully released without restrictions at 6 months post op.

Recovery Time Points

Day After Surgery

You will have your first office visit. X-rays will be taken, we will examine your knee, and we will discuss your surgery. Please feel free to ask questions.

3 months post-op

You may be able to begin jogging, but still should avoid any cutting, pivoting, or full contact sports.

3-4 months post-op

You will most likely have finished physical therapy by now.

6 months post-op

You will have your final office visit. If things have progressed as expected, you will likely be able to resume all activities as tolerated. You will not need any type of brace to play sports or exercise. Be aware that, for some people, it may actually be a year or more after surgery before you have full strength.

Frequently Asked Questions

When can I drive?

Please do not attempt driving until you are off the pain medications. You should wait to drive until you can comfortably and safely operate the vehicle (get from gas to brake). PLEASE DO NOT DRIVE WITH KNEE BRACE ON. If the brace were to lock up or get stuck, this could be dangerous. If you had a Right ACL reconstruction, it may be about 1 month before you can safely drive. If you had a Left ACL reconstruction, you may drive once you’re off pain medication and can comfortably and safely operate the vehicle.

When can I resume normal workouts?

Stationary bike: within 1-2 weeks after surgery. It is best to start doing a stationary bike during physical therapy. Weight training: You may do upper-body weights and core strengthening within 1-2 weeks post op. For lower-body strengthening, please rely on your physical therapist to outline a program for you. Light jogging: 3 months post-op, but start on an even-surface/treadmill to make sure your knee feels comfortable. Your physical therapist may have you first attempt jogging on a treadmill in therapy to make sure your knee is comfortable and ready. Swimming: 1 month post-op. Specifically, a gentle free-style or flutter kick. No frog kick or whip kick for 3 months post-op. Golf: Putting within 1-2 weeks after surgery (with your brace on) 3 months post-op: Chipping, pitching, and half-swings with your short irons 4 months post-op: Full but gentle swings with irons 5-6 months post-op: Full play with no restrictions *The reason for golf restrictions is because you must avoid excessive pivoting/twisting of the knee, to protect the ACL Contact sports, such as basketball, football, and hockey: You will be fully released without restrictions at 6 months post op.

When can I go back to work?

This will vary, based on the nature of your job. If you have a desk job, you may return to work as soon as you are off the pain medication, comfortable driving, and feel that you may perform your job. For example, if your surgery is on a Friday, you could likely return to a desk job by Monday. If you have a more labor-intense job that may require more walking, squatting or heavy lifting, you may need at least 2-4 weeks off work. We can discuss this in more detail during your 1st post-operative visit and we can give you work status notes (including light duty if this is an option for your job).

Do I need to go to physical therapy?

Physical therapy after an ACL reconstruction is very important. Most patient attend therapy 2-3x/week for 12 weeks. If you are making great progress in therapy, you may not need the full 12 weeks. Your physical therapist will help to determine the optimal amount of therapy needed. If your goal is to return to a certain sport after physical therapy, it may be helpful to transition from therapy to a sport-specific training program. We can highly recommend a few certified Strength and Conditioning Specialists in the area.

When will my follow-up appointments be?

We typically see patients back at the following time points after surgery: 7-10 days, 6 weeks, 10 weeks, 14 weeks, 18 weeks, 22 weeks, 26 weeks, then as needed.  This schedule serves as a guideline and can be modified to accommodate your schedule, travel, vacation etc.