Now that your surgery is behind you, the focus is on icing, elevating and getting ready to start therapy. INFORMATION FOR WEEK ONE  PAIN: After the first day or two, as the pain lessens, you may decrease the frequency with which you take the medication. Narcotic pain medications can cause constipation; you may wish to use an over-the-counter stool softener to help prevent this. It is also helpful to use ice or a cold therapy unit, as well as to elevate your leg to decrease pain and swelling.  Use ice or a cold therapy unit constantly for the first 48 hours, then as frequently as needed. Please note:

• The directions on the pill bottle must be followed- please don’t take the pills more frequently than directed
• If you have had a nerve block as part of your anesthesia, you may have increased pain when the block wears off. This is normal- please keep taking the pain pills as directed.
• If your pain is too intense and the above measures are not helping, you may need to proceed to the emergency room for further pain control
• In addition to pain medication, you have been prescribed an antibiotic to help prevent infection and aspirin to help prevent a blood clot. Please take these medications as directed.

  DRESSINGS: Leave your dressing intact until you go to physical therapy, usually 2-3 days after surgery. BATHING: Your surgical dressing will be removed by your physical therapist. Do not get your surgical dressing wet. 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. When showering, you need to cover your incisions with Press-And-Seal until the sutures are removed or until the steri-strips fall off. After showering, pat them dry with a towel, then cover each of the incisions with a band-aid if desired.  You may not soak in a bathtub or go swimming until incisions are well healed (usually takes a few weeks). BRACE & CRUTCHES: During this time period your brace should remain on and locked in a straight position. The crutches are to be used as needed for comfort and stability. Do not stop using the crutches until you have been instructed to do so by your physical therapist. Physical therapy typically starts in the next few days. If you do not have physical therapy arranged please call our physical therapy department at (219) 921-1401 to help coordinate. WHEN TO CALL: Please call our office at (219) 395-2109 if you develop a fever greater than 101°F, calf pain, shortness of breath, chest pain, increasing pain that is not responding to pain medication, redness around incisions or knee, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours call (219) 921-1444 and the answering service will contact the physician on call. AFTER SURGERY: You will be receiving a post-operative phone call from the surgical staff within the next day or two to check on you. DRIVING: At this point it is too early to drive. OTHER TIPS

• Avoid anti-inflammatory medication (ibuprofen, Advil, Motrin, Aleve, etc) during this period as some studies have shown it may actually slow down or prevent tendon healing. If your doctor has instructed you to take aspirin, you may do so.
• Allow yourself to rest and recover during the weeks following surgery.  Even if you knee is feeling better/less pain, don’t overdo it.  You might notice that your knee swells more and gets stiff if you’ve been up walking on it for too long.
• Plan ahead- if you need a refill on pain medication, our office requires 24-48 hours notice for your request to be processed.  We cannot refill medications after hours or on weekends.
• Rehabilitation is one of the most important aspects of ACL surgery. Work hard in therapy to get your knee motion back!

NEXT OFFICE VISIT You will have your first office visit approximately 1 week after surgery. X-rays may be taken and we will review surgical pictures and the procedures that took place. Please bring your surgical pictures with you. Feel free to ask any questions!

One week down. Motion is key – you should focus on getting your knee straight. INFORMATION FOR WEEK TWO (7-14 days after surgery) PAIN: At this point the pain should be improving though it is still quite common to continue to need narcotics. Physical Therapy may exacerbate the pain somewhat but it is important to be able to comply with therapy to get your motion back. For this reason, narcotics may be particularly useful before physical therapy sessions. Ice and the cold therapy unit will also help a lot. You can discuss the details of icing with your physical therapist. DRESSINGS: Your dressing should be removed by now and any remaining steri-strips can be allowed to fall off gently in the shower or removed at your office visit. BATHING: You may shower daily, but should not be allowing the incisions to soak. You should continue to cover sutures and/or steri-strips with Press-N-Seal. Pat them dry with a towel then cover each of the incisions with a band-aid if desired. BRACE & CRUTCHES: During this time period your brace should remain on and locked in a straight position. Your quadriceps should start to recover soon. When it becomes strong enough to hold your leg up without buckling, you may unlock your brace. This is a decision that should be determined by your physical therapist and usually occurs at around 2 weeks after surgery but everyone is different. (Note: If you had a meniscal repair performed, your brace should remain locked for the full 4 weeks. This is not for a meniscal trimming but just meniscal repairs. Ask your therapist or doctor/PA if you are unsure). The crutches are to be used as needed for comfort and stability. Do not stop using the crutches until you have been instructed to do so by your physical therapist. Physical therapy should be well under way and you should be attending therapy 2 or 3 times per week. WHEN TO CALL: Please call our office at (219) 395-2109 if you develop a fever greater than 101°F, calf pain, shortness of breath, chest pain, increasing pain that is not responding to pain medication, redness around incisions or knee, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours please call (219) 921-1444 and the answering service will contact the physician on call. DRIVING: There is no definite way to determine when you are ready to drive. You need to be off narcotics and able to safely operate your vehicle. In general, it is a little early at this time point if your ACL was on your right knee. If your ACL was on your left knee (and you do not have a stick shift) you may be ready to drive. The concern here is not so much about damaging the ACL but about you being able to safely react behind the wheel. Be honest with yourself and if you are not certain that you are ready then wait. It is not worth the risk if there is any question. OTHER TIPS

• Avoid anti-inflammatory medication (ibuprofen, Advil, Motrin, Aleve, etc) during this period as some studies have shown it may actually slow down or prevent tendon healing. If your doctor has instructed you to take aspirin, you may do so.
• Allow yourself to rest and recover during the weeks following surgery.  Even if you knee is feeling better/less pain, don’t overdo it.  You might notice that your knee swells more and gets stiff if you’ve been up walking on it for too long.
• Plan ahead- if you need a refill on pain medication, our office requires 24-48 hours notice for your request to be processed.  We cannot refill medications after hours or on weekends.
• Rehabilitation is one of the most important aspect of ACL surgery. Work hard in therapy to get your knee motion back!

NEXT OFFICE VISIT  You will have your next office visit 4-6 weeks after surgery. Usually no x-rays are taken at this visit.  Feel free to ask any questions!

INFORMATION FOR WEEK Three (14-21 days after surgery)   PAIN: Pain should continue to improve though you may still need narcotics. Physical Therapy may flare up the pain somewhat but it is important to be able to comply with therapy to get your motion back. For this reason, narcotics may be particularly useful before physical therapy sessions. Ice and the cold therapy unit will also help a lot. You can discuss the details of icing with your physical therapist. DRESSINGS: You do not need to have any dressings on your knee at this point. You can use an ACE bandage if it is more comfortable or helps your brace stay on. Don’t wrap the ACE bandage too tightly or it can cause ankle swelling.  BATHING: You may shower daily but should not be allowing the incisions to soak. If your sutures have been removed you no longer need to cover them with Press-N-Seal. You may let soap and water gently wash over your incisions, but do not scrub them. Pat them dry with a towel then cover each of the incisions with a band-aid if desired.  You may take occasional baths and go into a swimming pool if your incisions are completely dry and there is no more drainage. BRACE & CRUTCHES: During this time period your brace should be unlocked once your quadriceps strength recovers. You should ask your therapist if they feel like your quadriceps is strong enough to unlock your brace. They can also help show you how to unlock the brace. (Note: If you had a meniscal repair performed, your brace should remain locked for the full 4 weeks. This is not for a meniscal trimming but just meniscal repairs. Ask your therapist or doctor/PA if you are unsure). The crutches are to be used as needed for comfort and stability. Do not stop using the crutches until you have been instructed to do so by your physical therapist. You should be attending therapy 2 or 3 times per week. If you do not have physical therapy arranged please call our office now to help coordinate. WHEN TO CALL: Please call our office at (219) 395-2109 if you develop a fever greater than 101°F, calf pain, shortness of breath, chest pain, increasing pain that is not responding to pain medication, redness around incisions or knee, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours please call (219) 921-1444 and the answering service will contact the physician on call.  DRIVING: Around this timeframe is when many people are able to return to driving. There is no definite way to determine when you are ready to drive. You need to be off narcotics and able to safely operate your vehicle. The concern here is not so much about damaging the ACL but about you being able to safely react behind the wheel. Be honest with yourself and if you are not certain that you are ready then wait. It is not worth the risk if there is any question.  Do not wear the brace while driving as it can lock and cause problems. OTHER TIPS

• Avoid anti-inflammatory medication (ibuprofen, Advil, Motrin, Aleve, etc) during this period as some studies have shown it may actually slow down or prevent tendon healing. If your doctor has instructed you to take aspirin, you may do so.
• Allow yourself to rest and recover during the weeks following surgery.  Even if you knee is feeling better/less pain, don’t overdo it.  You might notice that your knee swells more and gets stiff if you’ve been up walking on it for too long.
• Plan ahead- if you need a refill on pain medication, our office requires 24-48 hours notice for your request to be processed.  We cannot refill medications after hours or on weekends.
• Rehabilitation is one of the most important aspect of ACL surgery. Work hard in therapy to get your knee motion back!

NEXT OFFICE VISIT You will have your next office visit 4-6 weeks after surgery. Usually no x-rays are taken at this visit.  Feel free to ask any questions! If this appointment is not scheduled, please call our office to schedule one (219) 395-2109.

With the guidance of the physical therapist, you may wean out of the knee brace if your muscles are strong enough to walk without it. By six weeks, you should have full motion of your knee.  It is important that you are able to get your leg completely straight.  At this time, physical therapy will start to focus more on strengthening your knee. If you are wanting to resume safe exercise at six weeks post-op, have you considered swimming? Water exercise is safe for your knee (avoid breast stroke kick). You could also do some light biking or elliptical machines.  No jogging until three months post-op. PAIN: You should not be in much pain at this point. You should try to stop using the narcotics over the next week or two. Ice and the cold therapy unit will also help a lot. DRESSINGS: You do not need to have any dressings on your knee at this point. You can use an ACE bandage if it is more comfortable or helps your brace stay on. Don’t wrap the ACE bandage too tightly or it can cause ankle swelling. BATHING: At this point you can shower, take a bath or swim whenever you want provided that your incisions are completely dry and there is no drainage. BRACE & CRUTCHES: Your brace should be unlocked but still worn until 4 weeks after surgery. (Note: If you had a meniscal repair performed, your brace should remain locked for the full 4 weeks. This is not for a meniscal trimming but just meniscal repairs. Ask your therapist or doctor/PA if you are unsure). You do not need to sleep in your brace. You should continue to attend physical therapy 2 to 3 times per week. The goal is to get your knee to come straight and to work towards getting to 90 degrees of flexion. WHEN TO CALL: Please call our office at (219) 395-2109 if you develop a fever greater than 101°F, calf pain, shortness of breath, chest pain, increasing pain that is not responding to pain medication, redness around incisions or knee, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours please call (219) 921-1444 and the answering service will contact the physician on call. DRIVING: Around this timeframe is when many people are able to return to driving. There is no definite way to determine when you are ready to drive. You need to be off narcotics and able to safely operate your vehicle. The concern here is not so much about damaging the ACL but about you being able to safely react behind the wheel. Be honest with yourself and if you are not certain that you are ready then wait. It is not worth the risk if there is any question.  Do not wear the brace while driving as it can lock and cause problems. OTHER TIPS

• Avoid anti-inflammatory medication (ibuprofen, Advil, Motrin, Aleve, etc) during this period as some studies have shown it may actually slow down or prevent tendon healing. If your doctor has instructed you to take aspirin, you may do so.
• Rehabilitation is one of the most important aspect of ACL surgery. Work hard in therapy to get your knee motion back!

NEXT OFFICE VISIT You will have your next office visit 4-6 weeks after surgery. Usually no x-rays are taken at this visit.  Feel free to ask any questions! If this appointment is not scheduled, please call our office to schedule one (219) 395-2109.

PAIN: You may have occasional discomfort but should not have real pain at this point. You should stop using narcotics during this time frame if you haven’t already done so. Continue to use ice and the ice machine as directed by your therapist. DRESSINGS: You do not need to have any dressings on your knee at this point. Put sunblock on your skin (high SPF) when out in the sun to help scars heal better and become less noticeable in the long run. BATHING: At this point you can shower, take a bath or swim whenever you want. ACTIVITY, BRACE & CRUTCHES: Your brace can now be removed. It is important that you are able to get your knee straight and at least 90 degrees of flexion by 6 weeks after surgery. At this point you should only be walking. No jogging is allowed as it may pull on the graft that is still in the healing process. You may be ready for a stationary bicycle during this time frame but check with your therapist first. WHEN TO CALL: Please call our office at (219) 395-2109 if you develop a fever greater than 101°F, calf pain, shortness of breath, chest pain, increasing pain that is not responding to pain medication, redness around incisions or knee, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours please call (219) 921-1444 and the answering service will contact the physician on call. DRIVING: You are probably ok to drive by now. Remember, you need to be off narcotics and able to safely operate your vehicle. The concern here is not so much about damaging the ACL but about you being able to safely react behind the wheel. Be honest with yourself and if you are not certain that you are ready then wait. It is not worth the risk if there is any question.  Do not wear the brace while driving as it can lock and cause problems OTHER TIPS

• Avoid anti-inflammatory medication (ibuprofen, Advil, Motrin, Aleve, etc) during this period as some studies have shown it may actually slow down or prevent tendon healing. If your doctor has instructed you to take aspirin, you may do so.
• Rehabilitation is one of the most important aspect of ACL surgery. Work hard in therapy to get your knee motion back!

NEXT OFFICE VISIT You will have an office visit during this time period. Usually no x-rays are taken at this visit.  Feel free to ask any questions! If this appointment is not scheduled, please call our office to schedule one (219) 395-2109.

PAIN: You may have occasional discomfort but should not have real pain at this point. If you are experiencing considerable pain you should let your doctor know. DRESSINGS: You do not need to have any dressings on your knee at this point. Put sunblock on your skin (high SPF) when out in the sun to help scars heal better and become less noticeable in the long run.  BATHING: At this point you can shower, take a bath or swim whenever you want.  ACTIVITY, BRACE & CRUTCHES: You should no longer be in a brace. If you think you may benefit from an ACL brace (this is different than what you had after surgery) discuss this with your doctor at your next visit. At this point you should only be walking; no jogging is allowed. You may go on a stationary bike and swim gently. You may also be able to do a gently elliptical for cardio but ask your therapist if you are ready. WHEN TO CALL: By this point we are usually past the time point of any surgical complication such as infections. However, you should still call our office at (219) 395-2109 if you develop a fever greater than 101°F, calf pain, shortness of breath, chest pain, increasing pain that is not responding to pain medication, redness around incisions or knee, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours please call (219) 921-1444 and the answering service will contact the physician on call.  DRIVING: You should be able to drive by now. OTHER TIPS

• You make take anti-inflammatory medications now if you need them for other conditions (e.g. arthritis). If your doctor has instructed you to take an aspirin a day to help prevent blood clots, you should have discontinued this by now. If you are suppose to take aspirin by the recommendation of another doctor (e.g. recommended by your cardiologist for your heart) you may continue to take it.
• Your therapy will now focus on strengthening your leg. You may reduce your visits to 2 times a week if your therapist thinks this is wise. You will notice that the muscles in your leg are much smaller than the other leg. This is very normal and takes some time to return to the way it was before your ACL injury and surgery.

NEXT OFFICE VISIT  Your next office visit will be at 3 months after surgery. Remember to ask your doctor or Physician Assistant about an ACL brace or any specific activity questions you may have.   Usually no x-rays are taken at this visit.  If this appointment is not scheduled, please call our office to schedule one (219) 395-2109.   Around this time your doctor may order you to do a functional test with your physical therapist. This is a test to evaluate and assess your progress during your recovery. If your ACL was reconstructed using your own hamstring the tests will be at 3, 4, 5, and 6 months post op. If your ACL was reconstructed with your own patella tendon the tests will be at 4, 5, and 6 months post op. If your ACL was reconstructed with cadaver tissue or if you had a revision surgery the tests will be at 4, 5 and 6 months post op.

   PAIN: You should not have pain any longer. If you are experiencing considerable pain you should let your doctor know. DRESSINGS: Continue to put sun-block on your incisions when out in the sun. BATHING: At this point you can shower, take a bath or swim whenever you want. ACTIVITY, BRACE & CRUTCHES: You can now start to jog. Take it slow and start off by just jogging 1 block and then slowly working your way up. Let your therapist know what you are doing so you can come up with a plan together. You may also go on a stationary bicycle, swim and use an elliptical machine. You may gently ride a road bike, but should avoid mountain biking. You may also start to golf. You should only swing with irons and not put much torque through the knee initially. By months 4-5 you can start to use a driver, but do not take a full swing until 6 months. It is essentially a gradual progression starting with slow, controlled iron shots at month 3 and moving up to full drives at month 6. WHEN TO CALL: You are past the point of most surgical complications. However, you should still call our office at (219) 395-2109 if you develop a fever greater than 101°F, calf pain, shortness of breath, chest pain, increasing pain that is not responding to pain medication, redness around incisions or knee, increased swelling, persistent bleeding or drainage, or drainage other than clear fluid or blood. If it is after hours please call (219) 921-1444 and the answering service will contact the physician on call.  DRIVING: You should be driving comfortably by now. OTHER TIPS

• You make take anti-inflammatory medications now as you normally would have before your ACL surgery.

• Your therapy will continue to focus on strengthening your leg as well as agility and balance. If you are an athlete, sports specific activity will also be introduced to get you back to your game. You will work with your therapist and us to determine how much therapy you need and when you can transition to a home program. It is important to continue your home exercise program after your formal physical therapy finishes. You will notice that the muscles in your leg are much smaller than the other leg. This is very normal and takes some time to return to the way it was before your ACL injury and surgery.

NEXT OFFICE VISIT Your next office visit will be at 6 months after surgery. Remember to ask your doctor or Physician Assistant about an ACL brace or any specific activity questions you may have.   Your doctor may take x-rays at this visit.  If this appointment is not scheduled, please call our office to schedule one (219) 395-2109.   Around this time your doctor may order you to do a functional test with your physical therapist. This is a test to evaluate and assess your progress during your recovery. If your ACL was reconstructed using your own hamstring the tests will be at 3, 4, 5, and 6 months post op. If your ACL was reconstructed with your own patella tendon the tests will be at 4, 5, and 6 months post op. If your ACL was reconstructed with cadaver tissue or if you had a revision surgery the tests will be at 4, 5 and 6 months post op.

PAIN: You should not have pain any longer. If you are experiencing considerable pain you should let your doctor know. Sometimes patients have discomfort due to arthritis or cartilage injuries. Your doctor may be able to help you with this. Some potential options are the gel shots and the use of glucosamine/chondroitin. Call your doctor and make an appointment if you are having issues (219) 395-2109. DRESSINGS: Continue to put sun-block on your incisions when out in the sun for one year after surgery. This will help the scars fade. ACTIVITY, BRACE & CRUTCHES: You can now return to all activities including cutting and pivoting. Keep in mind this should be a gradual return. You do not want to go from 0 to 60. Instead gradually work back towards your previous activity level. If you have particular questions about this, you can discuss with your doctor, physician assistant, trainer or therapist. OTHER TIPS

• You make take anti-inflammatory medications now as you normally would have before your ACL surgery.
• Your therapy will be completed by now. It is important for you to continue to strengthen your leg and it will take some time still for your muscle mass to return.

NEXT OFFICE VISIT Your next office visit will be at 6 months after surgery. Remember to ask your doctor or Physician Assistant about an ACL brace or any specific activity questions you may have.   Your doctor may take x-rays at this visit. Your doctor may release you from care at this point or may wish to see you again in 3 to 6 months.

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.

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.

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).

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.

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.