ACL Surgery: Beginning to End

A Few weeks before surgery

Start your rehab:

Working on your knee flexibility and strength before surgery will better prepare you for afterward. Sometimes surgery may be delayed if you do not have all the motion needed, so work hard on it. Referral to a physical therapist may be helpful for several reasons: They may show you exercises you hadn’t thought of yourself, it may help you get your motion faster, and will introduce you to someone who will follow you after surgery. Sometimes just a few visits are needed.

Get your home setup:

Set up your living space to accommodate you in a knee brace and crutches for the first few weeks. This may mean moving a bed downstairs to make things a littler easier at first. See if you can get an ice machine (polar care, cryocuff, etc) for your knee. Sometimes insurance will cover it.

Check out any medical issues:

Do you need a prep medical clearance visit? While most of my patients are young and healthy, you may have a medical concern that would benefit from a visit to your primary doctor, like a family history of blood clots, or heart condition. The goal is to minimize risk. Don’t take any chances.

Night before surgery:

Have a good dinner. You are not allowed anything to eat after midnight. Use an antibacterial soap before you come to the surgery center.  Don’t shave your leg, as any cuts on the operative knee may require postponing your surgery.

Surgery Day !

scopeACLThe day has come ! A little apprehension is normal: You will get through it. It will fly by in the blink of an eye. When you arrive, you will be asked a bunch of questions and your leg will be prepared. Your surgeon (me) will come in and be sure all your questions have been answered and we are on the same page in terms of important surgical decisions we make in the OR. It’s also a good time to have your family present to hear the discussion.

Most patients walk to the operating room and then are off to sleep. You will not remember anything that happens – no one wakes up mid-surgery. The next thing you know, you’ll be going home.

Everyone receives a dose of antibiotics to help minimize the risk of infection. The first surgical step is to get the ACL graft ready. If using your own tissue, a small incision is needed. The tendon is taken out and prepared to go back in to make the new ligament.

Three small portals are created to perform the reconstruction. These are used to look inside with a fiber-optic camera, flush fluid through your knee to make it easy to see, and to pass tiny instruments in and out. Pictures are taken of the knee first. Any torn meniscus tissue is either repaired or smoothed. A portion of the torn ACL is trimmed away, and small tunnels are created in just the right place for the new ACL. The new ACL is then brought into the knee through the tunnels and held in place with special devices designed just for this purpose.
The portals are closed and the surgery is over! Bandages are applied and your knee is placed in a knee brace to protect it. Next stop: recovery room.

Recovery right after surgery:

Most people spend about 45-60 minutes in the recovery room, waiting for the anesthetic mediations to wear off somewhat. Once able to sit up comfortably, and checked out carefully by a recovery room nurse specialist, its time to go home. Congratulations. Its Over !

The first few days:

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Take it easy the first few days. Keep your leg elevated on pillows above your heart to help with pain and swelling. You may take off the brace while on the couch.

A few words about medications:

Aspirin: I typically suggest 81mg of aspirin for the first 10 days to decrease the risk of blood clots. Symptoms to watch for are worsening calf pain, or leg swelling that seems unrelated to the swelling from the surgery. Let me know right away about this. I’ll send you for a simple painless ultrasound of the leg to check.
Ibuprofen: This medicine helps with pain and inflammation. It works in your knee. I typically will suggest 600-800mg three times a day unless it bothers your stomach.
Vicodin / Percocet: A strong narcotic. This does nothing for your knee, but tells your brain you don’t have pain. You are not required to take this, but may use it as needed. If it is not working, call me right away.
Start working on moving your knee. You want to slowly gain back your range of motion over the next weeks. This will not happen in just one day. It will take time.

Start physical therapy

. I like my patients to be in therapy within the first 24-48 hours after surgery. A friday surgery usually has to wait til Monday. The goals initially are decreased pain, swelling, and return of flexibility.

Change the dressing 2 days after surgery. Don’t take off the steri-strips stuck to your skin. They are holding some of the incisions together. Only take off the overlying gauze and non-stick dressings. Leave the steris on. Replace the gauze with new gauze and wrap your knee with an ACE wrap.

Dr. Scott Hacker is a Sports Medicine Orthopedic Surgeon in San Diego, CA, Team Surgeon to the US Olympic Team.  He specializes in sports medicine and sports injuries, knee and shoulder surgery.

If you have questions about ACL surgery, or have an ACL tear, please feel free to contact me at Ask Dr. Hacker or through my office.

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