POST OPERATIVE INSTRUCTIONS
Anterior Cruciate Ligament Reconstruction is usually done with a graft from one of two sources: from a donor (allograft) or from your own tissue (autograft).
In each case the graft itself may come either from hamstring tendons (soft tissue graft) or from a portions of the patella, patella tendon and tibia, (btb graft). The postoperative protocol will depend on the type of surgery you had.
Hamstring grafts require post operative protection and touch-down weight bearing follows for the first month.
Bone tendon bone (btb) grafts are allowed to walk immediately after surgery, pain restricted. Both types of ACL reconstruction require extension bracing at least until the first post operative visit. This is done at night only. The brace may be removed for range of motion exercises or showers as needed during the day. After weight bearing is progressed to pain restricted, the brace is recommended for the first month at least.
Anterior cruciate reconstruction is done using minimally invasive techniques. There will be two or more small incisions that will be closed with sutures or staples. Some are closed with sutures under the skin and these do not need to be removed and will dissolve with time. Wounds should remain clean and dry. Change dressings if they become saturated with blood. No dressing is required after day three unless this is more comfortable for you. Replace ace wrap and remember to start with the foot. If the foot is not wrapped with the ace, it will definitely swell. Sutures will be removed at your first post operative visit.
Showers can be taken on the third day after surgery. Please do not take a bath or swim until sutures are removed or you are seen in the office. Swelling and discoloration are common. Redness outside of the suture line and drainage occurring longer than three days post operatively should be brought to my attention immediately. Please call the office if you have questions or concerns.
Pain medicines will be prescribed for you during this postoperative period. Narcotics are used for the first ten days if needed. Please direct all medication needs to me during office hours or during our first post op visit. Some medicines cannot be "called in" to the pharmacy and require a prescription from me to be filled by your pharmacist.
Operative photographs are routinely taken during this procedure. Make sure you ask for them before leaving the hospital and make sure you keep them, along with the operative notes you will receive at your first postoperative visit.
Physical Therapy is vital to the success of this operation. Be sure that you are clear on your weight bearing status.
Hamstring reconstructions are touch down weight bearing for the first two weeks, progressing to 25-50lbs of weight bearing over the next two weeks, followed by pain restricted weight bearing as tolerated there after.
BTB graft reconstructions are allowed to weight bear as tolerated immediately after the surgery, although most people require several days of crutches because of pain to make this transition.
If a meniscal repair was performed at the same time, follow those instructions as well; weight bear only in extension when weight bearing starts. Most likely you are already involved with a therapist. Therapy begins immediately post operatively at home on your own. Extension bracing at night is followed by range-of-motion exercises during the day.
You should have a therapy appointment approximately five days after surgery to begin formal exercises. Ice and elevation are important to reducing the swelling. Use the ace wrap during this period as well. Expect some pain and frustration for the first several days. Look below for physical therapy links for both types of commonly performed anterior cruciate ligament reconstruction.
CHONDROPLASTY AND MICROFRACTURE
The post operative period should follow the instructions for Meniscal Debridement. Make sure weight-bearing status is clear. Microfracture patients will undergo a short period of protected weight bearing for the first month with restrictions remaining touch-down until released by me.
CHONDRAL REPAIR AND OCD REPAIR
As far as the weight-bearing status goes, Chondral Repair and OCD Repair must be touch-down weight bearing until released by me.
SYNOVECTOMY AND LOOSE BODY EXCISION
Patients should follow Meniscal Debridement instructions.