ANTERIOR CRUCIATE LIGAMENT
RECONSTRUCTION
Discharge Instructions
Operation:
The interior of your knee joint was visualized using a small telescope,
and the diagnosis was confirmed. The remnant of your torn ligament
was removed and your ACL was reconstructed using biologic tissue
from one of several sources—patellar tendon or hamstring tendons (called “autografts”),
or tissue from tissue banks (called “allograft”). Additional
surgery involving the removal or repair of damaged, torn, degenerative
or abnormal cartilage may also have been performed using special
micro-instruments.
Pain:
Upon discharge, you will be given one or two prescriptions for pain
medication that can be filled at either the hospital or a local
pharmacy. The pain medication can be taken every 3 to 6 hours as
needed (please follow instructions). The medicine will help decrease
the level of pain, but it is not meant to completely eliminate
the pain. Some pain is expected. If you develop itching, skin rash,
nausea or vomiting, please discontinue the medicine and call the
office. Additionally, narcotics can cause constipation if used
for an extended period of time. If this occurs, you should decrease
the use of the prescribed medicine, and increase fluid, roughage
and fruit intake in your diet. Please do not use Aspirin unless
you have OK’d it with your surgeon.
The use of ice or cold therapy decreases both swelling
and pain. The safest and most effective way to apply cold is to use
a cold
therapy wrap/unit which applies both uniform pressure and cold.
Alternatively, you may place a bag of ice in a towel over your knee
dressing. I
would like to caution you that ice should never be placed directly
on the skin but used in conjunction with a towel or dressing
next to the skin. We suggest using cold therapy 20 minutes every
one
to two hours while awake. Once you are ready for sleep, discontinue
cold therapy treatment. Cold therapy is most effective for two
to
five days after surgery. If you were given a cold therapy unit,
additional instructions will be provided.
Elevate your leg above the level of your heart while at rest.
This will help decrease swelling, and secondarily decrease
pain.
Pain Pump:
You may have been sent home with a continuous infusion apparatus
for pain management. The pump works automatically. Please do not
pull or push on the pump or its tubing. One of the doctors at Valley Bone & Joint Clinic will remove this apparatus in approximately 48 hours
to 72 hours.
Dressings:
Your surgery was performed arthroscopically, and therefore you may
notice pink fluid or bloody drainage soaking your dressing for
the first 24-36 hours after surgery. If this occurs and is bothersome,
simply reinforce the dressing with additional sterile gauze. The
incision on the front of your knee, as well as the small arthroscopic
puncture wounds, have been closed with suture and skin tapes/steri-strips.
These are covered by sterile gauze pads and held in place with
either a compressive Ace wrap or Tubigrip elastic stocking. This
bulky dressing will be removed and replaced with a smaller dressing
at your first post-operative visit one to three days after surgery.
You should change this new dressing daily until the gauze pads
are free of drainage. Do not remove the suture or skin tapes as
they are largely responsible for maintaining the integrity of your
skin incisions. The skin tapes will fall off on their own in 7-14
days.
Anti-Embolism Stockings:
You will be placed in long TED stockings post-operatively. Please
leave in place until your first post-op appointment.
Wounds:
The incisions and small puncture wounds may be sore and you may develop
bruising in the area of the surgery as well as down your leg over
the next several days. This will go away, and no special care if
needed.
Bathing:
It is safe to shower or bathe 72 hours after surgery. Your incision
sites should be kept dry for one week to minimize the risk of infection
or delayed wound healing. You may try covering the incisions with
saran wrap or a plastic bag. When showering, make sure you are well
supported so as not to slip and fall. You may sit down on something
if you are unsteady and extend the leg in the shower. After one week,
you may wash—but do not scrub—the incisions with regular
soap and water, dry them, and cover them with a dressing or Bandaids,
if needed. Try not to remove the skin tapes as they will fall off
on their own. You should not immerse your knee under water, and should
avoid hot tubs or pools for two weeks.
Activity:
You should rest, relax and make arrangements to have someone stay
with you for at least 24 hours after your discharge. Following
surgery, your knee was placed into a hinged brace locked in extension.
During the first week, you should wear your brace at all times
except while exercising or showering. Because there is a tendency
to curl your leg while sleeping, we strongly recommend that you
sleep with the brace on until you have achieved full extension
of your knee and can adequately perform straight leg raises (usually
2-4 weeks). You may loosen the velcro straps to sleep but do not
remove the brace. While standing or walking, you may place as much
weight as tolerated through your operative leg, unless otherwise
instructed. It typically takes 3-7 days to feel comfortable placing
full weight through your operative leg. All weight-bearing should
initially be done with crutches and your brace locked in extension.
The brace helps to maintain the knee in full extension while walking
and prevents it from buckling. As your leg strength improves, we
will unlock your knee brace to allow a more normal gait pattern.
Next, you may discontinue your crutches when you have achieved
a relatively smooth, even-paced heel-toe gait pattern. It is expected
that the brace and crutches will be necessary only for 2 to 3 weeks
while you develop strength to keep the knee fully extended while
bearing weight. Remember, do not walk on your toes or with a bent
knee, and do not limp. You should remove your brace several times
a day to work on your range of motion. You are permitted to bend
your knee as much as you like. When doing these exercises, there
should be no pillows or bumps under your knee. You should, instead,
place a pillow under your heel to allow the knee to sag and stretch
into full extension. This maneuver is a very important element
of your knee rehab, and should not be overlooked. Frequent ankle
motion (ankle pumps) is encouraged to minimize the risk of developing
blood clots following surgery.
Do not drive any vehicle or operate mechanical equipment for several
days following your surgery. Even though you feel normal, your
reaction time and strength have been affected by your surgery.
Return to driving
depends on which leg is operated upon and whether your car has
an automatic or manual transmission. It often takes 1-3 weeks
to be
able to safely return to the road.
You may resume basic daily activities in 3 to 5 days, unless otherwise
instructed. Return to employment depends greatly on working conditions
and requirements.
If more extensive surgery was undertaken, special instructions
will be provided, including prolonged immobilization and/or
protected weight-bearing.
Diet:
Drink clear liquids (apple juice, ginger ale, broth, 7-Up, etc.).
Progress to your regular diet as you feel able. Do not drink alcoholic
beverages for at least 24 hours following your surgery.
Precautions:
A common occurrence after general anesthesia is a low-grade fever
during the first 24-48 hours post-operatively. The fever is usually
below 101o and slowly abates. Tylenol works well to keep it in
check. If you develop a high fever (temperature over 101°), shaking,
chills, unexpected/severe pain, redness, or swelling, please contact
the office for consultation or examination. Occasionally, there
is minor swelling of the foot. This can usually be relieved by
elevation of the leg, and loosely reapplying a compressive wrap
(Ace wrap) around the knee region. If you develop pain, tenderness,
warmth, or swelling in your calf, please contact the office immediately.
Follow-up:
A post-operative visit with your surgeon, or assistant, will be made
1 to 3 days following surgery to check your wounds and discuss
your case. Formal physical therapy should begin 3 to 5 days after
surgery—this appointment may have been made at the time of
your pre-operative visit. Probably the most important thing to
remember about your knee surgery is that the post-operative rehabilitation
is more important than the surgery itself. Your surgeon and therapists
will monitor your rehab program, and if you have any questions
or concerns, please feel free to discuss the situation with either
of them.
Emergency Calls:
If you have a problem of an emergency nature and are unable to reach
your doctor, call or come to Altru Hospital Emergency Room (phone:
701-780-5280); or your nearest hospital or emergency facility.
CONTACT YOUR PHYSICIAN (OR HIS ALTERNATE) IF YOU HAVE ANY PROBLEMS:
- Fever greater than 101 degrees orally or if at all questionable.
- Chills
- Excessive bleeding
- Separation of the incision
- Excessive swelling or tenderness
- Unusual drainage:
pus-like drainage (white, yellow, or greenish in color); any
excessive drainage
from the area; foul odor from the incision or dressing.
- Change in color around the area; excessive redness may indicate
infection
- Change in temperature around the area: unusual
warmth
- Increased pain in operative area
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