Anterior Cruciate Ligament (ACL) Reconstruction Post-op Packet

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1 L. Ryan Smart, MD Anterior Cruciate Ligament (ACL) Reconstruction Post-op Packet Contents: Post-op Reference Sheet Physical Therapy Prescription Exercise Sheet Surgical Pictures SOS Fayetteville 4115 Medical Center Drive, Fayetteville, NY Tel: , Fax: SOS Liverpool 5100 West Taft Road, Liverpool, NY Tel: , Fax:

2 L. Ryan Smart, MD Patient Post-op Reference Sheet: Anterior Cruciate Ligament Reconstruction Pain Control and Ice A pain medication prescription will be provided prior to discharge. (do not drive while taking pain medication) You may take the prescribed medication as directed. You should expect to experience moderate knee discomfort for several days and even weeks following the surgery. Patients often only need prescription narcotics for a few days following the surgery and then switch to over-the counter medications such as Tylenol or Ibuprofen. Ice bags and elevation should be utilized to decrease swelling and pain. Ice should be applied to the knee for minutes, 5 times a day until swelling subsides Brace Instructions For the first 24 hours after surgery keep the brace locked in a straight or extended position (extension of knee during early post-op period is crucial!) After 24 hours you may unlock the brace (see figure to right). The brace should be in place and unlocked when up and about, and sleeping. Unlock brace by sliding locking bar away from brace hinge. The brace can be removed when your leg is resting in an extended position such as when in a reclining chair. Progress range of motion to tolerance with the goal of getting knee fully straight and bent to 90 degrees by your initial follow up appointment. Wound Care If the bandage is draining/ bleeding, reinforce it with additional dressings for the first 24 hours. After 48 hours, remove the bandage and place band aids over the incision sites. You may utilize an ace wrap for compression Showering is acceptable after 48 hours. Keep the incision dry for the following 48 hours Do not submerge or scrub the knee. Do not bathe. Rehabilitation/ General Post-op Care You will be able to put as much weight as tolerated on your leg utilizing crutches Physical therapy typically starts after you see Dr. Smart back for your first post-op visit. (Prescription is located within this packet) Take one 325 mg (full strength) Aspirin daily for 14 days (unless otherwise instructed or allergic) to help prevent blood clots. First post-op appointment is 7-10 days for suture removal. This appointment is often made ahead of time. You may drive once you establish control of you operative extremity. If your right knee was operated on, this may take approximately 3-5 days to achieve. You cannot drive while taking narcotic pain medicine. Plan at least a week away from work or school. Utilize this time to decrease swelling and participate in your home exercise program. You may be able to resume work once the pain and swelling resolves (this varies based on job activity

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4 (Bring to your initial physical therapy appointment. Bring whole packet so that your physical therapist can observe surgical pictures) L. Ryan Smart, MD Physical Therapy Prescription Patient Name: Diagnosis: ACL Reconstruction Prescription: Progressive range of motion, modalities for edema and pain reduction, patella mobilization, progressive resistive exercise General POST-OP protocol is provided on next page Frequency: 2-3x a week Precautions: Signature Physical Therapy Facility Phone Number SOS Fayetteville 4115 Medical Center Drive, Fayetteville, NY Tel: , Fax: SOS Liverpool 5100 West Taft Road, Liverpool, NY Tel: , Fax:

5 General Post-op Rehabilitation Guide Phase 1 (Weeks 0-2): Goals: Minimize effusion, maintain full terminal knee extension, Flexion to 120, Normalize gait pattern/balance and propriception abilities. Treatment plan: 1) Utilize cpm and electrical stimulation as directed by company representative and physical therapist. 2) Swelling Control with ice and compression wrap 3) Maintain full knee extension 4) Initiate quadriceps and hamstring muscle activation and general leg control Quad setting, SLR, heel slides, isometric hamstring/quadriceps contraction Ankle pumps 5) WBAT with crutches Phase 2 (Weeks 2-4): Goals: Full knee ROM in extension and flexion, progress quadriceps/hamstring strengthening, good patella mobility, independent mobility Treatment plan: 1) Continue with swelling control 2) Full knee ROM (half to full revolution on exercise bike) 3) Wall slides/ ball squats/ progressive step-ups 4) Balance and Proprioception: Single leg stance/weight shifting 5) Independent ambulation Phase 3 (Weeks 4-12): Goals: Full lower extremity strengthening/conditioning program, Agility and Plyometric drills, Full activity in gym Treatment plan: 1) Progress CKC strengthening lunges/ reverse lunges/ single leg squats 2) Full ROM Full revolution on bike 3) Progress dynamic balance training Phase 4 (Month 3-6): Goals: Agility and Plyometric drills, Sports specific training, Treatment Plan: 1) Progress lower extremity strengthening and control 2) Plyometric drills including lateral movements, quadrant exercise 3) Sports specific strengthening and conditioning 4) Treadmill/bike light jogging 5) Transition to self directed exercise program Phase 5 (Month 6 -) Goals: Continue with home exercise program to maintain strength of lower extremity. Return to sports of choice and independent gym activity. Treatment Plan: 1) Progress plyometric and agility training 2) Progress sport specific training 3) Fit for functional stability knee brace as needed

6 Post-op exercise program until formal physical therapy is started:

7 Frequently Asked Questions 1) When do I have to wear the brace? The brace must be worn at all times except when you are resting with your leg up and elevated or working on getting the knee straight. At the initial post-op appointment further brace wear will be discussed. 2) When can I unlock the brace? You can unlock the brace after 24 hours. This can be done by sliding the hinge bar away from the round joint/ hinge of the brace. 3) How long will I need to participate in Physical Therapy? This varies patient to patient. In general you should participate in physical therapy until all therapy goals are achieved. These goals will be established by the Physical Therapist. On average this is by 3 months. 4) When can I drive? You can drive when you have full control of your leg and are no longer using narcotic pain medication. 5) There is bleeding through the ace wrap on my knee, what do I do? You may experience some bleeding or staining of the ace wrap/ dressing that has been placed over the incisions of your knee. This is normal. Reinforce the current dressing with sterile gauze and an additional ace wrap. All of this equipment can be purchased at your local pharmacy. Remove all dressings 24 hours later and re-evaluate. 6) Do I need to use crutches? The crutches while recommended for at least 48 hours are not mandatory assuming you did not have a meniscal repair. If you can ambulate with out pain or instability you do not need to use crutches. 7) I have some numbness at the incision sites, is this normal? Numbness at the region of the incision is a normal result of cutting the skin. The numb region will likely decrease in size with time but may be permanent. No loss in function is expected as a result of this small region of decreased sensation 8) What can I do to decrease the swelling in the knee? Post operative swelling is normal after knee arthroscopy. You can decrease the swelling by utilizing a compression wrap (ace wrap), ice and elevation. 9) I have become constipated since the surgery, what should I do? Post-operative constipation is often a side effect of the narcotic pain medication. There are numerous over the counter remedies for this problem.

8 Your pharmacist is a great resource for this. Often Colace, a stool softener will do the trick. If you go past 3 days without a bowel movement please call the office or you primary care physician for guidance. 12) Why have I developed pain in the front of my knee? Pain in the front or knee cap region is normal within the first 6 months after the surgery. This is a result of joint swelling and muscle weakness. The pain will decrease with muscle strengthening and swelling reduction.

9 Bracing in review: At the completion of surgery, you will have a brace placed on your leg. The brace should be locked for 24 hours. You may unlock the brace after 24 hours, which will allow your knee to bend and straighten. The brace may only be removed when sitting with your leg elevated and in an extended position. It should be secured tightly in an unlocked position during all other times, including walking and sleeping.

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