ANTERIOR CRUCIATE LIGAMENT INFORMATION PACKET

Transcription

1 ANTERIOR CRUCIATE LIGAMENT INFORMATION PACKET Anterior Cruciate Ligament (ACL) Posterior Cruciate Ligament (PCL) Michael Angeline, MD Orthopedic and Sports Medicine Mercy Health System - 1 -

2 Instructions following Ligament Reconstruction Surgery This booklet offers information to help you recover from surgery to replace the anterior cruciate ligament (ACL) in your knee. These exercises can also be done following surgery to replace other ligaments in your knee, including the medial collateral ligament (MCL), the lateral collateral ligament (LCL), and posterior cruciate ligament (PCL). Your doctor and physical therapist will give you instructions on how to adapt these exercises to recover from surgery. These exercises should be done at home as part of your total recovery plan to improve your strength, flexibility, and mobility. If you have any questions, please contact your physician. Things to remember Do not forcibly bend your knee for the first six weeks after surgery. Do not hold your breath while doing any of the exercises Do not get your incision wet until after your follow-up visit with your physician and the staples or stitches are removed. Remove throw rugs and tack down loose carpeting in your home. Be careful of small children, pets, and any spills on the floor. All of these things may cause you to lose your balance and fall. Be certain to check the wing nuts on your crutches occasionally to be sure they are tight. When walking outdoors be careful of wet walkways, debris, and snow or ice adhering to the bottom of your crutches

3 REHABILITATION You will need to devote a lot of time to physical therapy following your surgery. For the first four to six weeks, you will attend outpatient physical therapy sessions once a week. After that, you will attend two to three sessions a week for up to six months, depending on your progress and access to exercise equipment. Your physician will tell you when crutches and the brace are no longer needed. You will use crutches and the brace for the first 4-6 weeks after surgery. In the 4-6 weeks following surgery, crutches and the brace may be gradually eliminated as long as you are able to perform a quad set, and walk normally without a limp. You can usually discontinue the brace at 4 weeks. Crutches will be gradually eliminated through the guidance of you physical therapist. Limit your activities according to the advice of your physical therapist or doctor. Vigorous sports activities should be avoided for at least four to six months after surgery. This rest will allow your knee to heal and become stronger. You probably will achieve full use at six months after surgery. Before returning to any vigorous sports activities, your doctor or physical therapist will give you other balance and coordination exercises to see if you are ready to return to sports, as well as to help you complete your recovery. Continue your exercises at home two to three times a week after your outpatient physical therapy sessions are finished. Exercising will help you maintain strength and flexibility. All of the exercises should be performed while wearing your knee brace, unless your doctor or physical therapist tells you otherwise

4 Quadriceps (quad) sets Lie on your back or sit with your affected knee straight, brace locked, and undo top two straps. Slowly tighten the muscles on the top of your thigh, press the back of your thigh into floor, and pull your toes toward the ceiling. You should feel your kneecap move up-ward. Hold for 10 seconds. Relax. Repeat 10 times. Straight leg raises Lock the brace. Lie on your back with your unaffected knee bent and your foot flat on the floor. Keep your affected knee straight. Repeat the quad set as instructed above then slowly raise the leg. Do not raise the affected leg higher than the knee on the unaffected side. Heel Slides Sit with your legs straight in front of you and unlock the brace. Grip the hinges of your brace and pull up on them slowly to bend your knee. Bend your knee as far as you can within your pain limits or as far as your brace allows. Hold position for two to three seconds. Slowly lower the leg by pushing down on the hinges. Repeat 20 times. Perform the exercises on a smooth surface and wear socks to decrease friction

5 Seated knee extension Sit in a chair or lie on your back on a couch. If sitting, place the heel of the affected leg on a chair in front of you. If lying down, place the heel on the arm of the couch. Allow the affected knee to straighten gradually. Hold position for three to five minutes. Ankle pumps Lie on your back with your legs straight. Bend your ankles to point your toes up toward your body, then down away from your body. Repeat 10 times. Outpatient Anterior Cruciate Ligament Reconstruction Before ACL Surgery Do not take aspirin or any medication that contains aspirin for 7-10 days before surgery (celebrex, motrin, alleve, advil). You may take non-aspirin pain reliever, such as Tylenol If necessary, before surgery you may take 2 extra strength Tylenol every 4 hours up until 12 midnight. Continue your daily medications (with the exception of aspirin and above mentioned products). Same day surgery will instruct you on what medications to take the day of surgery. Do not eat or drink anything after midnight the night before your operation

6 You may brush your teeth and use mouthwash the morning of surgery, but do not swallow any liquid. The hospital will call you the day before your operation to tell you what time to report to the hospital. Please remember to bring the knee brace (ELS), cryocuff, crutches, or any other surgery-related items that you have received. Bring shorts and a pair of sturdy shoes, such as tennis shoes, to wear after your surgery. The Day of Surgery At the hospital, a nurse will ask you questions about your medical history. You may be seen by the Physical Therapist before surgery. Remove all jewelry and other valuables and give them to a family member to hold. An intravenous (IV) line will be started in your arm in order to receive fluids and medication. You will be escorted to the operating room on a wheeled cart. After the surgery You will be taken to the recovery room when the operation is over and will remain there for up to two hours. In the recovery room the nurses will check your blood pressure, breathing, pulse, and temperature, circulation, and move your legs

7 You will also see a Physical Therapist who will instruct you on exercises and crutch instruction. When you are fully awake and have recovered from the anesthesia you will be discharged from the hospital. After discharge from the hospital Pain Control You will receive prescriptions for pain and anti-inflammatory medications. You may also be given a prescription for oral antibiotics. Medications may be taken as prescribed every four hours to keep your pain under control. After the first two days, you may no longer require pain medication every four hours, at that time continue taking your prescribed pain medication as needed for pain. We recommend you arrange your pain medication schedule to take the medication 1-2 hours before doing your exercises or using the CPM machine. Take your medications with food or at least crackers or milk Apply ice or the cryocuff to your knee and elevate your leg (above the level of your heart) as much as possible. Apply ice (cryocuff) for minutes after physical therapy or any other activity

8 When you no longer need your prescription pain medications, you may begin to take over the counter medications like Extra Strength Tylenol or ibuprofen (Motrin/ Advil, etc.) to control any discomfort you may be experiencing. If the medications, ice, and elevation do not provide pain relief, call your physician's office. Dressing Change Two days after surgery you will need to change your dressing as you were instructed to do pre-operatively, unless otherwise told by your physician. You should change the dressing daily until the stitches or staples have been removed. To change the dressing: Wash your hands with warm water and soap. Open the brace around your knee. Remove the dressing and discard it. Check the incision for signs of infection, such as redness, swelling, unusual pain, or drainage. Gently clean around the incision with warm water and soap. Do not get the incision or stitches wet. Apply a clean gauze dressing and tape the edges. Do not apply ointment to the incision. Wash your hands. Your doctor will tell you when the stitches or staples will be removed. It is important to keep the incision dry until then. You should sponge bathe, rather than take showers or tub baths, to keep the incision dry

9 Cryocuff Your physician will prescribe a Cryocuff for you after surgery. This device provides cold and compression to reduce pain and swelling. The cryocuff should be used as much as possible especially during the first week. The Cryocuff should be used for 20 minutes on and 40 minutes off. It should be drained after each use. After the first week you should use the cryocuff as needed especially after therapy. Post-Op Knee Brace After surgery you will be placed in a brace to protect your knee. During the first week the brace should be locked straight except while performing your range of motion exercises or when using a CPM machine. At the Post-op visit your physician mayor may not instruct you to unlock the brace. Continuous Passive Motion (CPM) Machine Your doctor may prescribe a CPM machine for use at home to assist with bending of your knee until you have achieved 90 degrees of flexion (bending) for two consecutive days. When using the CPM machine drain the cryocuff and unlock the knee brace. The CPM machine should be used three times a day, two hours at a time, for a total of up to six hours per day beginning the morning after - 9 -

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11 Increase the settings five to ten degrees per day as tolerated up to 90 degrees if flexion. The CPM should be used for 4 weeks unless instructed otherwise from your physician. Reapply the cryocuff after using the CPM machine. Activity/Crutch Walking After surgery you should use both crutches when walking. You may put as much weight on the operative leg as tolerated unless you are instructed otherwise. Your brace will be locked in full extension for the first week Continue to use your crutches until told to discontinue them by your physician. Your weight-bearing status may change depending on the outcome of the surgery. Suture Removal Your sutures or staples should be kept dry and clean They will be removed approximately seven to ten days after surgery during your first post-operative visit with your physician Once the sutures/staples have been removed you may begin to shower unless instructed otherwise from your doctor Physical Therapy You should perform the exercises that you have learned before surgery three times per day beginning the first day after surgery

12 on your knee, driving will usually begin three to four weeks after surgery unless instructed otherwise by your physician. IT IS ILLEGAL TO OPERATE A MOTOR VEHICLE IF TAKING PRESCRIPTION PAIN MEDICATION Normal Sensations and Findings after Surgery Shin pain Swelling and mild warmth of the knee for three to four weeks Small amount of bloody drainage for the first 3-5 days Numbness in the area of your incision. When the incision was made, small nerve fibers in the skin were cut. These nerves must regenerate before sensation returns to normal. Soreness in the Achilles tendon area may develop. Soreness and swelling in the back of the knee. Swelling of the lower leg including the ankle. If this occurs you should elevate the leg above the level of your heart and apply ice. Numbness in the area of the foot. This should resolve in several days. If it persists you should contact your physician. A low grade temperature less than Fahrenheit. If this occurs, you should drink plenty of fluids, take Tylenol and do coughing and deep breathing exercises every two hours while awake. This will help to expel any mucous that is present in the lungs. When doing the coughing and deep breathing exercises, you should take 10 deep breaths and on the last breath hold it for several seconds and then cough forcefully a few times. A small amount of redness in the area where the sutures or staples insert into the skin is normal