Advice following Anterior Cruciate Ligament (ACL) reconstruction

Transcription

1 Advice following Anterior Cruciate Ligament (ACL) reconstruction Information for patients

2 Mobilisation As soon as you feel well enough after the operation you will be able to get up and mobilise. You will have a large bulky dressing on it that will make the knee feel stiffer. Your physiotherapist will provide you with elbow crutches to assist you with your walking. You can take your full weight through the operated knee and should only require walking aids initially due to pain. You can stop using elbow crutches as advised by your physiotherapist. You should gradually increase your walking as you feel comfortable to do so. You may be required to wear a brace for the first few weeks to protect the graft. This is dependent on your consultant and you will be informed of this before the operation. Weight bearing status: Walking Aid required: Use for:.days / weeks / discard as soon as comfortable Hinge: Yes / No Use for:..days / weeks / discard as soon as comfortable Precautions Your Anterior Crucite Ligament (ACL) has many functions. Its main function is to stop the forward movement of the tibia on the femur (i.e. shin bone moving forward on the thigh bone). It also contributes to the stability of the knee and therefore it is important that the new ACL graft is not over stretched or stressed after surgery. To avoid over stressing or stretching the graft certain movements and exercise are avoided for the first few weeks and months. Open Chain Movements exercises where the foot is in open space i.e. in the air, off the floor or bed. Only one specific muscle group is used. The new ACL graft is placed under tension and shearing forces which can lead to it loosening or failing. 1

3 Closed Chain Movements exercises with the foot in contact with a surface, e.g. floor or bed. All muscle groups are used to support the leg. The new ACL graft is protected. You should only use CLOSED chain movements until advised otherwise by your physiotherapist. It is very important to protect the new graft. Getting out of bed to support the graft all muscle groups must be activated. With the leg straight tighten the knee by pressing the back of the knee into the bed. This activates the muscle above your knee (quadriceps muscle). Then dig your heel into the bed to tighten the hamstring muscles. Your knee and graft is then supported whilst you move your leg on and off the bed. Maintain these contractions until the foot is in contact with either the bed or the floor. You may use your hands or the other leg to support the leg below the knee if you struggle with this. Do NOT lift your heel off the floor when sitting in the chair (open chain movement) Mobilising and stairs it is important that you put your full weight through the leg when mobilising. This is a closed chain movement so the graft is protected. Hopping is an open chain movement and places undue tension on the graft. Swelling Most patients will experience some swelling around the knee after the operation and this can increase over the following 24-48hrs. To minimise swelling we recommend you elevate your leg. Ideally the knee should be higher than the hip to allow the swelling to drain up the leg. If your knee is swollen and/or painful, putting ice on will help. Please follow these instructions: o Take a bag of crushed ice or frozen peas. o Give the bag a knock to loosen the ice/peas. o Place a cold damp cloth/towel over the knee, place the peas on top. 2

4 o Leave in place for minutes. o Repeat up to every 2 hours. o Check skin colour regularly, it should be pink not blue. If your knee is particularly hot and swollen and painful, you should contact the ward or A&E. Exercises You will be provided with some exercises to carry out. These should be started as soon as you feel able to, and should be carried out 3-4 times a day. These exercises are designed to return your range of movement and strength after your operation. It is your responsibility to continue with the exercises independently to aid your rehabilitation. Outpatient Physiotherapy Out-patient physiotherapy will be organised for you after discharge from the ward. Your first appointment should be within the first two weeks of the operation. This first appointment may only be to check the exercises are being done correctly and to ensure there are no post-operative complications. You should not begin new exercises or activities without your Physiotherapist / Surgeon s advice. Return to Work Returning to work depends on the type of work you do. Generally you will not be advised to return to work until you are off elbow crutches and have functional range of movement and strength in you leg. If your job is sedentary you may be able to return to work earlier, usually 2-4 weeks post operatively. If your job is physically demanding i.e. you stand for long periods of time and involves heavy manual work, you may be able to return to work after 6 weeks. You can seek further advice from your surgeon or physiotherapist. 3

5 Driving You will not be able to return to driving until you are off elbow crutches and have functional range of movement and strength in your leg. You must be able to be in complete control of the car and it is advised that you discuss this with your car insurance company. You can seek further advice from your surgeon or physiotherapist. Return to Sport Returning to sport is dependent on the activity you wish to return to. Some non-impact closed chain gym work can be returned to after 2-4 weeks. Running and other impact exercise can not be started for at least 3 months. Full contact sports can be up to 6-9 months post operation. Please seek advice from your surgeon or physiotherapist before starting any new activities or exercises. Wound and Dressing You will usually have a large bulky dressing on your knee after the operation. If you still have the pressure bandage on when you leave hospital, it should be removed after hours. The nursing staff will provide you with advice regarding your wound and dressing. Pain Relief It is important that you do not stop taking pain medications too quickly. By continuing to take your pain medication you will be able to carryout your physiotherapy exercises effectively. You should reduce medications gradually prior to stopping. 4

6 For any queries or further information please contact the Physiotherapy Department at: Pontefract Hospital Tel: Pinderfields Hospital Tel: Dewsbury Hospital Tel: We are committed to providing high quality care. If you have a suggestion, comment, complaint or appreciation about the care you have received, or if you need this leaflet in another format please contact the Patient Advice and Liaison Service on: or pals@midyorks.nhs.uk To contact any of our hospitals call: To book or change an appointment call: a Published Oct 2011 Review Date 2014 SMOKE FREE hospital Design: The Mid Yorkshire Hospitals NHS Trust - design and print dept