ACL Tear/Reconstruction

What is it?

Ligaments are tough, non-stretchable fibers that hold your bones together. A tear to the anterior cruciate ligament (ACL) of your knee joint is among the most common sport-related injury. The ACL connects the femur (thighbone) to the tibia (the shinbone) and acts to prevent your femur from moving too far forward over the knee joint. This ligament also helps stabilize the tibia from rotating out of the knee joint.

The ACL can tear when it’s stretched beyond its normal range. This typically happens by sudden twisting movements, slowing down from running, or landing from a jump. You may hear a popping sound at the time of injury. Your knee may give way and begin to swell and hurt.

ACL reconstruction surgery is done to replace the torn anterior cruciate ligament. The torn ligament is removed and replaced with a graft from either your hamstring muscle, your opposite knee patellar tendon or a cadaver graft. It is an outpatient surgery that is performed through small incisions around the knee.

What are the treatment options?

Because the ACL is not capable of healing itself (ligaments, unlike muscles, do not have their own blood supply), it can only be reconstructed (replaced) surgically. Less active people may choose to treat a torn ligament nonsurgically with a rehabilitation program focusing on muscle strengthening and lifestyle changes. Surgical reconstruction, however, is your best chance to recover full function after an ACL tear. Your doctor can discuss these different options with you and help choose what is right for you.

Procedure Goals

The goal of ACL reconstruction is to restore ligamentous stability to the knee and allow for return to previous level of function.

Risks of the Procedure

As with any surgical procedure potential risks include bleeding and infection at the site of incision. Other risks specific to ACL reconstruction include knee pain and/or stiffness, poor healing of the graft and failure to achieve symptom relief.

What to Expect

Before Procedure

It is likely that you will go through physical therapy for a few weeks before surgery. The goals of attending physical therapy pre-operative include reducing pain and swelling, restoring the knee’s full range of motion and strengthening the muscles. Meeting these goals will assist with a better healing process post-operative including restoration of full range of motion.

Day of Surgery

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear shorts or loose pants.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center.

If crutches or a walker are needed, please rent or borrow them prior to your surgery. You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

You will discharge the same day of your surgery. Before you go home you will practice walking with crutches and you may have to wear a knee brace or splint to help protect the graft.

For ACL without meniscal repair, begin your post-operative exercises the day after surgery. You will be weight bearing as tolerated unless otherwise instructed. Wear immobilizer at all times except when doing exercises.

For ACL with meniscal repair, begin exercises the day after surgery. You will be toe-touch weight bearing only. Wear immobilizer at all times except when doing exercises.

Discharge Instructions

Diet

• You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Knee Care & Bathing

• Use your crutches as needed and maintain your weight bearing precautions. 
• Keep your knee elevated above heart level as much as possible for the first 48 hours, then as needed when symptomatic for up to two weeks. This will prevent painful swelling and promote healing. 
• Keep your incisions clean and dry all the time. 
• It is ok to shower or sponge bathe 2 days after surgery but you must keep your incision clean and dry at all cost! This usually entails wrapping your knee in a plastic garbage bag to keep it dry.

Cold Therapy

• To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48 hours and then as needed to help control pain and swelling. 
• To avoid frostbite, place a towel or t-shirt between the ice pack and your skin. 
• It is not necessary to use ice while sleeping. 
• We recommend the use of a cold therapy unit, which is often an out of pocket expense. The advantage of this unit is that the temperature can be regulated, allowing for continuous use for several hours at a time.

Pain Medication

• Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol. 
• While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off. 
• No driving while taking any narcotic pain medication! 
• The pain medication may cause some nausea so take it with food. 
• The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

• Watch for temperature > 101.5F, persistent numbness and tingling in the knee, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room. 
• Please make sure to follow instructions given to you by your physician, they may have specific instructions to your care.
• If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan - Exercises

Following your surgery and prior to your first post-op visit, the following exercises are very important in order to restore your knee motion and maintain muscle function. Your rehab program will be advanced at your first post-op visit with your surgeon and physical therapist. Use the ice machine as instructed or as often as possible. Crutches and immobilizer or brace (locked straight) should be used at all times while walking. You may put as much weight on the leg as is comfortable unless otherwise instructed.

Exercises:

1. Seated Extension Stretch: Open the immobilizer or brace and place a rolled towel under your heel to allow your knee to stretch into full extension. Restoring normal extension is very important and needs to be addressed now. Perform this 2-3 times a day. 10-15 minutes each session. You may and should use ice during this session. 

2. Seated Quad Set: With the leg straight and immobilizer open, place a rolled towel under your knee and tighten the quad muscles in the front of the thigh, pushing the knee down into the towel. Perform this 2-3 times a day. 25-30 reps each session.

3. Ankle Pumps: Move your ankle up and down frequently during the day. This will help the circulation in the calf and decrease lower leg swelling.

4. Heel Slides: To bend your knee, begin with sliding your heel towards your buttocks as far as you can into your pain tolerable range, then slide back down straight. When you can put your feet up on the wall, you can begin wall slides. Rest the operative leg on the non-operative leg, then lower the feet down the wall, allowing gravity to bend your knee. Use your non-operative leg to push your feet back up the wall. Repeat several times during a 10-15 minute session. Do this 2-3 sessions a day.