Recovering From Your ACL Reconstruction

About Your Surgery

Your Surgical Day

• Arrive 2 hours before your scheduled start time. You will check in and meet your anesthesiologist.
• You receive a nerve block in the preop area, then go to the operating room. Setup and anesthesia take about 30 minutes.
• Surgery averages about 2 hours, and may run longer if additional meniscus, cartilage, or ligament work is needed.
• Your knee is set up for recovery. A gauze dressing, ice machine, compression stockings, and a knee brace are placed. Waking and moving to recovery takes about 30 minutes.
• Dr. Jazayeri will speak with your point of contact and review how the surgery went.
• You will spend about 1 hour in recovery before you are discharged home.

Pain and Your Nerve Block

• Your nerve block typically lasts 12 to 24 hours. It helps control pain right after surgery.
• Take your oral pain medication before the block wears off. It is normal to feel more pain in the middle of the night or the next day as the block fades. That is expected.
• Stay ahead of the pain. Take a pain tablet when you get home and again before bed.

Your Equipment

• A cryo-cuff is placed on your knee in the operating room. Keep it on as much as possible for the first 1 to 2 weeks to reduce swelling and pain. Continuously change the ice water so it stays cold.

• Wear the brace for the first 2 weeks, at all times including sleep and showering, except during range of motion exercises.
• Keep the knee straight (extended) at all times, walking, sleeping, resting, and showering, except for the ROM exercises that start on day 1.
• You may remove it only for short periods when sitting or exercising, and you may wear it over clothes. At 2 weeks you may be fitted for another brace as needed.

• Wear the stockings until your first visit at 2 weeks to help prevent swelling and blood clots. You may remove them to wash, but do not put them in the dryer.
• Pull them all the way up to your thigh. Do not leave them halfway down your calf, which causes swelling.
• Pump your ankles often, rotating and moving both up and down, to keep blood circulating.

• Use crutches when walking for the first 2 to 3 weeks, then wean off.
• You may put as much weight on the leg as you can tolerate, often 25 to 50 percent at first, unless told otherwise.
• By 3 to 4 weeks you should be ready to stop using crutches.

Wound Care and Dressings

• Some bleeding and fluid leaking is normal for 24 to 36 hours. Change or reinforce the dressing as needed.
• Change the 4 by 4 gauze every other day, or daily if it gets wet or soiled.
• On day 3 you may remove your dressings and cover each incision with a regular band-aid, just enough to cover the incision itself.
• Do not use ointments, betadine, or peroxide.
• Do not touch, remove, or clean steri-strip tapes if they cover your incision. They help the wound close.
• Suture removal and a healing check happen at your 2 week visit. A small suture tag, if present, is removed then.

Your Medications

• Percocet 10/325 mg Narcotic pain
  Take 1 to 2 pills as needed every 6 hours, usually for the first 2 weeks. After that, if pain continues, a non-narcotic option (Tramadol) plus Tylenol and NSAIDs may be used.
• Mobic 15 mg NSAID, anti-inflammatory
  Take 1 pill every 12 hours for the first 2 weeks.
• Colace 100 mg Stool softener
  Take 1 tablet 2 to 3 times a day while taking pain medication, which often causes constipation.
• Zofran 4 mg Anti-nausea
  Take 1 tablet every 6 hours as needed for nausea, which can follow anesthesia.

Swelling and Elevation

• Expect more swelling on days 1 to 3 than on surgery day. This is normal. It improves with the anti-inflammatory, the ice machine, and, most importantly, keeping the leg elevated.
• Swelling makes the knee harder to bend. As it goes down, your motion gets easier.
• Swelling and bruising may spread to the calf and even the foot over the next week. This is normal and due to gravity.
• Some numbness near the incision is normal and may last 6 to 12 months.
• Keep the leg elevated. In bed, keep it straight with a pillow under the ankle, not under the knee. When sitting a while, raise the leg and foot above heart level, and do not let the foot hang down.

Bathing

• Keep your wounds completely dry for the first 7 to 10 days.
• Cover the knee with a waterproof bag to shower. It can be slippery, so be careful. Dr. Jazayeri prefers you keep the brace on in the shower under the bag. At 2 weeks you may remove the brace to shower.
  Tip: cut a small hole in the bottom of the bag so your foot rests on the shower floor and does not slip.
• No hot tubs or ocean for 4 weeks after surgery.

Range of Motion and Rehab

• Start your home exercise program the day after surgery, progressing as tolerated.
• Remove the brace 4 to 5 times a day to bend and straighten the knee, lying in bed or on the floor and sliding your heel toward your buttock. Aim for 15 to 20 minutes per session and at least 1 hour a day total.
• Your main goal is full extension and 90 degrees of flexion by 2 weeks. Fully straightening the knee is the most important motion in the first 2 to 3 weeks. A towel under your ankle helps keep it straight.
• Use the MyHealthTrack app to guide your rehab starting the day after surgery. Switch from the PRE ACL track to the POST ACL track; you may need to log back in.
• In-person physical therapy usually starts about 2 weeks after surgery. Combining the app and in-person PT gets the most out of your recovery.
• Confirm your physical therapy appointment is scheduled by calling the office at (310) 746-5918.

Driving and Return to Work

• Arrange transportation for discharge. It is not safe or legal to drive while taking certain prescription pain medications.
• Left knee, automatic transmission: you may drive once you can comfortably get the leg in and out of the car, usually by 2 weeks.
• Left knee, manual transmission: wait until you have good muscle control, usually 3 to 4 weeks.
• Right knee: wait until you have good muscle control, usually 4 to 5 weeks.

• Rest is part of recovery. Rest the knee, keep it elevated, and ice as much as possible. Do not overdo it.
• Sedentary work or school: return when you feel up to it, your pain medication needs drop, and you can walk safely on crutches, usually 5 to 10 days.
• Heavy or physical jobs (for example police, fire, construction, or labor): expect a minimum of 6 to 12 weeks off.

Return to Sport

• 2 weeks Stationary bike
  Low resistance, once you have enough motion for a full pedal cycle
• 3 to 4 months Jogging
• 5 to 6 months Running
• 6 to 8 months Agility and cutting
• 12 months Full return to contact sport