Page ContentPost Operative Instructions for ACL SurgeryAnup Shah, M.D. Jeffrey Whelan, M.D.You have just had major surgery to reconstruct the Anterior Cruciate Ligament and possibly one or more of your menisci, if applicable. You may have three or more incisions on your knee. You will have TED hose on both legs and an immobilizer on your operated leg. You should expect from 9 to 12 months of dedicated rehabilitation to return your knee to pre-injury status. The instructions below are to be followed in part or whole for the first 6-8 weeks unless modified by Dr. Shah, Dr. Whelan. Ice, Crutches and Immobilizer: Place a towel on your knee and then position ice on your knee and elevate your leg above the heart to reduce swelling for the first 72 hours (you can use a bag of frozen peas instead of a bag of ice). Your crutches and immobilizer will be used for six weeks to help protect your knee. You can apply full/partial weight to your leg as soon as you can do so comfortably or unless otherwise instructed. Dressings: The bandages on your knee are bulky to absorb any drainage that may come from your incision points. Keep your dressings in place until you follow up with your doctor in 2 to 3 days. Change your dressings with two 4x4 gauze dressings and secure them with either medical tape or a lightly wrapped ace bandage. TED Hose: The TED Hose are to be worn at all times, except for showering, on both legs for two days, however the operated leg should extend to a week duration. Showering: Keep the incisions dry for the first 7 days by covering the knee with plastic wrap when you shower. After 7 days you may shower without covering the incision, however DO NOT soak the incisions.Medication: You may be given up to four or more different medications, i.e.: sleep, antibiotics, pain, swelling and possibly nausea. You will be instructed how and when to take these medications. Be sure to take your first does of pain medication as soon as you are released from ambulatory surgery center to help reduce postoperative pain. You should also take your medication before your physical therapy. Refills will be given as needed. Call if there are any adverse reactions to your medications. Activity: You may bend and straighten your knee as soon as you can do so comfortably or unless otherwise instructed. Exercising your leg and foot will help to reduce the swelling, as long as you do not over do it. Remember to use your crutches and immobilizer except when showering or exercising. Exercising and Physical Therapy: Do your exercises with your leg out of the immobilizer. Refer to your exercise sheet that is given with your discharge papers. Start your home program either tonight or in the morning, as comfort will allow. The most important initial exercise is straightening your leg after surgery. You should rest the foot of your operated leg on two or more pillows to elevate it above the level of your heart. There should be nothing underneath the knee to prevent the leg from straightening. This should be done for at least 20 minutes three or four times a day. Start Health South Physical Therapy within the first week of surgery. After 6-8 weeks of physical therapy, you will need a gym (YMCA or similar) to continue your workouts.Note: Exercise and weight bearing will be modified if there were any meniscal or cartilage repairs made. Here are a few to start with at home: Heel Slides: Pull the heel toward the buttocks, flexing the knee, and then straighten the leg by sliding the heel downward. Repeat to recommended repetitions by your physician. Quad sets: Sitting on the floor with your injured leg straight and your other leg bent, press the back of the knee of your injured leg against the floor by tightening the muscles on the top of your thigh. Repeat to recommended repetitions by your physician.Passive knee extension: Do this exercise if you are unable to fully extend your knee. While lying on your back, place a rolled-up towel underneath the heel of your injured leg so the heel is about 6 inches off the ground. Relax your leg muscles and let gravity slowly straighten your knee. Repeat to recommended repetitions by your physician. Office Follow-ups: You will return to the office 2 to 3 days after surgery. Further follow up visits will be arranged at that time. You should call the office at 713-442-0000 prior to discharge to schedule an appointment, if not already arranged. Please call the office for the following reasons: A temperature above 101 degrees after the first 2 days. (A temperature within the first 2 days of surgery may not be unusual) Marked redness or continued swelling around the knee. Excessive swelling of the calf, toes and or foot. Loosen the dressings around the knee and elevate the leg about the heart. Call the office if swelling continues. Purulent draining or excessive bleeding from the incision at the knee. A clear to pink discharge is usual for a few days. Excessive pain and not relieved by pain medication For question or concerns, please call our office at (713) 442-0000 during offices hours or (713) 442-4984 after normal office hours. We will be glad to answer any questions that have not been covered. Call the pharmacy for medication refills the day before you run out of medicine. Give the pharmacy the Kelsey-Seybold medication refill number if necessary. (713) 442-0272.