Fb.873.an86 anterior cruciate ligament surgery readers spreads.indd

Anterior Cruciate
Ligament Surgery
Anterior Cruciate
Ligament
Table of Contents
General Information . 1Preparation for Surgery . 1Day Before your Surgery . 2Day of your Surgery . 2After your Surgery . 3Discharge Information . 4 After an Anaesthetic . 4 Pain . 5 Bleeding . 6 Swelling . 6 Bathing . 6 Activity/Rest . 7 Use of Crutches . 7 Muscle Spasms . 8 Nausea . 8 Urinating . 9 Diet . 9Helpful Tips while on crutches . 9Follow-Up Appointment . 10Notify Doctor or Go to Emergency if. . 10Exercises . 11 Knee Straightening . 11 Kneecap (Patellar) Movement . 12 Knee Swings . 13 Knee Bending . 14 Hamstring Strengthening . 15 Quads Strengthening . 15Notes . 16 General Information
Day Before Your Surgery
The Anterior Cruciate Ligament (ACL) plays an important • On the day before your surgery, the hospital will notify part in knee stability. It is the strongest ligament in the you of the time you should arrive at the Admitting knee and allows you to stand, walk and run.
Anterior Cruciate Ligament Surgery involves providing • Unless you are told otherwise, DO NOT eat solid food or the damaged ligament with additional tendon support or alcohol after midnight the night before your surgery.
replacing the ligament with a tendon. This replacement tendon can be taken from the same knee area, the opposite • Bathe or shower with soap either the evening before or knee, or rarely, a synthetic ligament may be used.
Preparation for Surgery
Day of Your Surgery
Prior to your surgery date:
• You may drink CLEAR FLUIDS (apple and cranberry juice, water, coffee or tea {no cream}) jello, clear pop • Purchase/rent crutches as you may need to use these to
(cola, ginger ale) up until 3 hours before your arrival at protect your knee for several weeks after surgery.
the hospital. (e.g.told to arrive at 10:00 a.m. - you can • Make arrangements for a responsible person to take you drink clear fluids until 7:00 a.m.). home and someone to stay with you overnight if your • You are then NOT to drink or eat anything (including doctor has told you that you will go home on the same water, gum and candy) until after your surgery unless Your doctor may also instruct you to:
• You will be admitted to the Ward or Surgical Day Care.
• Purchase an Ice Compression Device (used to decrease pain and swelling) and Knee Brace if necessary. • Bring your Medications, Crutches, Ice Compression (Examples of ice compression devices available are Cryo- Device and/or Brace to the hospital with you.
cuff, Polar Care Cub etc. Please read the package insert which explains how to use them.) • An intravenous may be started before your surgery through which you may receive antibiotics.
• Purchase medications (Anti-inflammatory, Pain • Approximately 30-45 minutes before your surgery, a porter will take you on a stretcher to the pre-operative • Have blood tests drawn as ordered by your physician.
care area. A nurse will be present to discuss any of your concerns.
• The intravenous will be left in place until you are able to drink fluids and have received the last dose of antibiotic • You will be seen by an anaesthetist prior to surgery. This is a good time to ask any questions concerning your • Once you are able to drink clear fluids, you may start to anaesthetic. (p.s. writing your questions down will help • The nurse will help you to get up out of bed the first time.
• From the pre-operative area, you will be moved into the • When you are feeling well enough, you will be discharged.
Operating Room where the Anaesthetist and your doctor • A doctor or resident will inform you about a follow-up • A General or Spinal Anaesthetic will be used during surgery. Your knee will be “frozen” with local anaesthetic Discharge Information
which will wear off later in the day.
After an Anaesthetic
• The Ice Compression Device and/or Brace if required, will If you have had a general anaesthetic, the effects persist for be put onto your knee when the operation is finished.
many hours. The following precautions are advised by your anaesthetist: After Your Surgery
a) Do not drive your car for at least 24 hours.
After your operation you will be taken to the Recovery Room. If you are involved in a car accident after surgery and A nurse will check your blood pressure and pulse frequently. it can be shown that your ability to drive carefully You will wear an oxygen mask for a short (brake suddenly, etc.) was affected by your knee period of time. It is important to indicate to your nurse if you condition, then your insurance claim might not be are having pain or feel sick to your stomach. Your nurse will valid. Take this into account when you are considering give you medication as ordered by your doctor. When you are your ability to drive. Consult with your doctor. ready, a porter will take you to your room.
• Your leg/foot may appear pink in colour. This is because b) Do not drink alcohol or take recreational drugs for the it has been washed with a pink tinged antiseptic in the first 24 hours following surgery and/or when taking pain medication (harmful interactions could occur with the • Your nurse will be checking the circulation to your foot medications you received during surgery and/or with the • Notify your nurse if you notice any numbness, tingling, c) Do not make any important decisions (i.e. sign important d) Have a responsible person stay with you overnight if discharged on the same day as your surgery.
The elastic bandage may also have padding under it. The sensation of “splashing” of fluid in the knee is normal If the bandage feels too tight or you feel numbness and and will gradually disappear. Take the pain medication as tingling in the foot, loosen the padding/ bandage. ordered by your doctor. Before taking any medications, discuss with your doctor any allergies that you may have.
Do not expose the wound until you see your doctor at If you experience any adverse effects, stop the
medication and notify your doctor.
Bleeding
If bleeding occurs, apply pressure for 10 -15 minutes or until
Do not drink alcohol when taking pain medications.
the bleeding stops.
If bleeding continues, call an ambulance as needed.
Bandage
You will have an elastic bandage on your knee. It may be:
Swelling
a) A tube like sock from mid calf to thigh. Ensure that
Your knee may be swollen and somewhat uncomfortable for this does not get wrinkled behind your knee. This should a period of time after your operation. This is normal.
not be removed until you see your doctor.
To reduce swelling: May begin on day of surgery b) A wrapped tensor bandage (mid calf to mid thigh).
b) apply covered ice (or cryocuff) for 15 minutes This should be removed and rewrapped twice a day, from the mid calf to the lower thigh. This can also be removed c) A brace and toe to thigh tensors.
Do not adjust the bandage or brace unless the elastic bandage is loose or falling off – position your leg comfortably and rewrap from toe to thigh, reapply your brace with the hinges at the level of your kneecap.
a) Do not shower until okayed with your doctor. You will This bandage does not need to be changed until your follow-up appointment unless it gets wet.
b) For a tub bath, put 2-3 inches of water in the bottom of the tub and sit with your operated leg on the rim of the tub or on a footstool in the tub.
If your bandage gets wet, it must be changed to prevent • You should walk as normally as possible, using the infection. Contact your doctor's office to arrange a bandage crutches to take weight off your repaired leg as needed change or go to the Emergency Department if necessary.
(i.e. walk, not hop with crutches).
• Managing stairs with crutches can be difficult, so use Activity/Rest
a railing whenever possible and hold the extra crutch Recovery after surgery is gradual. It is normal to feel weak sideways along with the remaining crutch (or let and to tire easily during your first week or two at home. Alternate your periods of rest and activity.
To improve the movement and circulation to your foot and Remember when going…
leg, we encourage you to move them frequently.
The purpose of this surgery is to improve the function of your knee. To regain movement and strength, it is important and necessary that you follow the exercises starting on page 11.
Use extra pillows to support your leg while in bed for the first 48 hours only. Following this time period, rest with your leg straight.
Muscle Spasms
If sitting for long periods, rest your leg on a couch or stool. A few people experience hamstring muscle spasms in the Ease your knee into a straight position.
back of the leg after surgery. These symptoms are due to the contraction of the cut tendon in this area. Sitting upright Plans for returning to work are dependent on the nature of with your leg elevated high can cause this spasm. Laying your job as well as your general health and recovery. Discuss flat and putting covered ice on your knee usually helps. This spasm does not hurt your surgical area and it is important to continue your exercises.
Use of Crutches
• At first walk using the crutches at all times to protect
Feeling sick to your stomach can sometimes be bothersome • Unless you are told otherwise, start by putting a little after surgery. If you experience nausea, we advise you to weight on your repaired leg and gradually increase to full drink clear fluids and take over-the-counter Gravol by weight-bearing after two to three weeks.
mouth or suppository following the package instructions, • The crutches come forward at the same time as your
unless your doctor states otherwise. Gravol is the trade repaired leg, followed by a step through with your name for dimenhydrinate. (It may be less expensive if requested by the name dimenhydrinate at the Drug Store).
Urinating
Follow-Up Appointment
If you are unable to pass urine and your bladder is hurting, If a follow-up appointment has not been arranged, call the put warm washcloths on your lower stomach or pour doctor's office/Sports Medicine Clinic to arrange a follow-up luke warm water over your genitals to allow your body to relax and let the urine come out. If you continue to have difficulties go immediately to the Emergency Department.
During this doctor's appointment, discuss any Physiotherapy required, use of crutches, bathing instructions, progression of weight bearing activities and eventual return to activities including sports and work.
Remember that a well-balanced diet is important for wound healing. You may eat when you feel like it but take small amounts at first.
Notify the Doctor or
Include high fiber and plenty of fluids in your diet to prevent go to the Emergency Department
constipation especially if taking Tylenol #3's or Codeine. if any of the following happens
• pain unrelieved by your prescribed medication • bran cereals (All Bran, Bran Buds, Fruit & Fiber) • pus-like (yellow or green) drainage from your knee • fruits (prunes, raisins, dates, bananas, apples) • vegetables (broccoli, corn, beans, potatoes) • numbness, tingling, coolness or change in colour to your leg/foot (ie. calf pain, difficulty moving toes/ankle up Ask your doctor or pharmacist about a mild laxative or stool • continued severe swelling in your leg/foot After surgery, while on crutches,
• chills or fever (38.5°C/101.3°F or higher) you may find the following tips helpful
• you have (unusual for you) shortness of breath or 4. Carry sealed beverage containers (use caution when 5. Don't stand on your feet for long periods of time 6. If your leg is swollen, elevate it as needed. (see page 6) Exercises
Knee Straightening (cont'd)
You must do these exercises to maintain or improve your knee movement and prevent stiffening. These movements • NEVER force or bounce your knee straight, or are all passive which means they should be performed using the unrepaired leg or gravity to assist. It is normal to have some discomfort during movement. Use ice to control pain and swelling. Apply to your knee for 10 minutes prior to exercising.
• Begin these exercises gently the day of surgery and • If you have difficulty understanding or doing these exercises, contact the physiotherapist that you will be seeing for your knee rehabilitation program or contact your surgeon.
Kneecap (Patellar) Movement
• Sit with your leg supported on a bed or couch.
Some of these exercises require an elastic resistance.You can use a black theraband (can be purchased at a sporting shop), • Place a small towel under your knee.
rubber tubing (hardware store) or a bicycle inner tube • With your thumbs, move your kneecap from side to • Your thigh muscle (quadriceps) must be relaxed and Knee Straightening
• Repeat 10 times each way, 4 times a day.
• Rest your leg on a bed, couch or floor and slowly ease knee into a fully straight position.
Side to Side
Knee Swings
Knee Bending
• Sit on a bed or chair that is high enough to let your The following exercise will help with bending
your knee.
• Cross your ankles with the repaired leg in front.
• Breathing in, straighten your repaired leg by lifting • Cross your ankles with the repaired leg behind.
with the other leg until your knee is as straight as • Breathe out as you gently ease your repaired leg into • Breathing out, slowly lower leg allowing your knee a bent position by pressing back with the other leg, to bend as far as possible up to a right angle (90°). but no further than a right angle (90 degrees) or the DO NOT bend further than this.
• Keep the repaired leg relaxed. Rest your hand on • Relax and hold bent position for 5 seconds.
your thigh to check that the muscle stays relaxed and use deep breathing.
Starting Position
Lift & Straighten leg
Starting Position
Lower & Bend leg
Hamstring Strengthening
b) 1/4 Squats
• Wearing socks, sit in a chair and bend your repaired • Stand, hold onto a firm support for balance.
leg by sliding your foot along the floor for resistance.
• Progress by bending your repaired leg back against about a 45 degree angle, then stand straight.
Quads Strengthening
a) Leg Press
• Sit with your leg supported on a firm surface and • Bend your knee towards your chest as far as you are able, then straighten your knee by sliding your heel on the supporting surface for resistance.
• Progress by pushing against an elastic resistance.
• Repeat 10 times, 4 times a day.
Bend to 90° (right angle)
Straighten
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Catalogue No.FB.873.An86
The information in this document is intended solely for the person to whom it was given by the health care team.

Source: http://www.asc-vancouver.ca/Anterior_Cruciate_Ligament_Surgery.pdf