Anterior Cruciate Ligament Reconstruction

What is Anterior Cruciate Ligament Reconstruction

A ligament is a strong, cord-like band of tissue that connects one bone to another bone. The anterior cruciate ligament (ACL) connects one of your lower leg bones to your upper leg bone.

ACL reconstruction is a surgery to replace a torn ACL. During ACL reconstruction, your torn ACL is replaced with tissue from a ligament in another part of your body.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had.
  • Any medical conditions you have.
  • Any history of tobacco use.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs.
  • Failure of the procedure.
  • Knee stiffness.

What happens before the procedure?

  • Follow instructions from your health care provider about eating or drinking restrictions.
  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
  • You may be given antibiotic medicine to help prevent infection.
  • Ask your health care provider how your surgical site will be marked or identified.
  • Plan to have someone take you home after the procedure.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
    • Hair may be removed from the surgical area.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic).
    • A medicine to make you fall asleep (general anesthetic).
    • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
    • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • A small cut (incision) will be made in your knee.
  • A thin, flexible, tube-like instrument with a camera on the end (arthroscope) will be inserted into your knee joint.
  • Your torn ACL will be removed.
  • Tunnels in your upper tibia and femur will be created with large drills over guide wires or guide pins.
  • The graft will be pulled into the tunnels.
  • The graft will be inserted into your knee joint.
  • The graft will be secured in place in the tunnels with screws.
  • The incision will be closed with stitches (sutures), skin glue, or skin tape (adhesive) strips.
  • The incision may be covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • Do notdrive for 24 hours if you received a sedative.

Anterior Cruciate Ligament Reconstruction, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After your procedure, it is common to have soreness in the area where the surgical cut (incision) was made.

Follow these instructions at home:

If you have a splint or brace:

  • Wear the splint or brace as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint or brace if your toes tingle, become numb, or turn cold and blue.
  • Do notlet your splint or brace get wet if it is not waterproof.

Keep the splint or brace clean.

Bathing

  • Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers.
  • If your splint or brace is not waterproof, cover it with a watertight plastic bag when you take a bath or a shower.
  • Keep the bandage (dressing) dry until your health care provider says it can be removed.

Incision care

  • Follow instructions from your health care provider about how to take care of your incision. Make sure you:
    • Wash your hands with soap and water before you change your bandage. If soap and water are not available, use hand sanitizer.
    • Change your dressing as told by your health care provider.
    • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
  • Check your incision area every day for signs of infection. Check for:
    • More redness, swelling, or pain.
    • More fluid or blood.
    • Warmth.
    • Pus or a bad smell.

Managing pain, stiffness, and swelling

  • If directed, apply ice to the affected area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.

Leave the ice on for 20 minutes, 2–3 times per day.

  • Move your toes often to avoid stiffness and to lessen swelling.
  • Raise (elevate) the affected area above the level of your heart while you are sitting or lying down.

Driving

  • Do notdrive or operate heavy machinery while taking prescription pain medicine.
  • Do notdrive for 24 hours if you received a sedative.
  • Ask your health care provider when it is safe to drive if you have a splint or brace on your leg.

Activity

  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do notexercise your leg unless instructed to do so by your health care provider.

General instructions

  • Do notuse the injured limb to support your body weight until your health care provider says that you can. Use crutches as told by your health care provider.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have more redness, swelling, or pain around your incision.
  • You have more fluid or blood coming from your incision.
  • Your incision feels warm to the touch.
  • You have pus or a bad smell coming from your incision.
  • Any of your incisions break open after sutures or staples have been removed.

Get help right away if:

  • You feel pain when you move your knee.
  • You have a lot of pain in your leg when you move your foot up and down at your ankle.
  • You have a fever.

Anterior Cruciate Ligament Reconstruction, Phase I Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.  Do notbegin these exercises until told by your health care provider. Ask your health care provider if you should wear your brace while you do these exercises.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain, numbness, and stiffness.

Exercise A: Knee flexion, active-assisted

Lie on your back with both knees straight. If this causes back discomfort, bend your healthy knee so that foot is flat on the floor.

Slowly slide your left / right heel back toward your buttocks.

When you have gone as far as you can, use your other leg to gently slide your heel closer to your buttocks until you feel a stretch or until your leg is at a __________ degree angle.

Hold this position for __________ seconds.

Slowly slide your left / right heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Knee extension, sitting

Sit with your left / right heel propped up on a chair, a coffee table, or a foot stool. Do nothave anything under your knee to support it.

Allow your leg muscles to relax, letting gravity straighten out your knee. You should feel a stretch behind your left / right knee.

If told by your health care provider, deepen the stretch by placing a __________ lb weight on your thigh, just above your kneecap.

Hold this position for __________ seconds.

Rest your left / right foot on the floor and allow your muscles to relax after each repetition.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise C: Knee extension, prone

Lie on your abdomen on a firm surface, such as a bed.

Place your left / right knee just beyond the edge of the surface so your knee is not on the bed. You can put a towel under the far end of your left / right thigh for comfort.

Relax your leg muscles and allow gravity to straighten your knee. You should feel a stretch behind your left / right knee.

Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise D: Patellar mobilizations

Sit comfortably with your left / right leg slightly bent. It may help to place a folded washcloth under your knee.

Gently grasp the edges of your kneecap with your thumbs and index fingers.

Imagine your knee cap is a clock face. Keeping your leg muscles relaxed, gently use your thumbs and index fingers to slide your kneecap from the center to the 12 o’clock position until you feel some resistance but no pain.

Hold for __________ seconds.

Return your kneecap to the center.

Repeat the previous steps, but instead of sliding your kneecap toward 12 o’clock, move it to 3 o’clock, 6 o’clock, and 9 o’clock.

Repeat __________ times to each of the four clock positions. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise E: Quadriceps, isometric

Lie on your back with your left / right leg extended and your other knee bent.

Slowly tense the muscles in the front of your left / right thigh. You should see your kneecap slide up toward your hip or see increased dimpling just above the knee. This motion will push the back of the knee toward the floor.

For __________ seconds, keep the muscle as tight as you can without increasing your pain.

Relax the muscles slowly and completely.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Straight leg raises (

quadriceps)

Lie on your back with your left / right leg extended and your opposite knee bent.

Tense the muscles in the front of your left / right thigh. When you do this, you should see your kneecap slide up or see increased dimpling just above the knee. Your thigh may even shake a bit.

Keep these muscles tight as you raise your leg 4–6 inches (10–15 cm) off the floor. Do notlet your knee bend.

Hold for this position for __________ seconds.

Keep these muscles tense as you lower your leg.

Relax your muscles slowly and completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise G: Straight leg raises (

hip abductors)

Lie on your side with your left / right leg in the top position. Lie so your head, shoulder, knee, and hip line up. You may bend your bottom knee to help maintain your balance.

Lift your top leg 4–6 inches (10–15 cm) while keeping your toes pointed straight ahead.

Hold this position for __________ seconds.

Slowly lower your leg to the starting position.

Let your muscles relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Bridge (

hip extensors)

Lie on your back on a firm surface with your knees bent and your feet flat on the floor.

Tighten your buttocks muscles and lift your bottom off the floor until your trunk is level with your thighs.

Hold this position for __________ seconds.

Slowly lower your hips to the starting position.

Let your muscles relax completely after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Anterior Cruciate Ligament Reconstruction, Phase II Rehab

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your knee. These exercises also help to relieve pain and stiffness.

Exercise A: Quadriceps, prone

  1. Lie on your abdomen on a firm surface, such as a bed or padded floor.
  2. Bend your left / right knee and hold your ankle. If you cannot reach your ankle or pant leg, loop a belt around your foot and grab the belt instead.
  3. Gently pull your heel toward your buttocks. Your knee should not slide out to the side. You should feel a stretch in the front of your thigh and knee.
  4. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Hamstring, doorway

  1. Lie on your back in front of a doorway with your left / right leg resting against the wall and your other leg flat on the floor in the doorway. There should be a slight bend in your left / right knee.
  2. Straighten your left / right knee. You should feel a stretch behind your knee or thigh. If you do not, scoot your buttocks closer to the door.
  3. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your knee. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Plantar flexors, standing

  1. Stand with your feet shoulder-width apart.
  2. Keep your weight spread evenly over the width of your feet while you rise up on your toes. Steady yourself against a wall or table, but try not to use it for support.
  3. If this exercise is too easy, shift your weight toward your left / right leg until you feel challenged.
  4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Step-ups (

quadriceps)

  1. Stand in front of step, a thick book, or a step stool that is __________ tall.
  2. Slowly step up with your left / right foot, keeping your knee in line with your hip and foot.Do notlet your knee bend so far that you cannot see your toes. Hold onto a wall or a counter for balance, but do not use it for support.
  3. Slowly unlock your knee and lower yourself to the starting position using gravity, not your muscles.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Wall slides (

quadriceps)

  1. Lean your back against a smooth wall or door while you walk your feet out 18–24 inches (46–61 cm) from it.
  2. Place your feet hip-width apart.
  3. Slowly slide down the wall or door until your knees bend __________ degrees. Keep your knees over your heels, not your toes. Keep your knees in line with your hips.
  4. Hold for __________ seconds.
  5. Use your quadriceps to push you up to the standing position.
  6. Rest for __________ seconds after each repetition.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Hamstring curls

If told by your health care provider, do this exercise while wearing ankle weights. Begin with __________ weights. Then increase the weight by 1 lb (0.5 kg) increments. Do notwear ankle weights that are more than __________.

  1. Lie on your abdomen with your legs straight. You can put a towel above your left / right knee for comfort.
  2. Bend your left / right knee up to __________ degrees. Keep your hips flat against the floor.
  3. Hold this position for __________ seconds.
  4. Slowly lower your leg to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise G: Single leg stand

  1. Stand near a railing or in a doorway so you can use the rail or door frame for balance if you need to. If told by your health care provider, do this exercise without shoes.
  2. Stand on your left / right foot.
  3. Hold this position for __________ seconds.
  4. If this exercise is too easy, try doing it with your eyes closed or while standing on a pillow.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise H: Side stepping

  1. Stand in a hallway or large room.
  2. If told by your health care provider, loop an exercise band around your knees or ankles to increase resistance.
  3. Keep your toes pointing straight ahead while you step to your left / right side to move down the length of the hallway. Do notlet your knees go inward or over your toes.

Repeat for __________ steps or __________. Start with small steps, and take bigger steps as you get stronger. Complete this exercise __________ times a day.

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