Patients are given a complete physical examination which provides an assessment of the patient's overall health.
An examination is given of the range of movement in both the injured and uninjured knee.
Strength and walking (gait) measurements and analysis.
Knee arthrometry is utilized to measure the tightness and stability of the knee.
Expectations for Recovery
A surgically rebuilt ACL which is rehabilitated properly will allow the patient to eventually regain complete strength, stability, motion, and control of the knee.
Patients that are in good physical condition are likely to recover within 7 months and will then usually be able to perform at previous levels of intensity.
Patients that are in poorer overall condition will also be able to return to previous activity levels, though rehabilitation and physical therapy will tend to be more lengthy and involved.
In all cases, physical therapy is required to restore the muscle strength, flexibility and balance lost during the injury and to acclimate the body to the repaired ligament.
Post Operative Recovery
Immediately after surgery, as anesthesia wears off, patients will usually feel tired and slightly disoriented, though the after-effects of anesthesia can vary greatly from patient to patient.
The knee will remain tender and painful after surgery. However, the pain will tend to decrease as pain killers are administered and the knee recovers from the operation.
Immediately following surgery, it is important that the knee obtains full extension. A continuous passive motion machine (CPM) may be used after surgery to help facilitate the movement of the knee, and the patient is given instructions on extension exercises for self-exercise at home.
At the first post-operative visit to the doctor, the sutures are removed, motion is examined, and the patient is directed to a physical therapist.
Braces are recommended until the patient has good control of the knee and can easily extend the leg and do deep knee bends without difficulty.
Close examination of the knee during the following 4-6 weeks is needed to ensure that the knee is correctly healing.
Patients should avoid putting a pillow under the knee. (This will tend to bend the knee and will prevent the full straightening of the joint)
More athletic activities like jogging are usually allowed after three months, though often only in a controlled environment as on a treadmill.
Sport-specific exercises are allowed according to their intensity level and strain on the recuperating knee.
Post Operative Instructions:
Wear the brace at all times, except when bathing or showering.
Bear weight as tolerated in the brace with the knee locked in full extension.
Use crutches as needed until stability returns.
Ice the knee three times a day for 20 minutes.
Keep the wound dry until the sutures are removed. If necessary, the dressing can be removed for showering (with the knee wrapped in plastic kitchen film) after 4 days.
Unlock the brace when using the continuous passive motion (CPM) machine doing exercises, or sitting.
Use the CPM machine for up to 8 hours daily. Start at 30 degrees. Progress in 5 degree as comfort allows. Discontinue using the CPM machine when the knee can bend to 90 degrees without using the machine.
Three times a day, for 30 minutes each time, sit with a large towel role under the heel with the brace locked in full extension.
It is normal to have some discomfort and swelling, as well as some blood-tinged drainage, following ACL surgery. If this becomes severe or the patients develops a fever, calf pain, shortness of breath, or chest pain, contact a doctor immediately.
Rehabilitation Program
Medication and Medical Products
NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
Pain resulting from inflammation or swelling.
Pain after injury.
Joint pain and arthritis.
Knee: Cold Therapy Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.
Cold therapy can be used to treat:
Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.
Knee Examples include:
Pre-operative ACL/PCL injuries.
Non-surgical ACL/PCL injuries.
General knee pain or swelling.
Soft tissue injuries.
Possible Complications and Risks
Risks during and after surgery include problems that may develop in relation to bleeding, the possibility of infection, and reactions to anesthesia.
Re-injury to the ACL is possible if physical therapy or other activities during rehabilitation are overly strenuous, causing damage to the recent tendon graft.
The patient may experience reduced mobility in the knee, even after the patient has followed physical therapy routines.
The knee may be subject to arthrofibrosis, the development of a fiber like material that the body sometimes generates in joints after injuries which can limit movement and cause stiffness.
Though the reconstructed ACL is often as strong as the original ligament, it will require a period of acclimation and will tend to remain robust if not subjected to abuse.
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