Anterior Cruciate Ligament (ACL) Reconstruction is usually an
outpatient procedure. It is usually performed under general anesthesia. The surgery itself takes about an hour to an hour and one-half. Surgery is performed through one small incision (about three inches in length) in the front of the knee. This incision is used to remove the tendon that will be used for the reconstruction (the patellar tendon). A small telescope (the arthroscope) is used to perform and view the rest of the surgery. The arthroscope is connected to a tiny camera, allowing the surgery to be viewed on a TV monitor. The entire inside of the knee can be examined with the arthroscope and any other damage that is found can be addressed at the time of the ACL reconstruction. Many different types of surgery can be performed, the most common of which are to remove meniscal (cartilage) tears, shave down arthritic areas, and remove loose fragments of tissue within the knee.
Before surgery, preoperative evaluation is necessary. The extent of the testing depends on each patient's age, gender and medical condition.
Everyone needs at least a history and physical examination which will usually be performed at your primary doctor's office. All females need at
least a blood count, and many patients will need other blood work or a cardiogram (EKG). Our office will order the specific tests needed on an individual basis. Instructions for scheduling your pre-admission testing (PAT's) are included in a separate instruction sheet from our office.
You will be seen in the preoperative area before your surgery to answer any questions you may have. Dr. Vernace will mark your knee with his initials to identify the correct knee for surgery. From the time you leave the preoperative area and walk back to the operating room to the time you are in the recovery room will be approximately 90 minutes. You will be in the recovery room for approximately 1 hour. Someone will need to drive you home that day. You are not allowed to drive for 24 hours after anesthesia.
At the time of your surgery, a complete and thorough evaluation of any and all abnormalities in your knee will be carried out. Any of those that can be corrected will be addressed at the same time as your ACL reconstruction.
Photographs will be taken that will be shown to you at your follow-up visits. These will be a permanent part of your office and hospital record.
Your incision will be closed with a buried stitch under your skin, which is removed ten days after surgery. You will be placed in a brace, which will be used for four weeks. Before you go home, someone from the physical therapy department will show you exercises to be done during the first
week after surgery.
At the end of your surgery, your knee will be injected with long acting Novocain (marcaine) into your knee. This should keep you fairly comfortable for several hours. Many patients actually feel better the first day of surgery than the next day due to the lingering effects of the marcaine. For this reason, you should limit walking on your operated leg for the first 24 hours. Use the crutches or a walker to get around the first day. You should use ice for the first few days for swelling and pain
control. Full instructions regarding icing, your dressings and pain medicine will be given to you at the hospital.
ACL RECONSTRUCTION POST-OPERATIVE CARE
The day after surgery is generally your worst day. Many patients say they are fairly comfortable the first day due to the marcaine injection. This is common and should not alarm you if your knee hurts more the day after surgery that it did the day of surgery. You are allowed to start putting weight on your leg the day after, using crutches as needed. Usually patients use crutches for 3 to 7 days after an ACL reconstruction. You may progress at
your own pace. The most important thing is to start bending your knee. This is much more important
that getting off the crutches.
As you continue to improve over the next several days you should bend your knee as much as possible. This should be done 3 or 4 times per day. Icing the knee at painful intervals even 4 or 5 days after surgery is helpful.
Taking over the counter medicines such as ibuprofen (Advil, Motrin, etc.) or Aleve is often helpful and can actually reduce your need for stronger pain medicine.
Returning to work depends on your specific job. Many patients who have desk jobs will be able to return to work within 4 to 7 days. Driving is restricted for a left knee until you are off narcotic pain medicine. For a right knee operation, driving is usually possible in two to three weeks.
You will return to our office ten days or so after surgery. At that time, you will be seen by Dr. Vernace or one of the physician assistants to check your incision. This appointment will be made at the time you scheduled your surgery. At the end of your first postoperative appointment, you will be given another appointment to return in 3 weeks.
ACL RECONSTRUCTION POST-OPERATIVE THERAPY
Once you are home, we want you to start outpatient physical therapy as soon as possible, as it is much more beneficial than home therapy. For those of you who live close enough to the office, we strongly recommend our therapy center, Founders Physical Therapy. We have chosen our therapists and therapy assistants for their experience, expertise and their warm and friendly manor in which they conduct their therapy sessions. They have over 40 years of combined experience and have
been recognized by many patients as the best therapy group on the main line. You will receive
individualized therapy, tailored to your needs. We work closely with them throughout your recovery. If you are having any difficulties, you will be right next door and the therapist and you will have easy access to your surgeon to promptly address any concerns. Our facility is arranged for your comfort and needs, with a full service bathroom and shower, plasma screen televisions and private treatment rooms to be used as needed by the therapists.
The phone number for the therapy office is 610-527-3300.
Recovery from an ACL reconstruction takes months. You will be in a brace for four weeks. You will use crutches for about one week. Physical therapy will be needed for two to four months. Your knee will be swollen for many weeks as you work to regain your motion and strength. Don't be surprised if you have several setbacks along the way. Your overall improvement will be steady but there will be bumps on the road. Sometimes the most difficult part of the recovery is in the third month or so, when your knee feels strong enough for activity but in actuality your new ligament is not strong enough to handle the stress of sports activities. You will need to be patient with your activity restrictions until you are fully recovered. Return to running will take three to four months and return to sports (tennis, skiing, basketball, etc) will take 6 to 9 months.