Discharge Instructions & Physical Therapy Protocol for ACL Reconstruction Quadriceps Tendon

Recovery after knee surgery entails controlling swelling and discomfort, healing, return of range-of-motion of the knee joint, regaining strength in the muscles around the knee joint, and a gradual return to activities. The following instructions are intended as a guide to help you achieve these individual goals and recover as quickly as possible after your knee surgery.

Comfort

• Elevation - Elevate your knee and ankle above the level of your heart. The best position is lying down with two pillows lengthwise under your entire leg. This should be done for the first several days after surgery
• Swelling - A cooling device may be provided to control swelling and discomfort by slowing the circulation in your knee. Initially, this can be used continuously for the first 3 days, (while the initial post-op dressing is on). After 3 days, the cooling device should be applied 3 times a day for 10-minute intervals. If a cooling device is not provided at the time of surgery, place crushed ice in a plastic bag over your knee for no more than 20 minutes, three (3) times a day
• Pain Medication - Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication
• Antibiotic Medication - If an antibiotic has been prescribed, start taking the day of your surgery. The first dose should be around dinnertime. Continue taking until the prescription is finished
• Driving - Driving is NOT permitted for six weeks following right knee surgery

Activities

• Range-of-Motion - Move your knee through range of motion as tolerated. This must be done while sitting or lying down
• Exercises - These help prevent complications such as blood clotting in your legs. Point and flex your foot and wiggle your toes. Thigh muscle tightening exercises should begin the day of surgery and should be done for 10 to 15 minutes, 3 times a day, for the first few weeks after surgery
• Locking Knee Brace - The brace is to be worn for up to 4-6 weeks following surgery. It will be locked straight until bone healing and good knee strength have been achieved, (usually 6 weeks after surgery). At that time your doctor will determine if your leg has enough strength to allow your brace to be unlocked. You may unlock the brace while sitting but lock the brace before standing. Sleep with the brace on until directed by Dr. Forsythe
• CPM - (Continuous Passive Motion Machine) - A Continuous Passive Motion (CPM) machine should be started the day after your surgery. This machine will be set at 30°. Motion on the machine should be increased at 10-15° per day or as much as tolerated, to a maximum of 110° in one week. The machine should be used 6 hours per day (i.e. 2 hours in the morning, 2 hours in the afternoon and 2 hours in the evening). Use of the machine will continue for 1-2 weeks, or until maximum flexion of the machine is reached (110°). DO NOT WEAR LEG BRACE OR COOLING DEVICE WHILE USING CPM MACHINE
• Weightbearing Status - You are allowed to put all of your weight on your operative leg using your brace in the locked straight position. Do this within the limits of pain. Two crutches should be used until directed to discontinue by Dr. Forsythe
• Physical Therapy - PT should be started 3-5 days after surgery. You should call the physical therapist of your choice for an appointment as soon as possible after surgery. A prescription for physical therapy, along with physical therapy instructions (included in this packet) must be taken to the therapist at your first visit
• Athletic Activities - Athletic activities, such as swimming, bicycling, jogging, running and stop-and-go sports, should be avoided until allowed by your doctor
• Return to Work - Return to work as soon as possible. Your ability to work depends on a number of factors - your level of discomfort and how much demand your job puts on your knees. If you have any questions, please call your doctor

Wound Care

• Tub bathing, swimming, and soaking of the knee should be avoided until allowed by your doctor - Usually 2 - 3 weeks after your surgery. Keep the dressing on, clean and dry for the first 3 days after surgery
• Remove the dressing 3 days after surgery. The steri-strips (small white tape that is directly on the incision areas) should be left on until the first office visit. You may apply band-aids to the small incisions around your knee
• You may shower 5 days after surgery with band-aids on. Apply new band-aids after showering

Eating

• Your first few meals, after surgery, should include light, easily digestible foods and plenty of liquids, since some people experience slight nausea as a temporary reaction to anesthesia

Call your physician if

• Pain in your knee persists or worsens in the first few days after surgery
• Excessive redness or drainage of cloudy or bloody material from the wounds (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor
• You have a temperature elevation greater than 101°
• You have pain, swelling or redness in your calf
• You have numbness or weakness in your leg or foot

Return to the office

• Your first return to our office should be within the first 1 - 2 weeks after your surgery. Call your physician’s office to make an appointment for this first post-operative visit

Rehabilitation Program for Arthroscopic Anterior Crutiate Ligament Reconstruction Using Quadriceps Tendon

0 - 1 WEEK

• Full ROM obtain at time of surgery
• Knee dressed and braced in full extension, use Cryo-Cuff for 3 - 6 days
• Active flexion and extension exercises
• Closed chain ROM
• Crutch ambulation with WBAT
• Prone extension stretch
• Avoid hyperextension
• Active straight leg raise

1 - 2 WEEKS

• Wound check/suture removal
• May remove brace for sleep and shower only when approved by physician
• “Good-leg” assisted ROM, if unable to achieve active ROM
• Continue protected weightbearing with crutches, progress to FWB in brace locked in extension
• Straight leg exercises
• Make sure terminal extension is achieved
• Patella mobilization
• Remember hips and contralateral leg strengthening
• 1/3 knee bends with current weightbearing status
• Kinetic chain strengthening

2 - 4 WEEKS

• Continue use of brace locked in extension during ambulation
• Advance slowly to full weightbearing with crutches
• Stationary bicycling/stair master
• 1/3 knee bends with weightbearing
• Leg press, leg curls, isotonic hams with T-band
• Selective aqua therapy for effusion control, ROM and begin strengthening

4 - 8 WEEKS

• Wean off crutches, if approved
• D/C brace at 6 weeks except for high risk
• Keep and maintain ROM
• Start bent knee light (2 - 3lb.) weight at proximal tibia, full ROM
• Continue exercises as above
• Stationary bike encouraged
• Continue patellar mobilization
• Pool exercise (walking/bobbing)

8 - 10 WEEKS

• Progressive resisted extension exercises
• Gait training
• Treadmill walking - forward, backward, uphill

10 - 12 WEEKS

• Isokinetics through pain free/crepitation free ROM

3 - 5 MONTHS

• Proprioceptive exercises, (i.e., BAPS, squats with surgical tubing, Stair Master, mini-tramp, treadmill with T-bank, BAPS with T-bank, ski machine, Euroglide) figure-of-eight and stairs-running test

4 - 6 MONTHS

• Running program straight ahead, if approved and effusion is gone
• Strength evaluation

6 - 8 MONTHS

• Stability evaluation, if required
• Triple jump test, stairs hopple test
• Individual progression (sport-specific)
• Figure-of-eight start/stop
• Skill drills endurance, coordination/proprioception training
• Strength test - full ROM
• Jump rope
• Paced sport return depending on sport and individual progress

NOTE: These are guidelines and individual rehabilitation will need to be changed depending on progress. The final decision is based on mutual agreement between patient, therapist and physician.