After arriving home from the hospital after your surgery, the care of the extremity is vitally important. The extremity should be elevated so that the knee is slightly higher than the position of the heart. I prefer that the elevation be placed under the thigh, calf and under the ankle so that the back of the knee remains free and allows you to work on gaining extension or straightening of the knee. You can get up to go to the bathroom, but other than this, most of the time should be spent lying down either in a bed or on a sofa with elevation of the extremity. This will go on for approximately five to six days after surgery. When you do get up, you can place as much weight on the operated extremity as pain allows, unless otherwise instructed. Please leave the dressing and brace intact and dry. The polar care can be used 14-16 hours in a 24-hour period (longer if you desire).
Your continuous passive motion machine should arrive at your house the day you coume home from surgery. I prefer the patient use the CPM device 1 to 1 1/2 hours, two times per day. It should be set at the slowest speed. When you first go home, set the flexion at approximately 45 degrees, but you can try to gradually work up to 65 or 75 degrees during the ensuing days until you return to my office.
I also would like you to work on passive extension of the extremity. A family member needs to place one hand on the front of the thigh, just above the kneecap area, and one hand under the heel and ankle. With gentle pressure on both areas, you try to lock the knee out into full extension. It is very important that you work on your ability to straighten the knee passively right from the beginning of your recovery. Inability to gain full extension of the knee after ACL surgery can be a problem. I expect you to work on passive extension approximately 3 times per day (do 5 extensions each session). The passive extension should be held for 1-2 seconds each time it is done. Passive extension can also be obtained by pushing toward the floor on the brace hinges. Also, place your foot and ankle on the foam block 2 times a day for 15 minutes each time.
I encourage range of motion of the foot and ankle to lessen swelling. Quadriceps setting and straight leg raising should aslo be done.
You will go home with pain medications. It will be a narcotic that can be used approximately every 4 hours. You also will receive an antibiotic- use as directed.
I would expect you to call my office (298-4417) to make an appointment to see me back for a follow-up visit as directed at the tome of the surgery. I also will have you call 395-3900 for your first physical therapy appointment. Every attempt will be made to coordinate your first follow-up visit to see me with your physical therapy visit.
Certainly, if any questions arise, please call me. I also would call the office if a temperature persists that is greater than 100 degrees (F), if pain is becoming increasingly severe, or if you are experiencing any numbness or tingling in the extremity.
My office staff and I will be happy to guide you in your recovery in any way that we can.
Article by Frank P. Mannarino, M.D.