What does the process look like leading up to ACL reconstruction?
Dr. Ramkumar has a detailed process and checklist to ensure your safety prior to undergoing ACL reconstruction. ACL reconstruction is a specialized operation that requires specialized attention. Once you have decided to proceed with surgery, we check the following:
- Brace: you must get this before surgery and bring it with you on the day of surgery. If you are struggling to acquire one in a timely fashion, you can purchase it through Amazon Prime here.
- Physical therapy appointment: you should have an appointment for your first session in the second or third week after surgery
- Medications: you should have these picked up before you are discharged from the hospital
What equipment do I need?
Dr. Ramkumar requires a brace for at least 2 weeks after ACL reconstruction. This brace is locked straight in extension (fully straight) the first two weeks after surgery and is critical to a successful outcome. You must wear this brace at all times. This brace should be picked up before surgery. Dr. Ramkumar’s office will help you receive authorization, should your plan need this.
Do I need physical therapy?
Dr. Ramkumar believes early physical therapy is absolutely critical. You must have an appointment for your first postoperative appointment before showing up for surgery! This will be important for you to learn how to move safely, regain your motion, and slowly normalize your gait. Physical therapy will be a 9-month process, but it is increasingly important in the earlier phases of your post-operative recovery to restore your motion, improve flexibility, and build strength in a safe manner.
What do I need to focus on immediately after surgery?
There are three elements Dr. Ramkumar needs you to focus on immediately after surgery but before your first postoperative visit two weeks later:
- Wearing the brace. Your knee needs to be locked in extension (fully straight) at all times (even when sleeping!) during the first 2 weeks after surgery. If you fail to do this, it becomes very difficult – and sometimes impossible – to get your knee fully straight ever again.
- Bending your knee. You need to work on your motion so that you can bend it to 90 degrees by the time you see Dr. Ramkumar at 2 weeks postoperatively. When you are in a safe environment at home, you can remove your brace and gently bend your knee to work on regaining motion. If you do not take this seriously, you may need another surgery to break up scar tissue.
- Breaking up scar tissue. This sounds more painful and difficult than it actually is! All you need to do is take your kneecap (patella) and move it around so that it can freely move. Scar tissue can quickly build up under the kneecap during the early phases of recovery after ACL reconstruction. Your simple efforts to manually mobilize your patella can break up scar tissue and prevent the need for future surgery.
How do you address pain management and nausea after ACL reconstruction?
Dr. Ramkumar prescribes you the following medications
- Ondansetron (4-8mg) for the first week of surgery: anti-nausea
- Naproxen (500mg) twice daily for the first two weeks after surgery: anti-inflammatory medication to be used on the 5th postoperative day after completing the course of indomethacin; do not take naproxen and indomethacin on the same day
- Norco (Hydrocodone-Acetaminophen) (5-325mg) every 6 hours for the first week after surgery: medication for breakthrough pain; take this scheduled for the first two days after surgery
- Colace (100mg) twice a day while on narcotics (Norco): stool softener medication
- Aspirin 81 mg once daily: to prevent harmful blood clots for the first two weeks when you may be less mobile although you should up and moving immediately after surgery
Between all the medications and physical therapy, what do the first few days look like after ACL Reconstruction?
Below is a table that has been designed as a guideline. If you do not have some medications listed here, you may ignore them or take as directed on your discharge instructions.
GENERIC (BRAND): Hydromorphone (Dilaudid), Acetaminophen (Tylenol), Omeprazole (Prilosec), Tramadol (Ultram), Naproxen (Aleve), Docusate (Colace), Sennosides (Senna), Ondansetron (Zofran), Indomethacin (Indocin)
| Time | Activity | Detail |
|---|---|---|
| 0200 | Medication | Norco 5-325mg (AS NEEDED) for severe pain; can take up to 2 mg every 6 hours) |
| 0700 | Wake up Breakfast | Naproxen 500 mg (Drink at least 8 oz. of water) Aspirin 81 mg (Prevent blood clots), Ondansetron 4mg (Anti-nausea) |
| 0800 | Medication | Colace 100 mg (Stool softener- take with breakfast) Norco 5-325mg (AS NEEDED) for severe pain; can take up to 2 mg every 6 hours) |
| 0900 | Medication | Dilaudid 2-4 mg (AS NEEDED for severe pain; can take up to 4 mg every 4 hours) |
| 1000 | Rehab | Walk in brace, Patellar mobilization |
| 1030 | Rehab | Range of motion out of brace |
| 1130 | Rehab | Ice and Elevate (Ice-20 min on, 20 min off) |
| 1200 | Lunch | (Drink at least 8 oz. of water) |
| 1230 | Nap | Keep brace on |
| 1400 | Medication | Norco 5-325mg (AS NEEDED) for severe pain; can take up to 2 mg every 6 hours) |
| 1500 | Medication | Ondansetron 4mg (Anti-nausea) |
| 1600 | Rehab | Walk in brace, Patellar mobilization |
| 1630 | Rehab | Range of motion out of brace |
| 1700 | Rehab | Ice and Elevate |
| 1800 | Dinner | Naproxen 500 mg (Drink at least 8 oz. of water) |
| 2000 | Medication | Norco 5-325mg (AS NEEDED) for severe pain; can take up to 2 mg every 6 hours) Colace 100 mg (Stool softener- take with dinner) |
| 2100 | Rehab | Range of motion out of brace |
| 2230 | Bedtime | (Try to get 8 hours of sleep) |
When can I drive after ACL reconstruction?
Patients usually feel comfortable to drive between 2-4 weeks after surgery. Dr. Ramkumar cannot formally know when you are safe to drive but he has the following criteria:
- No longer taking prescription narcotic medications such as Norco
- Walking without assist devices (crutches) for a week.
- You feel comfortable enough to slam on the brake.
What does the postoperative recovery look like after ACL reconstruction?
Your exact postoperative recovery protocol will depend on how the meniscus looks at the time of reconstructing your ACL. If your meniscus is not repaired, you can place the full weight of your leg on the ground immediately after surgery. If your meniscus does require a repair, you must limit the weight bearing on your leg for just balance. This is referred to as “toe touch weight bearing” and means your toes may rest on the ground while sitting or standing but you cannot place weight on this leg.
Week by week details for your recovery can be found here.
