ACL Surgical Information for Patients

The Anterior Cruciate Ligament, or ACL, is an important ligament that stabilizes the knee. If the ACL tears, the knee can be unstable, and give way on pivoting motions. You will now see information that you need to know for your anterior cruciate ligament surgery.

ACL Surgical Information for Patients Video Transcription

The Anterior Cruciate Ligament, or “ACL”, is an important ligament that stabilizes the knee. If the ACL tears, the knee can be unstable, and give way on pivoting motions. You will now see information that you need to know for your anterior cruciate ligament surgery.

As with any surgical procedure, there can be complications with ACL surgery. However, the incidence is fairly low. The knee can become stiff and lose motion. Since a patellar tendon graft temporarily weakens the kneecap, there is a risk of fracture of the knee cap until it heals. The risk of the graft stretching out or re-tearing is about 5%. The risk of deep infection is less than 1%. The incidence of clinically significant phlebitis, or blood clots in the veins of the leg, is in the same range. Other problems such as anesthesia complications, instrument breakage, artery or nerve injury, are rare but can occur. There are other potential complications that are even more infrequent. Precautions are taken to prevent all complications, but we must remember that they can occur in spite of all safeguards. We must weigh the risks against the potential benefits and alternatives in making a decision about having surgery.

In this video, we will describe your preparation for this procedure, how the ACL reconstruction is performed, and what you should do afterwards.

Several days before the surgery, start washing the knee frequently with soap and water. The skin has to be very clean, You can’t have any scratches, pimples, sunburn, or poison ivy. You don’t have to shave the area. We will do that when you arrive.

On the day before surgery, check in with the doctor’s office to find out what time you should report the next day. It is very important that you have nothing to eat or drink after midnight the night before surgery. You might want to put up a note as a reminder. Now let’s look at what you will do on the day of surgery.

The operation will be done either at Newton-Wellesley Hospital (200 Washington Street, Newton, MA), the New England Baptist Outpatient Care Center (40 Allied Drive, Dedham, MA), or at Boston Outpatient Surgical Suites (840 Winter Street, Waltham, MA). Please confirm the location with Dr. Gill’s office.

In the pre-operative area, the nurse or anesthesiologist will start an IV. You will then be taken into the operating room. The procedure is done arthroscopically. After your surgery, you will wake up in the recovery room. Your leg might be in a continuous passive motion machine, or “CPM”, that will move your knee very slowly. The knee will actually hurt less, and regain its motion more rapidly, if the CPM is used slowly and continuously, as directed by Dr. Gill.

You should use the CPM machine as directed in your instructions (www.bostonsportsmedicine.org). Keep the knee cool with your cryo-cuff, which is a cooling machine that is filled with ice water. Get out of bed frequently, but use the knee brace and crutches until the leg is painless and can support your weight. The CPM settings on the hand control should be “extension -5*. This means that the machine will allow the knee to hyperextend a little. It is important that the knee itself straightens all the way, NOT just the machine. The “extensor pause” button should be set for 5 seconds. This makes the machine pause for 5 seconds when it is straight. This gives you time to stretch your knee out straight once in a while. The speed can be set at whatever feels comfortable. The “flexion”, or how far the machine allows your knee to bend, should be whatever is comfortable. Start at about 40 to 60 degrees flexion and work your way up to 90-100 degrees in a few days (ideally 48 hours).

If an allograft is used, the CPM may or may not be needed. A knee immobilizer locked out straight should be kept on for the first week or two. Take off the immobilizer as needed to apply cold, or to gently move the knee. Use the immobilizer when in bed to keep the knee straight, or when walking. Use crutches, and put about half your body weight on the leg. It is OK to take off the bandages in 2 or 3 days to shower, but do not submerge in a bath tub or pool for 2 weeks.

Occasionally, another tissue is used for a graft, such as 1 or 2 hamstring tendons. You will receive separate instructions for these.

No matter which graft was used, the most important goal in rehabilitation after surgery is to get the knee straight (!). This is the hardest part, so if you get the knee straight early, the rest is easy.

Remember to wash the knee, and protect the skin before surgery. Also remember that you need an empty stomach at the time of anesthesia and surgery. Therefore, have nothing to eat or drink after midnight. Please make an appointment with Dr. Gill’s office about 10-14 days after surgery to have the stitches removed. Please re-read your written instructions (www.bostonsportsmedicine.com), and call Dr. Gill’s office if you have any questions or concerns (781-251-3535).