Discharge Instructions & Physical Therapy Protocol for Combined ACL/PCL Reconstruction

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 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
Weightbearing Status - You are allowed to put part 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 Dr. Forsythe
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 Dr. Forsythe

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 Dr. Forsytheâ€™s office to make an appointment for this first post-operative visit

Rehabilitation Guidelines for Combined ACL/PCL Reconstruction

Post-operative Bracing

Rehabilitation brace locked in extension for the first 4 weeks. After this time the brace may be unlocked for ambulation if good quad control is achieved. Discontinue brace after 6 weeks.

ROM Considerations

Passive extension exercises are permitted as tolerated by the patient. Full knee extension symmetrical to the non-involved side should be obtained within 1 week. Passive flexion exercise, in which the patient exerts an anteriorly directed force on the proximal tibia to flex the knee are permitted beginning 1 week after surgery. The range of passive flexion is restricted to 90° for the first 4 weeks after surgery. Additionally active contraction of the hamstrings to flex the knee should be avoided for the first six weeks. After 6 weeks passive & active assisted stretching exercises may be performed to increase knee flexion. Full knee flexion symmetrical to the uninvolved side is expected within 8 to 10 weeks. No CPM.

Muscle Considerations

Isometric exercises in full extension, limited arc open chain (60 to 45° ) and closed chain quadriceps exercises are permitted as tolerated by the patient. High intensity electrical stimulation and biofeedback should be used if patient cannot perform a satisfactory quad set or has a knee extensor lag 1 week after surgery. Closed chain exercises should be delayed until 6 weeks after surgery. Open chain hamstring exercises should be avoided for 3 months.

Weight Bearing Considerations

PWB progressing to WBAT for gait after 4 weeks with brace locked in full extension. After 4 weeks brace may be unlocked for ambulation once good quad control achieved. Crutches may be discontinued 6 to 8 weeks after surgery when the patient has full knee extension, 100° of flexion, no extensor lag, minimal swelling and is able to walk without a bent knee gait.

Return to Work

Return to sedentary work in 1 week. Return to heavy work in 6 to 9 months.

Return to Sports

May return to low impact aerobic exercises (i.e. walking, swimming & cycling) 8 weeks after surgery. Patient must be pain free and have full ROM and strength and no or minimal swelling prior to initiating return to sports activities. Running may be initiated at 6 months and return to sports may be initiated at 9 months provided patient has met the established criteria for progression to these activities (see appendix).

Duration and Frequency of Rehabilitation

32 weeks. 25 visits (1 visit per week for 4 weeks, followed by 2 visits per week for 8 weeks, then 1 visit per month for 5 months).

Note: Additional PT may be needed if patient does not achieve milestones.