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ACL Reconstruction Advice and Exercise Sheet

Your Operation

The Anterior Cruciate Ligament (ACL) is a ligament that connects the tibia (lower leg) to the femur (thigh). It helps to keep your knee stable.

The ACL may be stretched, partially or fully ruptured. A stretched or partially torn ligament maybe repaired or augmented with a graft.

A fully torn ACL is replaced using a graft either from your hamstring tendons or patella tendon attached from your kneecap to the tibia (shin bone). 

If you have your ACL reconstructed using your hamstring tendons, the graft is made by taking your Semi-tendinosis, and Gracilis tendons.  A long piece of each tendon is removed before being folded and braided to produce a quadruple thick strand. The new tendon graft is fixed by an anchor to the femur and a screw to the tibia stabilising the knee joint. Alternatively, a strip of tendon is taken from the tendon joining your patella (kneecap) and tibia, with small blocks of bone either side. 

It takes about 6 months for the new ligament to incorporate and gain full strength. The graft is at its most vulnerable during the first 3 months. Physiotherapy exercises and advice post operatively is extremely important in achieving the best outcome following the operation. There is a risk that you can re-tear the ligament if you don’t follow the advice.


After the operation

  • You will wake up with your knee in a bandage 
  • Your leg may feel numb following surgery, as often an injection of local anaesthetic is given near to the nerves which go to your leg (a nerve block) to help with pain relief.  You may also find that you are unable to move the leg properly and the leg will not be able to support you when standing.  It is very important that you do not attempt to get up on your own and await instruction from a Nurse or Physiotherapist. 
  • The Nurse or Physiotherapist may apply ice to the knee for swelling once you return to the ward 
  • You may be given a knee brace, which is to be worn when walking.  You may remove your brace for your exercises and normally when in bed at night, but this will be confirmed.


After the surgery you will be shown how to walk on your crutches by the Physiotherapist, and practice stairs if necessary prior to discharge. Crutches are used for about 2-3 weeks as guided by your Physiotherapist.  You are normally allowed to fully weight-bear with the help of the elbow crutches, however sometimes there are restrictions on weight bearing and you will be advised of this.


Stairs


Following this technique to ensure it is comfortable and safe when using your stairs.

Downstairs

  • Crutches to the step below 
  • Operated leg joins the crutch 
  • Un-operated leg completes the step

Upstairs

  • Un-operated leg goes up first 
  • Operated leg then follows 
  • Crutches last to join


Exercises

The Physiotherapist will show you how to perform the following exercises before discharge and an outpatient physiotherapy appointment will be arranged for your exercises to be progressed.

Ankle Pumps:

Move your feet up and down regularly to keep the circulation moving, as soon as you can after the operation  

 Do these exercises hourly for the first few days.

Knee Flexion:

Lying or sitting with your leg out in front. 

Slide your feet towards your bottom, keeping your heel in contact with the bed/floor. Bend as far as comfortable up until 90 degrees, don’t force it. (Note: be careful when you move your knee from a 30degree bend to straight as this can stretch the new graft). 

Repeat this 10x 3 x a day.

Static Quadriceps:

With your leg straight out in front.

Push your knee down into the bed, straightening it as much as possible (don’t force it). Hold for 10 seconds. 

Repeat 10x  3x a day.

Static Hamstrings:

Sitting with your leg out in front of you. 

At varying angles of bend in the knee, try pressing your heel down into the bed without moving the knee joint (i.e. to create a contraction of the hamstring muscle in the back of your thigh). 

Hold for 10 seconds. Repeat 10 times

Static Gluts:

Lie on your back. Gently squeeze both buttocks together   

Hold for 10 seconds. 

Repeat 10 times 3 x a day

Heel Raises:

Stand holding onto support for balance. Push up onto your toes. 

Repeat up to 20x 3x/day. 

This exercise start normally from week 2 after your operation


Things to remember:

Swelling

 It is very normal for your knee to swell initially following surgery.  If the knee is swollen you can try the following to reduce it:

  • Sitting with your leg up on a stool or raised up high on pillows.
  • Apply ice or a cold compress – such as a bag of frozen peas – wrapped in a damp tea towel.  Apply for 10-15 minutes maximum 3-4 times a day.

Caution

  • People who are known to have circulation problems or have sensory deficits will need to seek advice from your Physiotherapist or Consultant before using ice therapy.
  • Never apply ice directly to the skin as ice burns may occur, always have a layer between your skin and the ice.

Avoid

  • Pivoting/turning/twisting on a loaded leg for 3 months 
  • Squats/lunges for 3 months 
  • Resistance work, including cycling for 6 weeks 
  • Fully straightening your leg from the last 30 degrees without the support of your other leg.

Driving:

You can normally return to driving normally at about 3-4 weeks post-operatively, provided you feel confident to do so. You must have good muscle control, be able to walk well without crutches and be able to do an emergency stop safely.

Returning to work:

This is largely dependent on the type of job you do. Normally it is about 2 weeks for non-manual jobs, but longer for manual jobs.  Please be guided by your Physiotherapist and Consultant.

Other activities:

Swimming – You can go in the pool once your wound has completely healed, just to walk forwards and backwards. No actual swimming should be carried out for 8-12 weeks

Running – Usually not for the first 12 weeks – as guided by your Physiotherapist

Sport – Normally not for 6 months and no competitive or contact sports for the first 9 months. You will be guided by your Physiotherapist or Consultant.


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