Arthroscopic ACL Reconstruction

Arthroscopy is a minimally invasive surgical technique used in the treatment of sports medicine injuries. It involves the use of a fiber-optic camera, which we place into a joint through a small incision in order to visualize ligaments, cartilage, and soft tissue. Through another small incision, we can then use small instruments to remove or repair broken or damaged tissue.

Arthroscopy of the knee with ACL reconstruction is indicated for patients who have torn or ruptured the anterior cruciate ligament of the knee. Reconstruction is imperative in order to stabilize the knee and protect the cartilage of the knee from damage, which can result in early arthritis of the knee.

Prior to ACL reconstruction surgery, a patient must have full range of motion of the knee. Therefore, it is common to be sent for a month of physical therapy prior to surgery in order to regain range of motion.
A patient undergoing this procedure will have the ACL reconstructed with use of an allograft (cadaver tissue) or their own tissue. The reconstruction is completed arthroscopically and is minimally invasive. First, an arthroscope is inserted into the knee through two small incisions in the front of the knee. Any damaged tissue is cleaned out, including the torn ACL. An accompanying meniscus tear is common. If this is the case, either a meniscectomy or a meniscus repair is performed at the time of surgery. After treatment of the meniscus is addressed, bone tunnels are drilled into the thigh bone (femur) and the shin bone (tibia). The graft is placed into the knee and secured in these tunnels, using a screw, while being held under tension. This screw is usually permanent. This screw is usually absorbable and will fill in with bone. The fixation on the femur (thigh bone) is either absorbable or a small metal plate. Before the surgery is concluded, the surgeon will test the graft to ensure that is has good tension and that the knee is stable with range of motion.

Postoperative Instructions:

MOVEMENT

  • You can walk and bend your knee as much as tolerated. Use your crutches for the first week. Do not go for long walks or stand on your feet for extended periods of time. This will cause swelling and pain.
  • Use the CPM (Continuous Passive Motion) machine as much as possible. You should remove your brace when you use the CPM machine. Do not sleep with the CPM machine on. Increase the flexion on the machine as tolerated. When you are able achieve flexion to 100 degrees, call the company to pick up the machine.
  • If you are not icing or using the CPM machine, wear the brace at all times except when bathing.

ICE

  • An ice machine will be provided to you prior to your surgery. This will help decrease swelling and pain after your surgery. Use the ice machine as much as possible when you get home at intervals of 30 minutes on and off. You should keep the ice machine for approximately two weeks. Do not use the ice machine while you are sleeping.
  • In addition to icing your knee and using the CPM machine, elevate your knee so your toes are above your nose. This elevates your knee above your heart and will help reduce swelling.

MEDICATIONS

  • An injection of local anesthesia was injected into your knee after the completion of the operation. This medication will wear off in 5 to 6 hours. Therefore, begin taking the pain medication (e.g. Vicodin, Percocet, etc) immediately when you get home. This will prevent you from having severe pain. Take the pain medication every 4 hours until you go to bed.
  • The day after surgery you can take 600 mg of Ibuprofen (Advil/Motrin) every 6 hours to help with inflammation and pain. This medication will help cut down the use of narcotic-based pain medication. However, if you still have pain after taking the Ibuprofen, continue taking the pain medication every 4-6 hours as needed.
  • A sleeping medication (e.g. Ambien) is also provided to help you sleep at night. Take one tablet 30 minutes before you plan to sleep.

DRESSING/BANDAGES

  • Keep the ACE wrap clean and dry. You may shower the next day after surgery with a plastic bag over your knee. Do not take a bath or submerge your knee in water until your incisions are checked at your first post-op visit.

DRIVING

  • You may drive 3 to 5 days after surgery if you are not taking pain medication. If your right leg is the operative side, then you must have good control of your leg prior to driving.

APPOINTMENT

  • Please call the office prior to, or immediately following, your surgery in order to schedule a postoperative appointment. This should be scheduled 7-10 days after surgery. At that visit your stitches will be removed and you will be given a prescription to begin physical therapy.

If you have any questions or concerns, please contact our assistant at (310) 659-2910 extension 3048. Download the postoperative instructions for your procedure (PDF) 

Recovery Timeline:

Day of surgery: Arrive one to two hours prior to surgery, procedure will take approximately one to one and a half hours, and recovery time is one hour. For immediate post-op instructions, download the instruction sheet. One week post-op: First follow-up visit with Dr. Snibbe/Jennifer. Your stitches will be taken out. You will continue icing the surgical area two to three times a day (or more if needed). Your knee brace will be unlocked, allowing you to flex and extend your knee as tolerated. Physical therapy will begin at this time. Four weeks post-op: Second follow-up visit. You should have been fitted for an ACL brace since your last visit. Physical therapy will continue to work on range of motion and strengthening exercises for the thigh, hip, and buttocks. Eight weeks post-op: Third follow-up visit. Range of motion and strength testing. Continue physical therapy to work on range of motion. Twelve weeks post-op: Fourth follow-up visit. Range of motion should be full. Pain should be resolved. You can now start running straight forward with a brace. Sixteen to twenty weeks post-op: Fifth follow-up visit. Range of motion and strength testing. You should feel stronger and have very little pain, if any. Near to full recovery is expected at this time. You can start sports-specific training with a brace as tolerated.





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