ACL Surgery in Vail, CO
Anterior Cruciate Ligament (ACL) surgery is a common, but serious procedure, with a high success rate. Below is information regarding steps patients can take to better ensure a successful outcome, as well as potential complications and the risks of this surgical procedure.
What to Expect Before ACL Surgery
- The night before surgery, you can eat and drink but as of midnight you should have nothing to eat or drink. You can take your normal medications with just a sip of water but should not take any blood thinner medicines unless cleared by Dr. Cunningham.
- There should be no skin damage (cuts, animal scratches, pimples) over the knee. If this has occurred, please let Dr. Cunningham's staff know.
- Patients should ideally be off cigarettes and oral contraceptives at least one week before surgery as this can increase the chances of developing a blood clot in the leg after surgery. If you have ever had a blood clot in the past, please bring this to Dr. Cunningham's attention.
- Most patients can go home the same day.
- We can provide patients with a circulating ice machine after your surgery. Insurance rules are constantly changing, but unfortunately most of these are not covered by insurance. However, if you choose, we have arranged with our vendors for you to be able to purchase a cooling device for a reasonable cost. You can also rent a “Game Ready” device, which applies both cold and compression through a nice compression sleeve.
- Physical Therapy is started immediately postoperatively, either with the patient doing some simple home exercises or starting formal physical therapy.
- Patients can be immediately weightbearing as tolerated with crutches and with their knee brace. The knee brace is to be worn locked in extension or holding the knee straight whenever the patient is up walking. When sitting or lying down, we encourage you to unlock the brace or remove it and do gentle range of motion exercises.
- A CPM or continuous passive motion machine is not used as your range of motion should exceed that allowed by the machine in 7–10 days. Furthermore, studies have shown that there is no benefit to using this when recovering from ACL surgery. However, a few patients request these units and we can arrange for this.
- You may remove your dressings and shower over the wound 4 days after surgery. Do not submerge the knee under water for at least 2 weeks.
- Most patients no longer need crutches or the brace after 10-14 days, but this transition is supervised by your therapist. If you also required a meniscus repair in addition to your ACL reconstruction, then patients are required to use a knee brace for 6–8 weeks depending on the extent of the meniscus repair.
- If you do a desk type job, try to take at least one week off from work. People who work in a retail type environment who need to stand or walk for 8 hours a day may need 4–6 weeks before they are able to do this. People who do very physical type work such as construction may not be able to return to their normal duties for 4 months, but hopefully can do some form of light duty work well before this, if they so choose.
- You should not drive a motor vehicle until you are off all pain pills and feel that you could quickly move your right foot to the brake and apply strong pressure if needed.
- Physical Therapy usually involves going 3 times a week for 3 months or more.
- You are encouraged to ride a stationary bike with minimal resistance as soon as you can get around on the pedals.
- Patients can ride a bike outdoors at 6 weeks as long as the conditions are safe.
- Patients can jog at 3–4 months.
- Depending on the status of other structures (meniscus, articular cartilage, other ligaments) that may have been injured and/or repaired, patients can expect to return to all sports at around 8-9 months after ACL reconstruction surgery or when there is good muscle control and protection around the knee.
- Bruising and swelling occurs in all patients. The tunnels created in the femur and tibia will ooze blood during the first day. Patients often comment that when they stand up, the feel a "rush of blood" down into their lower leg. For this reason, it is recommended that you ice and elevate the leg as much as possible for the first 3–5 days.
- Not uncommonly, there is numbness around the skin incisions as the tiny sensory nerves in the skin are cut. However, these small sensory losses usually resolve in 12-18 months as the small sensory nerves regenerate.
- With a hamstring ACL, 2 of the 3 hamstring tendons on the medial (inside) aspect of the knee are harvested in order to create your ACL graft. These tendons regenerate. If the hamstrings are suddenly engaged in the first 2 months, it is possible to feel a “pull” or “tear.” This can result in 1–2 weeks of increased pain and swelling in the region of the hamstrings but the hamstrings will eventually heal well. With a quadriceps tendon ACL, the quad tendon is sutured back together after removing a portion of it for the graft and this can take several months to heal, thus we limit quad strengthening in the first few months.
- Infection after ACL surgery is rare (1 in 400). When it occurs, it usually occurs between 10–30 days after surgery. Surgery is done under sterile conditions and any work done in the knee is done arthroscopically. One dose of antibiotics are given immediately before surgery. Long-term antibiotics are not administered as this has been shown to increase the chances that one could become infected with a bacteria that is resistant to most antibiotics. If one does develop an infection, it is most often a superficial wound infection that responds to a 10 day course of oral antibiotics. In the rare case where the infection extends into the knee joint, this is usually cured with one or two arthroscopic washouts of the knee followed by 6 weeks of IV antibiotics. In cases where the infection has been present in the knee for a longer period of time, treatment may require that the graft be removed in order to completely rid the knee of infection.
Complications Specific to ACL Reconstruction Surgery
If you have any concerns for one of the above complications, or are experiencing increased redness, fever, chills, increased knee pain and swelling, then please call Dr. Cunningham and his team. We would rather be made aware of any concerns earlier rather than later. Contact Dr. Cunningham's Vail, Edwards, or Frisco CO office locations.
Risks of ACL Surgery
All surgical procedure have possible risks and complications. Dr. Cunningham makes every effort to minimize them through various means. The most common risks include pain, swelling, and numbness around the incisions. All patients have some degree of stiffness after surgery but normal range of motion can be restored with good physical therapy.
Graft impingment is also a risk but an experienced surgeon can help avoid this by placing the graft anatomically in the knee. Wound hematoma (blood pooling) is more likely if patients take aspirin or non-steroidal anti-inflammatory (NSAID) medications (ie. Motrin, Alleve, etc). For, this reason, these weak blood thinners should be discontinued one week before surgery unless contraindicated for medical reasons. Less common but possible complications include infection and deep venous thrombosis. Please let us know if you or a family member has had a blood clot in the past as we may then put you on a blood thinner after ACL surgery.
Fortunately, the facilities where these surgeries are done have extremely low infection rates, with rates of orthopedic infections of about 1/3 lower than Denver area hospitals.