Day of surgery
Surgery will typically be done as an outpatient. You will come in and go home the day of surgery.
Activity Once You Return Home
You will be given crutches. You should not bear weight on your operated leg until given clearance to do so. See the Rehabilitation section for more details.
You likely will have a brace on your knee. In general I find it simplest if patients leave the brace in place until their 1st post-operative appointment 4-5 days after surgery. At that point the dressing will be changed and sutures removed. Usually only Band Aids will be necessary from then on. We will review how to properly remove and reapply the brace.
Post-Operative Pain Management
I will typically prescribe a pain medication that does not contain Tylenol. This way a broader safe dosing range is possible. Your prescription will have a range, usually 1-3 pills, every 3 hours as needed for pain. You should start with the lower dose of 1-2 pills then increase to 3 pills if 2 are not adequate to control your pain and you are not excessively sedated. You may add Tylenol to this pain medication using the dosing schedule on the Tylenol bottle for additional pain relief. I do not want you using medications such as Motrin, Aleve, or other “anti-inflammatory” drugs in the early post-operative period as they can inhibit the processes necessary to allow incorporation of your graft into the bone. If you have inadequate pain control l or someone at my office will always be available to assist you.
This process begins the day of your surgery. Much like what is emphasized to my knee replacement patients the early focus is “straightening, strengthening, and bending!” Once I have done my best to reconstruct your knee, you have the most control over the outcome. After your 1st post-operative visit you will usually be referred to physical therapy but even at that point you will likely only see the therapist 3 days per week for 1 hour each visit. You will have approximately 16 waking hours each day to rehabilitate your knee. You can accomplish useful things for your knee whether you are lying in bed or sitting up in a chair if you understand the goals and the techniques to achieve those goals. Working together, my aim is to give you both the knowledge and the tools to succeed on your own. This gives you confidence, and gives me comfort, as patients may sometimes live far from my office, have therapists with whom I am unfamiliar, or have limited access to therapy services.
The best way to work on bending is while out of bed and sitting in a chair. This should begin the day of surgery in most cases when you are out of bed for meals. Choose a firm chair on a smooth surface like a kitchen chair. First if your brace is locked unlock it to allow bending. Sit with your knee bent to whatever degree you can easily manage. With your foot flat on the ground use your hands to gently pull up on your thigh, taking the weight off of your foot, and making it easier to slide your knee back and increase the bend. Usually you will move it only an inch or so. This is fine. If you hold it in this position with the increased bend the tightness and pain will subside. Then repeat sliding back another inch. Keep doing this and you will be amazed at the gains you will make! It is not unusual for me to do this with patients during the course of a post-operative visit and see them make 20-30 degrees of gain within 5 or 10 minutes. You are in charge! No therapist, no pushing, no one hurting you. As you get more advanced try to scoot yourself forward on the chair to increase your bending even further. When you tire or fatigue, slide your foot forward and take a rest. You should work on this during every meal and once you are home at least 4-6 times each day for 5-10 minutes each time. Your basic initial goal will be to achieve 90 degrees of bending by 10 days after surgery at which point you will have your second post-operative visit.
The next activity is straightening. Spend some time with the foot propped up off of the ground with the knee out straight. Gravity will help you regain full straightening. You can also lean forward and gently push on your shin. Do not ever lay with a pillow under your knee! This is what I call “no man’s land.” Your knee in this position is not straight nor is it bent to a useful degree. Work on straightening and bending as reviewed above avoiding time spent in “no man’s land.”
The final pieces of “straightening, strengthening, and bending” are your strengthening exercises. Your leg will feel heavy after surgery and your thigh muscle will feel weak. This is normal but again with knowledge and specific exercises you can overcome this. The critical exercise is the leg raise. You need to be in bed lying flat. It is important to practice lifting your leg up in the air while it is out straight early on (the first 4-12 hours after surgery). Slight assistance from a friend or family member lifting gently under your foot is fine, but you should strive to be free of this help. The faster you gain a strong independent straight leg raise the easier you will move about without assistance and the better your walking will be. Once you have a strong straight leg raise we will be able to wean you from your brace and your crutches. your goal should be 10 straight leg raise attempts each hour. Even if you can’t always raise the leg off of the bed, the act of trying will keep blood moving in your leg helping to prevent clots, reeducate your muscle, and move you closer to independence. If you don’t try today, tomorrow will be no different. That’s not what we want.
By 7-14 days after surgery I expect that you will be in physical therapy and working to be off of your crutches and out of your brace. Therapy will continue for some number of months. The exact duration will vary from patient to patient depending upon their personal rate of progress and their personal activity goals. Someone expecting to return to high intensity athletics will typically have different strength and agility requirements than someone who had the procedure done primarily because their knee was unstable with activities of daily living and doesn’t really anticipate sports participation.