ACL reconstruction - discharge

You had surgery to reconstruct your anterior cruciate ligament (ACL). The surgeon drilled sockets and tunnels in the bones of your knee and attached the new ligament to the bone. You may also have had surgery to repair other tissue in your knee.

You may need help taking care of yourself when you first go home. Plan for a spouse, friend, or neighbor to help you. It can take from a few days to a few months to be ready to return to work. How soon you return to work will depend on the kind of work you do. It often takes 4 to 6 months to return to your full level of activity and take part in sports again after surgery.

Your health care provider will ask you to rest when you first go home. You will be told to:

• Keep your leg propped up on 1 or 2 pillows. Place the pillows under your foot or calf muscle. This helps keep swelling down. Do this 4 to 6 times a day for the first week after surgery. Do not put the pillow behind your knee. Keep your knee straight.
• Be careful not to get the dressing on your knee wet.
• Do not use a heating pad.

You may need to wear special support stockings to help prevent blood clots from forming. Your provider will also give you exercises to keep the blood moving in your foot, ankle, and leg. These exercises will also lower your risk for blood clots.

You will need to use crutches when you go home. You may be able to begin putting your full weight on your repaired leg without crutches 2 to 3 weeks after surgery, if your surgeon says it is OK. If you had work on your knee in addition to ACL reconstruction, it may take 4 to 8 weeks to regain full use of your knee. Ask your surgeon how long you will need to be on crutches.

You may also need to wear a special knee brace. The brace will be set so that your knee can move only a certain amount in any direction. Do not change the settings on the brace yourself. The brace is usually locked when you are using crutches when walking for the first few weeks.

• Ask your provider or physical therapist about sleeping without the brace and removing it for showers.
• When the brace is off for any reason, be careful not to move your knee more than you can when you have the brace on.

You will need to learn how to go up and down stairs using crutches or with a knee brace on.

Physical therapy most often begins about 1 to 2 weeks after surgery, however you can do some simple postoperative knee exercises immediately after surgery. The duration of physical therapy may be 2 to 6 months. You will need to limit your activity and movement while your knee mends. Your physical therapist will give you an exercise program to help you build strength in your knee and avoid injury.

• Staying active and building strength in the muscles of your legs will help speed your recovery.
• Getting full range of motion in your leg soon after surgery is also important.

You will go home with a dressing and an elastic bandage around your knee. Do not remove them until the provider says it is OK. Until then, keep the dressing and bandage clean and dry.

You can shower again after your dressing is removed.

• When you shower, wrap your leg in plastic to keep it from getting wet until your stitches or tape strips (Steri-Strips) have been removed. Make sure that your provider says this is OK.
• After that, you may get the incisions wet when you shower. Be sure to dry the area well.

If you need to change your dressing for any reason, put the elastic bandage back on over the new dressing. Wrap the elastic bandage loosely around your knee. Start from the calf and wrap it around your leg and knee. Do not wrap it too tightly. Keep wearing the elastic bandage until your provider tells you it is OK to remove it.

Pain is normal after knee arthroscopy. It should ease up over time.

Your provider will give you a prescription for pain medicine before your surgery. Get it filled ahead of time so that you have it when you need it. Take your pain medicine when you start having pain so the pain doesn't get too bad.

You may have received a nerve block during surgery, so that your nerves do not feel pain. It is normal that your leg will feel a bit numb after the nerve block. The numbness can last for hours and sometimes up to a day. Make sure you take your pain medicine, even when the block is working. The block will wear off, and pain can return very quickly.

Ibuprofen (Advil, Motrin) or another medicine like it may also help. Ask your provider what other medicines are safe to take with your pain medicine.

Do not drive if you are taking narcotic pain medicine. This medicine may make you too sleepy to drive safely.

Contact your provider if:

• Blood is soaking through your dressing, and the bleeding does not stop when you put pressure on the area
• Pain does not go away after you take pain medicine
• You have swelling or pain in your calf muscle
• Your foot or toes look darker than normal or are cool to the touch
• You have redness, pain, swelling, or yellowish discharge from your incisions
• You have a temperature higher than 101°F (38.3°C)

Anterior cruciate ligament reconstruction - discharge

Brotzman SB. Anterior cruciate ligament injuries. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 47.

Hantes ME, Tsarouhas A. Anterior knee problems after anterior cruciate ligament reconstruction. In: Prodromos CC, ed. The Anterior Cruciate Ligament: Reconstruction and Basic Science. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 136.

Micheo WF, Sepulveda F, Sanchez LA, Amy E. Anterior cruciate ligament sprain. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 63.

Miller RH, Azar FM. Knee injuries. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 45.

Updated by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.