Dr A.G. Marshall, M.D., F.R.C.S. (C), Dip. Sport Med.

Orthopaedic Surgeon

595 Montreal Road, Suite 202

Ottawa, ON K1K 4L2

Telephone: (613) 746-6745

LIGAMENT SURGERY

1 WEEK BEFORE: Arrange for physiotherapy post op, arrange for fitting of leg immobiliser splint and cryotherapy unit.

DAY BEFORE:Getting ready check list:

  • Do you have crutches?
  • Do you have extra ice for cryotherapy
  • You must arrange for someone to stay with you for the first 24-48 hrs and you need a ride home following surgery.
  • Remember nothing to eat or drink after midnight unless otherwise instructed.

DAY 1 of Surgery:

  • Wear or take shorts to facility
  • Take crutches, splint and cryotherapy unit
  • Prescription will be given to you for medications needed following surgery. Follow post op pain instructions.
  • Daily heavy deep breathing and drinking 6-8 glasses of water is beneficial the first week.

ACTIVITY:

You may be up with crutches with progressive weight bearing over 5 days, off crutches in 1-2 weeks (unless otherwise instructed). Ankle swelling is usually a sign of being up too much or exercising too little. Start passive range of motion (passive bending/straightening the knee). Start isometric tightening of the thigh (quad sets) and leg lifts. Start toe points occasionally. These will be explained to you by your physiotherapist. Plan to take it easy around the house approximately one (1) week.

KNEE SPLINT:

If you need to go somewhere, be sure to take your cryotherapy and wear the leg immobiliser. Snug straps up so that brace is secure. As swelling reduces adjust accordingly. A splint should be worn up to 5-6 weeks( you will be told when you don’t need it any longer by your surgeon or physio) depending on quadriceps control. WEAR AT NIGHT.

GENERAL ADVICE

  • Get plenty of rest for two or three days but do not stay in bed. Elevate the leg when possible.
  • Use crutches as required, you may fully weight bear as tolerated unless otherwise instructed.
  • Local anaesthetics in the knee (freezing) will wear off 2 to 7 hours after surgery, use pills prescribed and ice to relieve pain and swelling.
  • Perform exercises as tolerated as instructed by physiotherapist pre-op.
  • Occasionally you may feel/hear sloshing in your knee for a few days after surgery. It is air/fluid from surgery and is not dangerous.

WOUND CARE

  • Elevate leg (2 or 3 pillows) when possible and ice knee for 20 minutes every 2 or 3 hours
  • Remove tensor and reapply if too tight (swelling of foot or excess pain) or too loose. Keep it off overnight in bed.
  • Some swelling is expected, as is some discomfort. Use prescribed pain medications as advised, if required.
  • Do not soak the limb in water for one week, may shower and pat dry after 24 hours.
  • The steri strips (tapes) will be removed at the post op visit, they may fall off earlier and this is not a problem.
  • 3M Duraprep surgical solution was used to prepare your skin, it can be removed with 70% isopropyl alcohol placed on the area for 40 seconds and then lightly scrubbed to remove the solution. It will wear away and doesn’t have to be removed if you desire.
  • DAY 2-7:
  • Continue exercise consistently at home as well as beginning physiotherapy within one week (arrange preop)
  • Continue cooling knee with cryotherapy for at least 5 days continually and then after use or when pain or swelling occur.
  • Work on weight bearing (unless otherwise instructed)
  • May take shower (not soak).
  • Expect moderate calf/shin bruising, usually resolving around day 14.

  • Exercise Goals:
  • Strengthening directly affects stability and pain in your knee.
  • Strengthen quadriceps
  • Range of motion to approximately 90 degrees bend, straighten completely.
  • Wear your splint when up and about.

Remember: 100% compliance in the first few months pays big returns by saving muscle mass loss and strength as well as gets you back to normal daily living faster.

******Contact office or surgeon directly should you notice any of the following:

Fever over 38 degrees,

Unexpected pain in the leg,

Increasing redness around a portal of entry and/or pus,

Excessive swelling.

DAYS 7-14:

  • Your skin incisions should be healed by one week. You may shower. A bath is permitted after 10 days if preferred.
  • Return to work: based on general condition of knee, surgery date, progress, and type of work demands.
  • Follow up with Dr Marshall at 2 weeks, book appointment at Montfort clinic (746-4621 ext 4307)

DAY 15-30:

You will begin to feel generally better - more strength, less aching, decreased swelling. Do not skip physiotherapy or Doctor's office appointment in order to assure the doctor can review a normal progression of recovery and keep you going in the right direction.

MONTH 1-3:

Daily strengthening, Strengthening is the KEY!

  • Splint use is stopped unless you have significant quadriceps atrophy, need it for protection at work, or otherwise directed by doctor.
  • Full range of motion
  • Walk with normal gait
  • Begin restrictive biking and sliding activities (Nordic track) as suggested by physiotherapist and doctor.
  • Do not jump, run, full squat or use knee extension machines because they may compromise your rehab success.
  • Weeks 6-8 is when you new ligament is at its weakest, so heed precautions and restrictions.
  • follow-up with surgeon at 6 weeks, 3 months.

MONTH 6 to 1 Year:

Return to doctor's office for recheck and restarting of sport activities.

1 Year:

Return to doctor's office for recheck.

Revised 09