1. Overview
- This guide provides post-operative and rehabilitation instructions following arthroscopic ACL reconstruction surgery.
2. General Post-Surgery Instructions
- Diet: Start with liquids after anesthesia wears off and no nausea is present; resume normal diet as tolerated. Avoid alcohol while on medication.
- Hospitalization & Medication: 2-night hospital stay is usually sufficient. IV antibiotics/painkillers in hospital, oral after discharge. Restart regular meds after consulting your doctor. Report adverse reactions immediately.
- Bath & Toilet: Body sponging and a bedpan are recommended for 2 days. After that, use the bathroom with assistance (crutches/walker). Keep the operated leg elevated when bathing; wrap the area to keep it dry. After suture removal and wound healing, you may wet the area.
- Leg Position: Elevate the operated leg on pillows (from ankle to knee) for the first 2 weeks to prevent swelling and ensure good support.
3. Becoming Ambulatory (Getting Mobile)
- On 2nd post-op day, begin walking with a walker or crutches.
- Hop on the non-operated leg, avoid weight on the operated leg for first 2 days.
- From day 3, gradually take partial weight on the operated leg, progressing to full weight-bearing in 10–15 days.
- For additional procedures (e.g., meniscus repair), non-weight-bearing period may be longer.
- When getting out of bed, ask someone to support your leg and lower it gently to the ground.
- If redness or swelling occurs, reduce walking and keep the limb elevated. Apply ice packs to the swollen area 3–5 times daily for 3–5 minutes.
4. Stairs, Knee Brace, Dressings, and Return to Work
- Stairs: Learn stair climbing from your physiotherapist; avoid stairs for first 3 weeks.
- Rigid Knee Brace: Wear post-surgery for 3 weeks, including sleeping and walking (remove only for exercise and when awake). The wider part goes on the thigh, the narrower on the leg, with the central strap over the knee.
- Dressing & Stitch Removal: Dressings and stitches are removed after 10–15 days. Change dressing earlier if wet/itchy.
- Returning to Work: Sedentary jobs: 2 weeks post-stitch removal; jobs with much standing/walking: 6–8 weeks. Avoid public transport for at least 3 months.
5. Hinged Knee Brace, Driving, and Minor Issues
- Hinged Knee Brace: Use from 3 weeks to 3 months post-surgery, outdoors only, not while sleeping. Allows bending, restricts sideways movement. Prefer cotton or neoprene.
- Driving: Car driving possible after 4–6 weeks. Avoid two-wheelers for 3 months.
- Minor Problems: Occasional pain (use painkillers only if necessary), mild swelling without pain/warmth is normal, bruising can occur (apply thrombophobe ointment gently 2–3 times/day).
- Minor ACL Issues: Clicking/crepitus, stiffness after sitting/standing, numbness over a small patch on the upper outer leg (some are temporary, some may be permanent).
6. Early Post-Operative Exercises
- Day 1: Ankle pumps (up/down movement) every few hours for circulation.
- Day 2: Quadriceps setting: contract thigh muscles by pushing knee downwards on pillow/bed, hold 5 seconds, repeat 5–10 times every few hours.
- Knee Bending: With support, bend knee to 30° first day, increase by 15° daily, reach 90° by week 3.
- Hip Movement: Gently move operated leg side-to-side, also exercise non-operated leg.
- If needed, muscle stimulator may be used for better contractions.
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7. Post-Stitch Removal Exercises
- Isometric Hamstring: Bend knee to 30°, hook heel on bed edge and gently pull towards buttock, hold 5 counts, relax, repeat 10 times (3 sets).
- Assisted Straight Leg Lifts: Use a towel/dupatta to lift leg to 30°, lower to 5°, repeat 5 times, 3–4 times/day. Progress to unsupported as strength improves.
- Heel Slides: Lie on back, bend knee to 20°, slide heel towards buttock, straighten knee. Repeat 5 times every couple of hours.
8. Exercises After 3 Weeks
- Theraband/Knee Presses: Use resistance bands for knee straightening, 10 reps × 3 times/day. Progress to higher resistance.
- Wall Slides: Back against wall, feet apart, bend knees, hold 5 seconds, rise. Repeat 5 times every few hours.
- Straight Leg Raise: With normal knee at 90°, operated leg straight, lift to 30°, lower to 5°, 10 reps/set, 2–3 sets.
- Heel Raises: Hold table, rise onto toes, lower, 10 reps × 3 times/day.
- Prone Knee Bending: Lie on tummy, bend operated leg with help of normal leg, hold 5 counts, relax, repeat 5 times every few hours.
9. Hip Extension, Side-Lying Leg Raise, and Early Gym
- Hip Extension: Lie on stomach, tighten buttock, lift leg to 30°, lower to 5°, repeat 5 times/set, 3 sets.
- Side-Lying Leg Raise: Lie on one side, bend lower leg, lift top leg to 30°, lower to 5°.
- Gym (after 6–8 weeks, avoid treadmill/stepper/heavy weights):
- Static Cycling: Zero resistance, start at 10 min, increase as tolerated.
- Leg Press: Feet 5° inward, press both legs, mid-range only (10°–90°/100°), do not fully bend/straighten, progress to single leg, 10 reps × 3 sets.
- Reverse Leg Curls: Mid-range (10°–90°), 10 reps × 3 sets.
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10. Advanced Gym Exercises & Return to Sports
- Leg Extension: Extend knee up to 45° only, not fully straightened, mid-range, progress to single leg, 10 reps × 3 sets.
- Calf Raises: Use calf machine or free weights, 10 reps × 3 sets.
- Abductors-Adductors: Push knees in/out against resistance, both directions, 10 reps × 3 sets.
- Avoid: Treadmill, stepper/elliptical/crosstrainer, twister, Suryanamaskar, lunging.
- 6–9 Months: With physiotherapist/trainer, begin conditioning for strength, flexibility, balance, agility; progress to sports-specific training as required.
Note: Always consult your orthopedic surgeon or physiotherapist before starting, changing, or progressing your exercise plan.
These instructions are for general guidance following ACL reconstruction. Individual recommendations may vary.
These instructions are for general guidance following ACL reconstruction. Individual recommendations may vary.