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Peri-Operative Instructions for ACL Reconstruction of the Knee < Back to Peri-Operative Instructions Dear Mr. ________ You are scheduled for an ACL Reconstruction of the Left/Right Knee on _________, 2004. Methodist Hospital (506 Sixth Street Brooklyn, NY) will be contacting you on the day prior to surgery regarding your time of surgery. If the hospital does not contact you, please call the admissions office at 1-718-780-3214 after 5:00 pm the day before your surgery to find out what time you will be required to come in for surgery. Please be aware that you will be asked to come to the hospital several hours prior to your surgical intervention. If you are taking any medications, vitamins or supplements, please check with your doctor to see if you should discontinue them. You may need your doctor to give a written medical clearance letter prior to surgery if you have a medical condition or are taking medication. Please inform the office if you are taking any medications or if you develop a cold. (If medically permissible, stop any aspirin or aspirin-like medications, approximately ten days prior to surgery). The type of anesthesia that is used for this surgery is usually a general anesthesia or an epidural/spinal anesthesia. This is dependent upon your medical condition as well as personal preference. Preoperatively, the anesthesiologist will be speaking to you regarding the risks and benefits of the type of anesthesia to be used. Most likely you will be discharged the day of surgery; however, if pain is significant, you will be admitted over night. IF YOU HAVE CRUTCHES BRING THEM WITH YOU THE DAY OF SURGERY. IF YOU DO NOT HAVE ANY, THE HOSPITAL WILL SUPPLY THEM AT A CHARGE TO YOU. THEY WILL NOT BILL YOUR INSURANCE. An appointment should be made to see me approximately one week postoperatively. At that point in time, I will guide you to further postoperative treatments. Sutures and/or staples are usually removed on the first and/or second postoperative visit. A physical therapy program will be initiated approximately one to two weeks after surgical intervention. In general, as mentioned, you will be on crutches for approximately 2-3 weeks. You will use the immobilizer for walking and sleeping for three-four weeks and progress as tolerated to ambulation with a cane. Consideration for using a customized ACL brace for athletic events in the future will be determined several months after surgery as I monitor your progress and individual needs. Note: Numbness or tingling around the outer aspect of your scar is to be expected as there are small sensory nerves that are affected by theanterior incision. PRE-OPERATIVE INSTRUCTIONS: I. Please inform our office of any allergies that you may have, especially allergies to LATEX. 2. DO NOT EAT SOLID FOOD OR DRINK LIQUIDS after midnight prior to your surgery. You must have NOTHING by mouth; this includes water and coffee. These instructions are for your safety. 3. Please bathe or shower the night before or morning of your surgery. 4. Get a good night’s rest before your surgery. 5. Wear loose, casual clothing; leaving all jewelry and valuables such as watches, rings, cash, cellular telephones, etc., at home. 6. Notify your physician if there is any change in your physical condition prior to your surgery day, such as a cold, fever, or infection. If you are on prescription medications, please discuss taking them prior to surgery with your medical doctor. 7. Please try to avoid aspirin 10-14 days before surgery. 8. The admitting office will call you the evening before your admission date to reconfirm the time of your surgery and admission. If you do not hear from the admitting office, or you will not be home in the evening. Please call 1-718-780-3214 by 9:00 pm to confirm your admission. 9. Visiting hours are 1:00am to 8:00 pm 10. On day of your procedure you should go to the admitting office which is located on the first floor of the hospital. 11. You will need a responsible escort to take you home once you are discharged. POST-OPERATIVE CARE: Postoperatively, you will be placed on a CPM apparatus (continuous passive motion machine), which will slowly move your knee back and forth in order to encourage motion. Utilization of crutches and partial weight-bearing ambulation will be encouraged the first postoperative day. Generally, crutches and a knee immobilizer (removal brace from upper thigh to ankle) will be used for approximately two to three weeks with your foot to be placed on the ground as tolerated. There may be specific situations in which I will request that you be non-weight bearing with crutches for several weeks post-operatively. This recommendation would be based on specific pathology seen at the time of surgery and usually occurs in less than 10% of patients. The crutches will be given to at the hospital and your insurance will be billed or you may have to pay at the time they are given to you. While lying in bed at the hospital and postoperatively at home, the lower extremity should be either in one of three positions. 1) The first position is using the CPM machine. The CPM machine will be used in the hospital and most likely one will be delivered to your home as well. This motion machine should be used as tolerated. There should not be significant pain while using the machine. Try to increase the motion approximately 5°-1O° a day. Generally, there is no restriction for range of motion to be performed unless a meniscus repair is performed. The machine should he placed so that the motion is performed slowly. Ideally, the machine should be used for approximately six to eight hours a day for the first week. 2) When not using the machine, your knee should be placed in a knee immobilizer (2nd position). 3) The third position is for you to lie in bed without the CPM machine or the immobilizer, but with the lower extremity free with pillows or blankets underneath your heel, (even though you will feel more comfortable by placing some pillows and blankets underneath your knee). The purpose of placing the pillows or blankets underneath your heel is to obtain full extension of the knee. Obtaining full extension of the knee is one of the primary goals in the initial stages of the postoperative course. The above technique is a simple and effective method of attempting to achieve this goal. The dressing maybe wet or bloody, which is usually of no concern. 72 hours after surgery you may replace a light dressing on the knee using 4”X4” sterile sponges and an ace wrap. IMPORTANT: Do not think that the more walking, standing or stair climbing you do the better you will be. That is a myth. Do what you need to do but limit the above activities until full range of motion is obtained and minimal swelling is present. Notify the office immediately if you notice any of the following: 1. An increase in temperature above 102 degrees The office number is (212) 935-1777 and the answering service number is 1-866-508-2026 Sincerely, David S. Menche, M.D. 263 7th Avenue (1212) 935-1777 |
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