What to expect with ACL reconstruction surgery?

June 2, 2006 10:42 AM

I am having ACL surgery in 10 days. I'm looking to get some more information on the surgery, people who have had the experience under spinal anaesthesia, and recovery times. I've found some blogs, but looking for more. I'm also looking to hear about how long people were required to wear the Zimmer splint, or similar products, assuming all went well in the surgery, and physio. Thanks! ^^
posted by irishkitten to health & fitness (14 comments total)

My girlfriend tore her ACL back in February while skiing, and just had the surgery yesterday (at Beth Israel Ambulatory Center in Manhattan). She opted for the cadaver graft, over harvesting her own tendon or hamstring. She was under general anesthesia along with a "hip-block". Upon coming out of surgery, she was in pain (8 out of 10, according to her), so they gave her some pain killers which helped greatly. She went home a few hours later, and asides from a bit of nausea this morning, she's been fine all day. She says she feels a bit of pressure/discomfort where they inserted the arthroscope, but it's nothing bad at all.

She currently has a layer of Ace bandages covering her leg from mid-calf to mid-thigh, on top of that is a full leg brace, similar to what she was given after tearing her ACL. Under the bandages is a special cooling pad, which has tubes which connect to a little pump and cooling machine, which keeps cold water flowing through the pad at alll times. This is much much better than what she had after the accident, which was ice packs which had to be replaced far too often. She also has a passive exerciser, which bends her leg. She tried it for the first time this morning, and she was scared of it being very painful. It wasn't, and she used it for about 2 or 3 hours until it got too annoying to continue.

She did a lot of PT after the initial accident, and stopped going a week before the surgery. She'll start it back up in a few weeks. Her initial PT sessions were painful, but she kept at them. Besides the exercises, there were two things they did which helped her pain/swelling. One was running some sort of laser pen over her knee, which she said worked like magic and made any pain and swelling go away. The electro-therapy also helped.

If you have any specific questions I can relay them to her.
posted by skwm at 11:08 AM on June 2, 2006

I tore the ACL in my left knee and had reconstruction surgery (patellar tendon autograft) last summer.

I had an epidural block, which worked out pretty well. There was no real pain getting the line put into my spine, just an amazing amount of pressure as the anesthesiologist inserted the needle. Not being able to feel my legs upon waking up was pretty odd, but the effect wore off pretty quickly. Overall, I preferred the epidural to my prior experiences with the side effects of general anesthesia.

As for initial recovery, I rebounded pretty quickly. I was off of my crutches within 4 days and out of my brace within 12. The first day back at work without the brace may have been one of the most tiring days of my life though. Probably a bit ambitious, but I only took it off once my doctor allowed me to.

For my initial recovery, I had a PolarCare pack, which pumped ice water around my knee round the clock and was pretty good for keeping the swelling down. I began PT with a CPM about 4 days after surgery and pretty quickly got up to a good amount of flexion. I had to work really hard at getting good extension though.

Overall, my recovery went well. I was approved for full activity at 6 months post op, took another couple of months to get into better shape, and finally began playing soccer again. My game is horrible but my knee has held up fine.
posted by rorschach at 11:22 AM on June 2, 2006

I had ACL reconstruction surgery in 2000, using the hamstring tendon from the injured leg as the means of reconstruction.

My post-op recovery period was exactly as skwn described above, so I won't reiterate.

After the initial recovery period (about a week of using the passive excerciser), I started physical therapy. These were hour-long visits with a therapist two or three times a week. Initially, the therapy consisted of stretching, ultrasound, electro-therapy, massage, and putting weight/pressure on my leg (just pushing against the therapists hand or body at first and building gradually from there).

As therapy progressed, the exercises became more intense and varied. There were balance/flexibility exercises, squats, stationary bike rides, etc. I was surprised at how quickly I regained confidence and strength in my leg. I forget how long I continued with the therapy visits... I want to say 8 or 10 weeks. By then, I was told that I was ready to resume physical activities (wearing a brace) as I saw fit.

That said, my knee isn't the same as it was before the surgery. It's creaky and randomly painful (noticeably, but nothing too intense). My hamstring in that leg is not as flexible as my other hamstring and I have to stretch that leg thoroughly if I'm going to engage in even light exercise.

And, with the exception of biking, I still wear the knee brace when I exercise.

Good luck! Email is in my profile if you have any follow up questions.
posted by 27 at 11:35 AM on June 2, 2006

I had an ACL reconstruction (patellar tendon autograft) about 10 years ago.

The general anesthesia was nice, but coming out of it was a little wierd.

I stayed overnight in the hospital with a morphine pump--- the pain was quite intense for about 4 days and I managed it reasonably well with Celebrex and Tylenol 3s.

Went through about 10 kilograms of ice over a week and had to wear the brance for about 10 days--- my wife just about went crazy from the sound of me adjusting the velcro during the nights.

Today, it's better than new. Worth the trouble.
posted by mykl at 12:14 PM on June 2, 2006

Oops... "...had to wear the brace for about 10 days..."
posted by mykl at 12:15 PM on June 2, 2006

Possibly as mentioned in skwm's comment - the game ready was the number one factor in my wife's comfort and recovery. It pumps (ajustable temperature) cold water through a pressurized full-leg cuff (kind of like a blood pressure cuff). It was covered by our insurance for 2 weeks, and we grew to love it as another family member. I even used it a couple times after excersize. All it needs is a steady stream of frozen dixie cups to feed it with...If you can get it it's worth whatever co-pay you'd have to pony up.
posted by true at 12:18 PM on June 2, 2006

I snapped my ACL in a knockabout game of soccer in the local park about 10 years ago. It was about a further year before it was surgically repaired. A strip of tendon from below my patella was used for the replacement (no option, I was told that's how it should be done). The operation was under general anaesthetic. After, I was in bed with a constantly running passive exerciser for about a day or so, an ice pack for a few hours, and a fluid drain. The pain was present, but dull, and didn't need very much in the way of medication. After that I was discharged and was on crutches for about a week, I think, and given some gentle, frequent exercises, mainly to keep the knee moving. Post operation, I had no splint, just a support bandage.

Finally, there was about three months of physiotherapy - lots of low load, high-repetition exercises. Nothing high-tech, just gentle gym stuff and stretching, gradually increasing in intensity. It was strongly emphasized to me that the quality of recovery is very dependant upon following the post-operation physiotherapy program and, in my experience, this is true.

I was a keen cyclist before the injury and since. The surgeon who repaired me was concerned that the delay in operating (UK NHS waiting list), might have resulted in peripheral knee damage. Afterwards he told me that upon opening it up he was very impressed with the overall condition of my knee, despite the injury. He attributed this to lots of cycling. In recovery he encouraged me to bicycle lots and stressed it was excellent therapy for this injury (no impact and no twisting under load). I found this to be true.

Ten years or so later, I'm very pleased with the repair and my knee works fine other than an occasional mild twinge if I kneel heavily on it. As, 27 said, I have sometimes noticed the hamstring isn't quite as flexible in that knee. I have to be careful not to set my bike saddle too high, or I'll get some pain and swelling in the back of the knee on a longer ride. Stretching is a big help.

One vaguely interesting statistic I was told was that the hospital I attended saw more ACL patients from soccer injuries than every other cause combined. This was London, UK and I guess this might be different elsewhere, like somewhere nearer a ski resort. It was strongly suggested to me that I quit playing soccer, at least for a year or so, which was no big deal because I was always a really bad player, anyway.

Anyhow, obviously I'm not a doctor, this is only my experience, and very best of luck to you.
posted by normy at 12:28 PM on June 2, 2006

I tore my left ACL as well as some cartilage, and had arthroscopy. Are you having a full incision, or just arthroscopy?

The arthroscopic surgery was pretty decent... I was put under for a couple of hours for the surgery and I woke up with relatively mild pain... I had painkillers for the first several days, and the pain afterwards was annoying, but not excruciating..

The part I really hated was the huge amount of physical therapy I had to go through to get my muscles back up to strength afterwards... I just didn't like the schedule or the work/therapy.. it was a pain in the butt..

I was on crutches for about 4 weeks, then walked in a brace for another 2 or 3, and then I was walking without one. My knee doesn't feel normal to this day, though (about 10 years later). It doesn't always hurt, but it just always feels like there's "something there"...

Also, the weather myths are somewhat true... it does bother me sometimes when barometric pressure goes nuts before a big storm...
posted by twiggy at 12:58 PM on June 2, 2006

My experience was similar to mykl and normy's. I did it back around 1995 playing rugby, left knee. My doc actually had me wait a few months for the actual surgery--his theory being that if you do it immediately you can aggravate trauma, i.e., scar tissue, in the area. Sounds like the jury is still out on whether to do the repair immediately or wait a bit. I was totally put under, stayed one night, given some hardcore Perkacet which I tried to avoid taking--swallowed about two or three out of a bottle of 30. The worst part, IMO, was sleeping--the first few nights when I had to lock the brace in place were excruciating, but looking back my best friends were water, tylenol, and some good books to pass the time.

Over ten years later and it feels great--I definitely can't bike as well as I used to, but that's got more to do with the fact that I haven't tried hard enough. I did play rugby again too, but maybe that wasn't the best idea. I definitely lost some speed, but then again I wasn't as faithful to my trainer's rehab schedule as I should have been. The scar doesn't look too bad either--decent conversation starter at least.

Stay strong--it'll be over soon and you'll be back to your normal routine.
posted by bardic at 1:04 PM on June 2, 2006

Twiggy: Honestly, I don't know. I think only arthroscopy. I haven't talked directly to my surgeon since ... oh, December, which of course adds a little to my nervousness. I went through my pre-op appointment about 2 weeks ago, and it left me with more questions than answers, and my surgeon is unavailable for another week. I'm not even sure if it will be a patellar graft, or hamstring tendon. Apparently I will find all of this out the morning of the surgery. I am picking up my cryo-cuff next Saturday, I have my Zimmer splint, and my crutches... and I'm just playing the nervous waiting game now.

Everyone else who has commented so far, thank you so much for the insight, it is greatly appreciated.
posted by irishkitten at 2:24 PM on June 2, 2006

My bet is on full arthroscopic. That's standard these days. Myself, I had the tendon graft. It's supposedly stronger than ligament generally.
posted by bardic at 2:45 PM on June 2, 2006

_. I'm not even sure if it will be a patellar graft, or hamstring tendon. _

It's your choice, and you should be aware of the advantages and differences between them before going into it. It seems quite crazy that you seem to have no say in it.
posted by skwm at 3:29 PM on June 2, 2006

Patellar graft, right knee, after a poorly judged lateral field hockey move. I definitely had the cooling pump thing, which was a lifesaver. While I went off prescription drugs the first day, I was diligent about pain management with ibuprofen. I was back to teaching and working in a lab full time after about a week. I don't recommend it, but it's possible.

Getting back to walking was pretty smooth, but getting full range of motion (4 mo) and back to contact sports (6 mo) was a lot of work. I had a kick ass brace for contact sports - but not for running - for the first year. I haven't had any issues since.

I found the physical therapy unbelievably painful, but I had a demanding therapist. I think it's a question of being diligent about the stretching. Once I mastered that, getting through the strength and agility training was easy.
posted by synapse at 3:53 PM on June 2, 2006

I was quite young (I'd just turned 15) when I had a patellar graft ACL reconstruction, so I'm not sure if my experience may be atypical (kids bouncing back and all that). While reconstructive surgery isn't really fun, the surgery itself wasn't that bad. Waking up from the general anaesthesia proved to be a bit disorienting - though I knew where I was, it seemed like no time had elapsed and, since I wasn't feeling any pain in my leg (which had been partially frozen with a local anaesthetic), I managed to convince myself that they hadn't done the surgery! As my leg started to thaw out, the pain increased; however, it was very manageable with pain killers and ice.

I stayed in hospital overnight, stayed home from school for a couple of days, and started physiotherapy later that week. I was walking, albeit tentatively and only for small stretches, a couple of days after surgery and on a regular basis about a week or two after that.

Here's my postsurgery advice. Ice/coolness is fantastic for pain management. You'll have a cryo cuff, so should have no problem there. You can also use things like frozen peas or snazzy gel packs tucked inside your big post surgery brace for when you're out and about. In fact, I found that I was able to stop taking tylenol with codeine three days post-op (and prior to that, I'd only used them to be able to get to sleep at night).

It will be a pain in the ass to wear some kind of brace while sleeping for the first while (I can't remember just how long at the moment). This is important, though, since it takes time for bone to fuse around your newly installed ligament and you can't really control motion while sleeping!

Work on regaining your range of motion as quickly as possible, following your physiotherapist's and doctor's advice, of course - this will allow you to do things like cycle and swim to maintain fitness and begin to regain strength. I remember this hurting, since your body tightens up to protect a fragile and injured area (in this case, your knee). Know that you're not going to be able to get your knee fully flexed/extended right away - take your time, note all small gains, and then it's not too bad!

Track your progress. Rehabilitation can seem slow! Writing down what you've done provides an incentive to keep doing it as well as allows you to see how far you've come post-op. Even writing things down like "walked from sitting room to kitchen and back" are important at first and you'll awesome looking back at that when you're able to write something like "walked around the block" a week or so later!

It took me just over a year to fully regain strength in my right leg, though I was back to (very) competitve sport in seven months. Things were sluggish at first, but picked up with hard work and practice. My knee is (mostly) normal now, some ten years later, though I've stopped playing sports with extreme lateral stress (now I row and cycle!).

Email's in profile if you've any further questions! I think that the stress of waiting for surgery is almost worse than the surgery itself!
posted by lumiere at 7:17 PM on June 2, 2006