Arthroscopic Anterior Cruciate Ligament Reconstruction

WHAT YOU SHOULD KNOW:

Arthroscopic anterior cruciate ligament (ACL) reconstruction is surgery to replace your torn ACL. The ACL is a ligament in your knee that connects the tibia (shin bone) to the femur (thigh bone). Ligaments are strong tissues that connect bones together.


CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You could get an infection or bleed too much. You could have trouble breathing or get blood clots. Sometimes, even after surgery, the knee may not go back to the way it was before. If you do not have surgery, the pain and problems you have when moving your leg may worsen. Your knee may be weak or you may have problems with walking. You may have trouble going back to your usual activities, including sports. Call your caregiver if you are worried or have questions about your injury, treatment, or care.

WHILE YOU ARE HERE:

Before surgery:

  • Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

  • Monitoring:

    • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

    • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Anesthesia: This is medicine to make you comfortable during surgery. Your caregivers will decide which type of anesthesia medicine is best for you.

    • Intravenous (IV) regional anesthesia: This is medicine put into an IV in the injured arm or leg. A pressure cuff is first put on your arm or leg. After the cuff is tightened, the medicine is put into the IV. The cuff keeps the medicine in the arm or leg so you will not have pain.

    • Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.

    • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

During surgery:

  • A rubber cuff called a tourniquet is put around your thigh. This slows down the blood flow to the knee. Your caregiver cleans your knee and leg with soap and water. This soap may make your skin yellow, but it will be cleaned off later. Sheets are put over you to keep the surgery area clean. An elastic bandage is wrapped tightly around your leg and foot. This helps drain blood from your leg. Liquid is pumped into the knee joint. This also decreases blood flow to the knee and makes it easier to see inside the joint.

  • A small incision is made in your knee. Caregivers use an arthroscope to look inside your knee joint by inserting it through the incision. Additional small incisions are made in different places around your knee. Tools are put into these incisions to reconstruct your injured ACL. Another incision is made if the graft (piece of tendon or muscle) will be taken from another part of your body. The graft is pulled through a tunnel drilled in your tibia and femur and screws are used to hold it. The incisions are closed using stitches, staples, or tape and a drain may be placed temporarily. Surgery itself may take about 2 to 2 and one-half hours.
  • Activity: You may need to walk around the same day of surgery, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Talk to caregivers before you get up the first time. They may need to help you stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

  • Deep breathing and coughing: This will help decrease your risk for a lung infection after surgery.

    • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.

    • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Electrical muscle stimulator: This is also called EMS. This may be used to decrease your pain after surgery. Sticky pads are put on the skin around your knee. Electrical impulses go into one pad and energy comes out the other. This treatment may last 15 to 20 minutes one or more times a day. EMS makes your muscles contract which helps your muscles heal and get stronger.

  • Ice: You can use ice to decrease pain or swelling. Put crushed ice in a plastic bag and cover it with a towel. Place this on your knee for 15 to 20 minutes every hour as long as you need it. Do not sleep on the ice pack because you can get frostbite.

  • Medicines: You may be given the following medicines:

    • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

    • Medicines to treat pain, swelling, or fever: These medicines are safe for most people to use. However, they can cause serious problems when used by people with certain medical conditions. Tell caregivers if you have liver or kidney disease or a history of bleeding in your stomach.

  • Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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