James Paget University Hospitals

NHS Foundation Trust

Anterior Cruciate Ligament

Reconstruction Advice Booklet

Patient Information
Introduction
You have just had an Anterior Cruciate Ligament (ACL)
reconstruction. This booklet is designed to provide information
and advice about your recovery and rehabilitation during your
stay at the James Paget University Hospital and once you are
discharged home.
A structured rehabilitation programme is vital for the
reconstructed ACL to function properly long term.
This booklet contains exercises that will help strengthen the
muscles around the knee so that you regain full range of
movement and function.

Reasons for your operation

The ACL ruptures usually as a result of a twisting injury.

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Your hospital stay
ACL reconstruction is usually a day case procedure. You may
require an overnight stay depending on your recovery after the
operation and the time of day it was done. You will need to see
a physiotherapist before discharge.

Post-operative advice
The wound
You will have five small wounds which will be closed with
dissolvable sutures and glue. Keep the wounds dry until they are
healed, which is normally within eight to 10 days. Avoid using
creams near or on the wounds until they are healed to reduce
the risk of infection. The dressing will normally be removed at
your GP practice between 10 and 14 days post-surgery.

Sleeping
You can sleep on your back or side. Do not rest your knee with
a pillow/towel under. It is very important to keep your knee
straight.

Walking
You will need a walking aid after your operation as you are
likely to have a reduced weight-bearing (partial weight-bearing)
capacity through your operated leg for two weeks. The ward
physiotherapist will inform you of this and teach you how to use
your walking aid. If appropriate, you will be taught the correct
technique for using the stairs.

Brace
If you have had an additional surgery, other than your ACL
reconstruction, you may require a brace after the operation.
The physiotherapist will show you how to fit the brace and will
explain how long you will need to wear the brace. The partial
weight-bearing period then will be six to eight weeks in this
case.

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Pain relief
You will be given painkillers post-operatively and also some to
take home. It is important to take your painkillers as directed to
allow you to move your knee and mobilise. Ice should also be
used to help control the pain and reduce swelling. Make sure
you place a protective layer between your skin and the ice (e.g.
a damp tea towel and a bag of frozen peas). Remove the ice
after a maximum of 15 minutes. Elevation of the foot on a foot
stool also helps to reduce swelling.

Physiotherapy knee exercises

These exercises should begin straight away following your
procedure and movement should be as far as your pain allows.
Aim to gain a range of 0° to 90° in your knee within two
weeks of your operation. It is extremely important to work on
straightening your knee fully.
It is important to have a balance between rest and exercising
your knee. Rest your leg on a stool when sitting in a chair. Aim
to do five to 10 repetitions, three to four times daily.
It is essential that you have adequate pain relief to allow you
to complete your exercises effectively so take the painkillers
offered to you and tell your nurse, doctor or physiotherapist if
your pain is preventing you from completing your exercises.

Resting on a bed or settee:

Exercise 1
Squash your knee down into the bed and hold for up to five
seconds. While your calf remains on the bed your heel will come
off. Relax.

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Exercise 2
Rest your heel on a rolled up towel for up to 10 minutes. This
can also be achieved by using a footstool the same height as
your chair under your heel when sitting.

Exercise 3
As with Exercise 1, tighten your thigh muscle to straighten your
knee, and then lift up your leg approximately 10cm off the bed.
Hold for up to five seconds and then lower your leg slowly to
the bed.

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Exercise 4
Put a rolled up towel underneath your knee so your knee is
slightly bent. Lift the heel up to straighten the leg. Hold for up
to five seconds and then lower the heel back to the bed.

Sitting in a chair:

Exercise 5
Sit on the edge of the bed or
in a chair. Practise sliding your
foot back towards you; once it
is as far as your pain will allow
you to go, tap your toes on the
floor five times, and then slide
your foot back further. This is
important to improve your knee
bend, which helps with walking
and stairs.

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Your recovery
Movement and function
You should aim to increase your range of movement
immediately after your operation as pain allows by continuing
the above exercises. Once full movement has been achieved you
may begin to carry out light tasks. It can take up to a year to
fully recover.

Leisure activities
Progression to other activities will be guided by comfort and
advice from your outpatient physiotherapist. You will be
referred to a physiotherapist once discharged from the hospital.

Return to work
Generally you should be able to return to work after four to six
weeks. If unsure, please discuss further with your consultant or
outpatient physiotherapist.

Driving
It is best to avoid driving after your procedure for the first few
weeks. You must feel comfortable and be able to safely operate
the vehicle before returning to driving. Talk with your GP or
consultant to discuss this further.
It is advisable to contact your insurance company to inform
them of your procedure.

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Return to sports
Discuss with your consultant and your outpatient
physiotherapist initially. General progression will be guided by
your pain and it is as follows:

Timescale Sport activities you can return to

Four weeks to four months Cycle
Cross-trainer
Swimming (front crawl kick only)
Light weight training
Four months Running on a treadmill
Squats
Golf
Five to six months Running outside
Changing directions
Single hops
Jumping and landing
Nine months Tennis
Squash
One year Football
Rugby

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Flying
Discuss with your surgeon and with the airline’s medical
department if you wish to fly within six weeks of your operation
due to the risk of clot formation. You should also discuss with
your GP if there are any other measures to be taken as you may
be on new medication due to your operation.

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What happens when I am discharged?
On discharge, your ward physiotherapist will refer you for
outpatient physiotherapy. The location will depend upon your
GP address. The outpatient physiotherapist will contact you to
arrange an appointment with you.
They will continue to see you until about six months after the
procedure and will discharge you once you have completed the
rehabilitation programme.

Contact numbers
Ward 7, James Paget University Hospital
01493 452007

Orthopaedic Therapy Office

01493 453849

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Feedback
We want your visit to be as comfortable as possible. Please talk to the person in charge if you have
any concerns. If the ward/department staff are unable to resolve your concern, please ask for our
Patient Advice and Liaison (PALS) information. Please be assured that raising a concern will not
impact on your care. Before you leave the hospital you will be asked to complete a Friends and
Family Test feedback card. Providing your feedback is vital in helping to transform NHS services
and to support patient choice.

Courtesy and respect Responsive communication

Trust Values

• A welcoming and positive attitude
• Polite, friendly and interested in people
• Value and respect people as individuals
So people feel welcome
Attentively kind and helpful
• Look out for dignity, privacy & humanity
• Attentive, responsive & take time to help
• Visible presence of staff to provide care
So people feel cared for
• Listen to people & answer their questions
• Keep people clearly informed
• Involve people
So people feel in control
Effective and professional
• Safe, knowledgeable and reassuring
• Effective care / services from joined up teams
• Organised and timely, looking to improve
So people feel safe

The hospital can arrange for an interpreter or person to sign to assist you in
communicating effectively with staff during your stay. Please let us know.

For a large print version of this leaflet, contact PALS 01493 453240
Authors: Melissa Bayes, Senior Physiotherapist, © September 2016
James Paget University Hospitals NHS
Marina Kloni, Physiotherapist Foundation Trust
Editor: Review Date: September 2019
12 PH 36 version 1
Mr Deo, Consultant Orthopaedic Surgeon