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  • ACL reconstruction

Rehabilitation week 1 to 4

Knee extension exercises and isometric quadriceps exercises are especially important in the early post-operative period. I encourage you to familiarize yourself with these exercises beforehand. The sooner you start doing them after the anaesthetic the better.

It is important that you follow this post-operative program carefully.

The new ACL ligament forms a strong bond to the bone in the tunnels that have been drilled during the reconstruction operation during this phase.  Movement of the knee is safe, but excessive loading of the knee by weight-bearing is detrimental to healing.

  1. Use of a brace: You will only need a brace if a hamstring graft was used or if a meniscus repair was performed. This needs to be worn only while walking. It is not necessary for you to sleep with the brace on. Some patients do prefer to sleep with the brace on so the decision is entirely yours to make.
  2. Walking: You will be able to start walking immediately after the procedure with the use of crutches. You can walk by means of partial weight bearing with the use of two crutches. You will be taught the technique of ascending and descending stairs while using the crutches.
  3. Driving:You should be able to start driving a vehicle at two weeks after surgery.
  4. Return to work: Depending on your type of work you will not be able to work for between one and six weeks. If you are at school or a student at university you should be able to return to classes/lectures one week after surgery.
  5. Ice pack:You will be supplied with an ice pack and will be shown how to use it. Ice therapy is very beneficial to the healing process and helps with pain control.
  6. Dressings:The dressings are water resistant so you are able to shower with them in place. You will receive a spare set of dressings upon your discharge from the hospital. These only need to be used if a dressing should come loose. All the dressings can be removed one week after the surgery. The stitches used are positioned beneath the skin and do not need to be removed. The wounds can be left open and can now be exposed to water. Avoid exposing the scars to direct sunlight for the first four weeks as it can lead to darkening of the scar.
  7. Range of motion exercises: It is important to put the knee through a range of movement right from the start. Do this at least three times a day.  Concentrate especially on regaining full knee extension. The normal post-operative swelling of the knee will restrict the range of knee flexion initially. As the swelling recedes you will be able to regain knee flexion.
  8. Isometric quadriceps exercises: Do this exercise as often as you can. Each contraction should last 5 seconds. As a minimum do 10 sets of 10 contractions three times a day.


What should you be on the lookout for in the first 4 weeks? It is during this period that there is a risk of infection and deep vein thrombosis (DVT). Please contact me if any of the following symptoms occur:

  1. Wound drainage: There will always be drainage from the wounds during the first 12 hours after surgery. Any drainage thereafter should be reported.
  2. Increasing swelling of the knee: The swelling should gradually recede over the first few weeks.
  3. Increasing knee pain: The post-operative pain should be well controlled with the medication you receive on discharge.
  4. Swelling of the calf: Progressively worsening swelling of the calf is suggestive of a DVT.


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