ACL Wound Care
The avoidance of swelling and the uncomplicated healing of the surgical wounds are paramount. It
is most important that patients remain in bed for the first five days, following release from
the hospital. Patients may leave the bed for meals or to go to the restroom only. This enforced
rest will pay tremendous dividends in the upcoming weeks.
Patients should expect some blood drainage through the dressing. This is normal and should not be
cause for alarm. Dressings are not reinforced, because it inhibits knee motion. Compressive stockings
(TEDS) and Plastizote pads are placed on the legs and may be removed in order to shower the day after
surgery. Following a shower, the Plastizote pads and compressive stockings are replaced. For the first
ten days, the compressive stocking remains on and only showers are allowed. Bathing in the tub should be
avoided for the first ten days.
Rehydration
Too often patients come in for surgery, particularly outpatient surgery, having had very little to
drink and subsequently become dehydrated following the surgery. It is important that patients rehydrate
following a surgical procedure – consuming sufficient quantities of water and a sports aid drink containing
sugar and electrolytes. Proper hydration is key for the body, particularly one in recovery. Patients are
encouraged to continue drinking until their urine turns clear and stays clear.
Preventing Infection
Infection is a serious complication following Orthopaedic surgery, so patients are given antibiotics by
vein at the time of surgery in order to reduce this risk. No further antibiotics are necessary. Patients
are responsible for the care of their wound and prevention of infection. Two showers per day are advised.
Patients can purchase Hibiclens over the counter at the local pharmacy and fill half a container the size
that is typically used to carry a sports drink. The remaining volume is filled with ordinary water.
Patients use this combination as a body shampoo, first thoroughly cleaning their knee wounds and then
the rest of the body.
A washcloth is helpful in avoiding excessive Hibiclens use per shower. Following the shower, Triple
Antibiotic Ointment, also available over the counter at the local pharmacy, is placed over the knee
wounds - followed by an ordinary gauze pad and replacement of the TED stockings. The shower is repeated
two times per day.
Avoiding Blood Clots
Another serious complication following lower limb surgery is deep vein thrombosis (blood clot), which
could lead to a potentially fatal pulmonary embolus (Thromboembolic disease). In order to prevent this,
the thigh high TED hose is used on both legs for ten days. A Doppler test is then performed in order to
rule out deep vein thrombosis during the first week. Patients who are not at an increased risk for
thrombosis are not given anticoagulants.
LOVENOX®, an anticoagulant (or blood thinner), is given to those patients at increased risk for thrombosis.
These patients include, but are not limited to, those with a history of this problem and those on oral contraceptives.
This medication is administered much like an insulin injection and must be taken twice a day for ten days. The nurse
instructs patients on how to administer these injections. This rare but devastating complication is generally
preventable by following this program.
Preventing Swelling and Excessive Pain
Cryo/Cuff® (cold therapy device) is placed over the compressive stocking on both the graft and ACL legs the first
day post surgery and is kept on for the next week, in order to further minimize the amount of swelling and pain.
The Cryo/Cuff should be removed only when performing active knee flexion exercises. Otherwise, it should be maintained
at all times. With less swelling and pain, motion is more quickly regained. The legs are elevated, with the feet
approximately eight inches above the heart. Nothing should rest behind the crease at the back of the knee. Limited
trips to the bathroom are acceptable for short (emphasis on short) periods. Leaving the house is best avoided the first week.
