Need Some Advice On ACL Reconstruction

hey guys im sorry i aint no physiotherapist,
but i just underwent surgery last week on Monday (ACL Reconstruction). the docs and physiotherapist at the time said i should be able to put my full weight on it and be walking in 3/4 days .. its been 8 days now i still have to use my crutches to get around, i can walk a little bit but my knee is very swollen and painfulll. i gather you will be asking why i am posting this here and not going to my physiotherapist. the reason is .. i am from Bradford and studying at Nottingham .. i request physiotherapy in Nottingham so it didn't interrupt too much with my knee. it was booked for a week in advance the physiotherapist thinking i will be able to walk be then .. i cannot so i had to cancel my appointment. now i have an appointment with my surgeon in a week as a follow up as you have after surgery ..

i was just wondering if any one can tell me some exercises to do meanwhile .. the swelling is pity bad, anything would be better than nothing. i do the 4 exercises i was told after my surgery
1. straightening my ankles up and down while leg is straight.
2. put a pillow under the knee, bend the knee so muscles in thigh tighten, while keeping these tight, contract the muscles at the front of your thigh,
3.with heel resting and knee straight bring the heel back to yourself making sure i don't bend my knee more than 90 degrees
4.and just getting a book and placing my heel on it so my knee will sag off.

Any other advice would be great as i will not get to see my physio for around 2 weeks.

Regards

Hellow gmb_sim,
First of all, do you wear any protective brace on your knee? Because you have to. Any way you can use cryotherapy. (Put a towel around your knee then apply ice massage.) Also you can elevate your leg slightly over a pillow. This will help decreasing swelling and pain untill you see your surgeon. Quick release of swelling is important. You are now in what we called "Maximum protection phase" so you should walk with partial weight bearing by 2 crutches or walker. Your exercises are fine but it's not recommended to full extened your knee in the first week. Focus on your hamestring, that will help. Any exercise should be pain free.
Don't worry about walking stuff, it may takes 4 to 6 weeks before you can walk independent. At last, I think you have to find a physiotherapist cares about you. Good luck!

hi
couldnt agree more with ramywhite. specially with the physio statement. even if you wearing a brace (what you hopefully do) you are not allowed to fully weight bear for the first 4-6 weeks. weight bear only that it is pain free or half of your body weight. a flexion of 90 deg. is to much as well, 60 deg. for the first 4 weeks is indicated. another thing is it a patella tendon or semitendinosus tendon reconstruction??
for mobilisation try to flex your knee actively with heel on ground up to 60 deg. and extension as close to full as possible without pain. use isometric contractions for quads and hamstrings. exercise your abductors in side laying and lifting your leg up. and from same position bend knees 60 deg. and lift the upper knee up, but the foot stays on the other. its important to keep strength of you hip/pelvic muscles for the gait without cruches. also keep core stability.
the decrease pain and swelling use iceing and elevation and REST. (RICE)
Most important is to find a therapist how knows what he is doing and telling you. Because the different stages of wound healing/soft tissue healing and rehab are very important.
good luck

hi wutti,
I am glad you share your experiences with us. Wearing knee brace doesn't mean full weight bearing. On contrary, it means maximum protection to the knee because full weight bearing is completly contraindicated in this phase. But wearing the brace and walking with crutches or walker is fine. So, as you see we both said that:
1-partial weight bearing.
2-PRICE(protection-rest-ice-compression-elevation)
3-every thing should be pain free.
4-find a good physiotherapy.
You are right about flexion to 60 not 90. But i am not agree with you about full extension . You shouldn't full extend the knee in the first week because that apply more stress on ACL.
I am waiting for your replies , we can discuss about this case together.
good luck.:)

Hi gmb_sim

Different surgeons have different protocols following ACL surgery. If your surgeon and physio have told you that you are able to full weight bear (FWB), then the graft is well fixated and stable enough for you to FWB. This doesn't necessarily mean that you WILL be able to do this. You need to progress your weight bearing as your pain allows - you can expect to be on crutches for 2 -4 weeks. You may have been trying to take extra weight on the leg as you felt this was expected of you, this may be the reason that the knee has now swollen up so much. You should consult your GP if the swelling and pain is really excessive and not within "normal/expected" limits. Ice and elevating your knee should help to reduce the pain and swellling. The exercises that you are doing are great, don't worry about adding any others until you see a physiotherapist who will progress your exercises as appropriate.

Hope this helps!

Emily:)

P.S. Full weight bearing is NOT contraindicated, you MAY fully extend the knee, some surgeons do not allow SLR, but otherwise the only contraindication is no open chain quads for 3 months. 90 degrees flexion IS allowed, this does not necessarily mean that the patient will achive this is the first week, but if he can, great!

Emily

Thanks loads for everyones advice ,, il just fill you in on what i had been told by the surgeon ..

He said its ok for me to put my weight on straight away but i may not want to do that because of the pain .. hence i was given crutches ..

The physio at the time said i would only need the crutches for 4/5 days until i could walk. 11 days in i do not feel comfortable walking too far without them, when i put weight on it the knee feels weak, sometimes when i try to walk without them my knee kind of "gives way". The swelling is really bad and doesn't seem to be going down .. i gave it a ice massage once a day .. do you recommend i do this more ??

I didn't even try to straighten my knee fully in the first week i was advised not to do this, but now i can do this now without a problem. i was not given a knee brace.

sorry to be a pain i am not a physiotherapist so if any further advice is given, please let it be in baby language i would appreciate that.

Thank you for all the reply iv had soo far your a great help. i see my surgeon on Thursday, i will probability end up seeing a physio in around 12 days time.

hey gmb sim
I am really sorry for what happens to you. to see a physio in 12 days is as worse as fully weight bear without a brace. Sorry, but you need physiotherapy next day after surgery, slight mobi and techniques to decrease swelling, pian, etc. you should then get physio 3 times per week (minimum) with techniques covering all different problems.
@ramywhithe: you are right, we said the same things. as far as i know, the ACL doesnt get mucj stress in extension. it is stretched/stressed in flexion with internal rotation, thats why 60 deg of flexion are indicated in the first weeks. only the lower part of the lig is stressed a little in full extension, because of the external rotation of the tibia (loched position of the knee). but i think these minor problems might be handled different all over the world. More important is that we agree with the important treatments.
i really hope that this patient gets the right treatment of this severe injury. seems that there are not really competent people around. our patients get physio imediately after surgery, continuing for at least 6 month to cover all different stages of rehab and wound healing.
anyhow, good luck to gmb sim.