How to prepare for ACL surgery
An ACL (anterior cruciate ligament) tear or rupture is a very serious injury that commonly occurs during sports like soccer and basketball in which rapid changes in the speed of human movement, and abrupt changes in direction are common. A ruptured ACL won’t heal on its own because of the relative lack of direct blood supply to this important ligament in the human body. As a result, an ACL rupture almost always requires reconstructive surgery to facilitate complete healing and a return to full athletic activity. Surgery is always serious business, and detail oriented preparation for it will ease the distress that can come with it. For this reason I recommend reading this article more than once before you go anywhere near your surgeon’s knife. I am fairly confident that you will gain some bit of wisdom from this article that will make surgery and its aftermath easier for you. The information in this article could also be easily applied to help others who are about to go through ACL reconstruction. For example, a doting mother could read this article and use the information contained in it to help her son or daughter get through ACL reconstruction with as little extra fuss as possible. The surgery is already painful enough… so it is advisable to do all in your power to alleviate as many potential added difficulties as possible. How do I know that these suggestions will be of use to you or someone you know who is preparing for ACL surgery? Well because I wish someone had told me all this before I went under the knife for my own ACL reconstruction surgery in early 2012.
Do your pre-hab
Schedule your surgery date
Arrange for transportation and human help after surgery
Be prepared to ice your knee regularly
Learn how to use crutches if you don’t already know how to
Go to your pre-op appointment
It is human nature to “favor” an injured limb by using it less often or putting less weight on it to avoid pain. After all, it is the most base of all human instincts to preserve self first and foremost. The problem with favoring an injured limb is that it will lead to muscular atrophy (loss of muscle mass) and postural imbalance. Plainly put, if a particular muscle remains idle for any extended period of time, it will become smaller, weaker, and less flexible.
It is in your best interest to ensure that the muscles of the injured limb are as strong and as flexible as possible prior to surgery. The general inability to walk after surgery will lead to muscle atrophy which will prove more and more difficult to reverse the longer it persists. Strengthening your leg before surgery will have a buffering effect on the atrophy that will occur in the surgically repaired leg as you recover. This is why strengthening the leg muscles and restoring range of motion before going through knee surgery is so crucial.
Your surgeon will give you several exercises that will help you restore range of motion and some strength to the injured leg prior to surgery. My personal advice to you is to please, please, please do your prehab. It will probably be boring and some of it might hurt a little. When the pain and frustration comes, try closing your eyes and visualizing yourself nailing a jump shot on the court, doing a flip turn in the pool, or scoring a touchdown so you can find the motivation to push through. If you diligently adhere to your prehab, you should be ready for surgery between 2 – 4 weeks after diagnosis.
Give yourself at least 3 weeks between the surgeon’s final diagnosis and surgery. This will give you sufficient time to do all the preparatory work you will need to do in order to fully prepare for surgery. Once you have set a surgery date, inform your employer, customers, professors, or whomever you answer to that you will be out of commission for at least 2 – 3 weeks after surgery. You will need this time to rest and recover. I am sure your superiors and colleagues at work will appreciate this sign of respect. Although I doubt anyone would forget anything as serious as surgery, I recommend putting your surgery date on your calendar (iCal, google calendar etc) to serve as a constant reminder to yourself of your upcoming ordeal.
You will need to have someone drive you to and pick you up from surgery. You could also ask this person if they will be able to take you to your post-op (after surgery) appointments. The first post-op appointment is usually the day after surgery and the second one is usually two weeks after surgery. Look for someone with a large car because the immobilizer brace that you will be wearing after surgery will keep your leg straight and if you are on the tall side, it can be a nightmare to fold yourself into a little car. If you cannot find someone to drive you, you can always use a commercial taxi or a professional car service (like lyft or uber) to get you to and from the hospital as needed.
Try to arrange for someone to sleep over and help you get through at least the first night after surgery. You could ask a family member or good friend to do that. If you have a live in girlfriend, boyfriend, husband, or wife, they can help you too. If you’re a loner, you can hire someone from a trusted source to help you out for the night or for however long you think you might need care. TaskRabbits are a great resource that you can employ to get things done for you while you heal.
You will experience a substantial amount of pain and swelling after surgical ACL reconstruction. To alleviate this, you will need to ice your newly repaired knee fairly regularly. In my case, I iced my knee between 6 – 8 times a day for about 20 minutes each time. Be sure to allow 15 – 20 minutes after each icing session for your knee to settle back down to your body temperature before you ice it again. This will help you avoid inadvertently causing the onset of frostbite.
Many folks in the developed world have refrigerators that make ice on their own. If you don’t have such a refrigerator, you can easily purchase bags of ice from your local grocery store. You can buy yourself some ziploc bags and stuff some ice from your refrigerator or from your purchased bag of ice in them. Place the ziploc bag now full of ice on your injured knee for a 20 minute icing session. This is an effective and relatively cheap way to ice your knee without making a drippy mess.
The refrigerator ice maker strategy is a good one, but it is very likely that you will probably need to use ice at a faster clip than your refrigerator can generate it. This is especially true in the first few weeks after surgery. As a result, you will need to increase the availability of ice that you have at your disposal. You can either buy many bags of ice from the grocery store, or you can invest in a standalone portable ice maker to supplement whatever your refrigerator makes. It will cost you extra money, but you will find it a worthwhile investment for a considerable chunk of your athletic life. I bought a stand alone ice maker for my surgery and continue to use it a couple of times every week for general maintenance and I am 4 years removed from surgery.
Even better than using a ziploc bag filled with ice to ice your own knee is to buy or rent an automatic cold compress that automatically circulates iced water around your newly surgically repaired knee. Game ready is a very good brand for this sort of therapy. If your surgeon offers you one of these units for your recovery, I highly recommend renting it if it is one of the expensive brands, or buying it if it is on the affordable side. If your surgeon doesn’t recommend one of these cold compress units, you should feel comfortable asking for one. It may seem like something that it isn’t quite necessary for recovery, but trust me when I say it will make the immediate aftermath of surgery several orders of magnitude easier and more comfortable. The reason why these automated ice machines are so useful is that they will drastically reduce the number of times you have to get up to get fresh ice from your refrigerator or ice maker. Although you will still need a primary source of ice (i.e. refrigerator or stand alone ice maker) for the cold compress to run, it is so much more convenient than the manual alternative. Simply fill the insulated tub with ice and water per the directions that come with the instrument, plug the device in, wrap the sleeve around your knee, and push the on button. You can switch it off or turn it on at any time. You may want to follow the same pattern we previously discussed for icing… 20 minutes on, 15-20 minutes to recover. Rinse and repeat.
I could go on and on about this, but I’ll just direct you to the video below for a very good visual tutorial on how to use crutches.
Your doctor will ask to see you a couple of days before surgery. By this time, you should have come up with a list of things that you need to clarify with him or her prior to going under the knife. The notes app on your iPhone is a great place to store your questions as you think of them because chances are you will probably have your phone on you when you actually go to this appointment. Please leave any shyness at home and make sure you get all your questions answered. You are paying for the appointment and you have every right to ask all the questions you need to in order to give yourself the best shot at a full recovery. You should also be warned that the reality of surgery will probably be dawning on you so try to be mindful of that. Be careful not to get too emotional and have an outburst towards your doctor as that won’t help to be honest. Pray if you are religious, watch a funny movie, read a good book, talk with a good friend… I don’t care how you do it (provided you aren’t hurting anyone) just try to keep yourself in a good mood.
Your surgeon will give you a list of action items and instructions to follow in preparation for the big day. I have listed some of the instructions that you can expect from your surgeon below:
- Do not eat or drink anything after 10pm on the night before surgery. The general anesthesia you will be under will make you nauseous and if you have food in your stomach, chances are you will vomit all over the place when you regain consciousness and attempt to move around.
- Make sure you call your ride to surgery and remind him/her that you will need them the next day and the day after that for a ride to surgery and your first post op appointment respectively. We all have an unreliable friend or two in our lives, make sure you get one of your more reliable buddies to handle this responsibility.
- Plan to get to your surgery appointment at least 2 hours before “go” time. This will give you time to get changed, sedated, and have your surgical leg shaved with time to spare so you can catch some SportsCenter or your favorite TV show.
- Don’t wear any jewelry to the hospital because you will need to take it off before surgery and it isn’t worth the hassle. Please also leave your smartphone, iPad, watch etc at home… you will have plenty of time to play with those things once you are off the operating table.
The bottom line here is to please listen to your surgeon. He/She has probably done a ridiculous number of these procedures in the past and knows what is best for you. You don’t have to assume their word is law, but their advice probably has a huge chunk of truth in it. I’d keep that in mind if I were you.
Get your prescription pain medication prior to surgery.
We all intuitively know that wounds are painful and surgery is really just a very serious and intricately controlled wound. In essence, your surgeon will have to wound you (by cutting you open) in order to repair your torn ligament. ACL surgery can be really painful and you will most likely need prescription narcotic pain medication to help you get through the first 2 – 3 weeks. The usual pain medication options provided for ACL surgery patients are vicodin or oxycodone. One of the things you should get from your doctor during your pre op appointment will be a prescription for these narcotic pain meds. It is highly recommended that you go to your local pharmacy and pick up these pain meds before surgery day. During my own recovery, I found it useful to take my narcotic pain medication as soon as I felt the onset of severe pain which was usually between 3 – 4 hours after the last dose. If you wait too long to take your pain medication, you will be much more uncomfortable for a longer period of time than if you stayed on top of it by taking your medication early. It is important to note here that some people suffer from upset stomachs while on narcotic medications. Making sure you have some food in your stomach when you take your pain medication may ease these stomach problems.
Make big batches of food that you can warm up and eat as you recover
It is vital to provide your body with quality nutrition while it is on the mend so that it has the best raw materials to repair itself. It should be emphasized here that this isn’t just about maintaining your caloric intake. The major goal here is to strive to provide quality macronutrients (carbohydrates, protein, fats, water) and micronutrients (full spectrum vitamins, phytonutrients, bioflavonoids and minerals) to the body in a readily digestible form. Sure, you can still have the odd slice of pizza here and there, but your focus should be on high quality nutrition. The best way I have found to get through the days after surgery when it is difficult to move let alone cook, is to make big batches of food and freeze them down before surgery so that a good meal is only 5-6 microwave minutes away.
You can look up this article to get a really good smoothie recipe that you can have for your daily breakfast. You can also talk mom, the husband, the wife, whomever, into making some big batches of nutritious food for you to eat while you get better.
And there you have it… 8 helpful tips that will help you get through ACL surgery and recovery. I wish you all the best as you prepare for your ordeal. If you need to talk to someone about what you are about to go through, don’t hesitate to shoot me an email. Also, there are a few helpful facebook groups with many people who are surprisingly helpful and willing to answer any questions you might have about preparing for and recovering from surgery. I highly recommend using these facebook groups as another information resource as you recover. Just please be sure you think critically about the advice you get from people or your own research to be sure it makes sense to you. It is always prudent to trust others but verify that their advice is sound. Till next time friends, take care of yourselves and each other.
This article is an excerpt from “In Kneed of Repair… Getting through ACL reconstruction”. A comprehensive interactive eBook designed to guide you through ACL reconstruction and recovery. You can buy the full iBook for iPad or Macintosh on the Apple iBookstore
Oyolu B.C. Ph.D.
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