Day 3 after ACL Reconstuction

Surgery Dressing Taken off.









*Leg comfortably at 0 degrees lying flat.

and bending to 60 degrees.



bathing , but not wetting these plasters.

They must remain un tampered with till Doctors appointment 10th June.



Exercises: becoming esier

Quads and Hamstring contractions :) perfect!



Very Happy with the pain, as it is bearable+ manageable!

Synap Forte x 2 (p/6hrs)

Day 2 After ACL reconstruction 28May

At Home.





Lots of sleep.

It is quite swollen. (the leg)

This is the dressing used to compress the area.

Remove dressing:
Revealed 4 incisions, covered by waterresistant dry plasters.

No. 1 priority now is to REST + ICE + KEEP LEG ELEVATED.
No PRESSURE (FULL WEIGHT) ON LEG.

Day 1 after ACL reconstruction 27 May

Discharged from hospital 11am.

knee brace to be adjusted to 60 degrees when mobile.

Partial weight bearing on crutches.

I must always remember that no matter what my ACL Rehabilitization Program says,Each of these exercises should be done gently and gradually, and Ishould not push myself to the point where I'm in a significant amount of pain.


Exercises:

Knee extensions -- This exercise helps you to restore range of motion. Place your heel on object like a telephone book so that your heel and calf are not touching the bed. Remain in this position for five to ten minutes.

Quad sets -- This exercise helps you to maintain your strength and your range of motion. Keep your heel elevated as in the knee extension exercise. Begin by tightening the quadriceps muscle and holding it for ten seconds. Repeat ten times.


Heel slides -- This exercise is for ROM. Begin with your knee flat on the bed and slowly bend your knee until it is just slightly uncomfortable. Hold your knee in this position for ten seconds, and then relax by straightening your leg. Rest for ten seconds. Repeat ten times

*Foot pumps .... every hour

Straight Leg raises 3 sets of 20/30 (3 times a day)
Straight leg raise --This exercise helps you maintain your quadriceps strength. Start with your leg flat on the bed. Begin by tightening your quadriceps, as in the quad sets exercise. Then lift your leg off the bed until your heel is approximately eighteen inches off of the bed. Lower your leg back down and relax for ten seconds.

ACL Reconstruction 26 May 2010

Picture:Tourniquet on upper thigh


I went in at 7am this morning.
Had the operation at 9:30am.

ACL Hamstring Reconstruction Technique

*Pre-operative antibiotics, +/- regional block
*Supine postion, all bony prominences well padded.
*Anesthesia (GETA / regional)
*Examination under anesthesia.
*Tourniquet placed high on thigh.
*Perform Knee Arthroscopy.
*Hamstring Harvest
*Sartorius, sartorius fascia=superficial and proximal
*Gracilis=rounder, palpable, proximal. Proximal attachment is circumferential, i.e. after harvest you should note muscle fibers coming off both sides of tendon. If only on one side you may have harvested semitendinosis.
*Semitendinosis-flat, larger, broader insertion, difficult to palpate. Muscle fibers only come off one side of tendon proximally.
*3-4cm incision 3 fingers breadths below medial joint line, midline tibial shaft between crests
*Dissection to sartorius fascia, incise fascia just above Gracilis.
*Isolate gracilis, free fascial slips and excise with tendon stripper.
*Right angle clamp to pull semitendinosis into view, isolate, free fascial slips and excise with tendon stripper
*Deeper structure surrounded by fat is saphenous vein and nerve
*Cut grafts to 24cm and prepare on back table with #2 Ethibond whip stitches in each end.
*Debride ACL stump
*Notchplasty
*Tibial tunnel;just lateral to medial tibial spine, 7mm anterior to PCL in posterior half of ACL footprint, along posterior edge of anterior horn of lateral meniscus. Tunnel angled @45 degrees drill/dilate to size
3-4mm offset femoral tunnel guide used to place guide wire in the 11o’clock position for right knee. 1 o’clock=left knee.
*Drill femoral tunnel to 35mm with acorn reamer. Offset <5mm.
Drill endobutton tunnel with endobutton drill. Measure femoral tunnel length.
*Endobutton size = femoral tunnel length – 25mm. Usually 25-45mm. (see Endobutton Technique for full instructions)
*Place a line on the graft 6mm distal to the femoral tunnel length to indicate the point at which the graft is seated deep enough to flip the endobutton.
*Intrafix tibial fastener: make sutures 5” form tibial tunnel and knot corresponding limbs together. Loop sutures over Tie Tensioner. Cylce knee with 30 lbs of tension. *Compress tendons with sheath trial. Insert sheath with derotation lab in 12 o’clock position. Insert screw
*Consider spiked washer and screw tibial fixation augmentation.
*Irrigate.
*SQ closed 2-0 vicryl inverted interrupted
*Skin closed 3-0 monocyl running SQ
*Steri-strips, mastasol, portal sites closed with steri-strips
*Zeroform, 4x4’s, ABD’s, sterile-webril, Ace bandage, cryo-cuff, knee immobilizer locked at 15 degrees.



Picture above: Stripping of gracilis, with firm countertraction to deliver the tendon out of the incision





Picture: The two tendons have been stripped, and will subsequently be detached from their distal insertions.




Picture: The tendons have been sutured together



Orthopedic Surgeon Dr Mark Human.
Recovery afrter anesthetic = good
Femoral Nerve block dont to left leg.
feeling returning from the evening after 8pm.
Omnopon administered for pain via intravenous injection.
Knee Brace locked on 0 Degrees at night.
I sleep on my back.

Week 2_Day3_ SATURDAY

I had a pretty decent sleep this night. I did quite abit of moving in the bed, didn't sleep on my back with my leg propped up on pillows. It was acceptable!!
I have been eating really healthy.
But my skin isn't co-operating? i'm thinking ts medication, or the stress/trauma surgery does to ones body.

My leg is more bendable today. I ate breakfast with my leg on a chair opposite me with the ball of my foot on the rim, then i did some point+ flex stretches of my foot + calf muscle. It was not sore.

I was quite mobile today and starting to stand/balance on two legs ( without crutch aid) just taking it slow.
Whenever I just sit I wiggle my toes, do muscle contractions &leg raises (bended or straight leg_)