Ice

• You will be provided with ice packs on the day of your surgery. We recommend that you use ice on a consistent basis for the first 2-3 days to reduce post-op swelling. After that, use as necessary.
• Use a cloth between the ice and your skin- DO NOT place ice directly on skin. Do not leave ice wrap or cold therapy on for more than 20 minutes without checking your skin.
• Breg Polar Cubes are available for purchase. Please contact 513-354-3710 or 859-905-1006 for details.
• You may consider purchasing other commercially available ice and compression devices available online (e.g. amazon.com). Some options include a NICE Machine, Game Ready machine or Cryocuff. These devices are not always covered by insurance; we advise you contact your insurance company for cost details. If desired, we can write you a prescription for these devices.

Brace

• With an Anterior Cruciate Ligament (ACL) Reconstruction with Quad Tendon Autograft, you will wear your brace while sleeping and ambulating for the first week.
• You should keep the brace in the locked position (leg fully extended) for the first week.
• Remove your brace during Physical Therapy/home exercises, and hygiene
• After 1 week you may unlock your brace when walking and remove when sleeping. Your physical therapist will assist you in gradually increasing weight bearing.

It is crucial to commit to obtaining full range of motion following your surgery. Please work diligently on straightening the leg fully and bending (flexion) with goal of 90° by 2 weeks.

Crutches & Weight bearing status

• Following an ACL reconstruction with a Quad Tendon Autograft, you will be weight bearing as tolerated in your brace with crutches for the first 2 weeks.
• After 2 weeks you will progress to full weight-bearing and walking normally without crutches. You will still need to wear your brace until 4 weeks post-op.

Pain Control and Medications

You have been given a regional anesthetic block prior to your operation. This will wear off in the evening following your surgery.

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. DVT prophylaxis: Please take one 81 mg baby Aspirin twice daily for 30 days following surgery to help minimize the risk of blood clot (extremely rare). If you are under age 16, unable to take aspirin for other medical reasons, or currently on anticoagulation, you do not need to take aspirin after surgery.
5. Muscle relaxer: Flexeril (Cyclobenzaprine) for muscle spasms in quadriceps muscle. Take this as needed, it will make you drowsy.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

You are not required to take any medication; however, it is recommended that you stay on top of the pain with the anti-inflammatory and Tylenol.

Oral Contraceptive medication: If you are currently taking oral contraceptive medication, you may be at a higher risk for a blood clot after surgery. You may consider talking with your primary care physician about discontinuing this temporarily surrounding your surgery.

Physical Therapy

• Formal physical therapy will be ordered by your orthopedic surgeon. You should start formal physical therapy within 1-5 days.
• The protocol should be given to a physical therapist of your choice.
• Once you schedule surgery, you should contact your physical therapy facility to schedule your first PT appointment within 1-5 days.
• The day following surgery you may begin exercises at home, such as quad sets, leg raises, flexion and extension, and calf pumps (see pictures below).

Follow-up Appointment

• Your first post-operative appointment will be scheduled within 7-10 days following your surgery. Typically, dissolvable sutures are used during surgery and do not need to be removed. If you do have sutures that need to be removed, this will occur at your first post-operative visit. If you do not have an appointment scheduled when you leave the surgery center, please call 513-354-3700 to make the appointment.

Driving

• You may drive once you have full control of your arms and legs AND are off narcotics. If you have surgery on your RIGHT knee, please wait at least 2-4 weeks. If you drive a manual transmission vehicle and have had surgery on your LEFT knee, please also wait 2-4 weeks to prevent irritation from operating the clutch. We recommend you practice driving in an open parking lot before returning to the road. If you have to drive for long periods of time within 2-4 weeks after surgery, we recommend taking frequent breaks to walk and stretch, to decrease the risk of a blood clot.

Return to Work

• You may return to work as soon as you are comfortable, this typically occurs 1-4 weeks post-op. Return to work notes can be obtained at your first post-op appointment.

****Signs & Symptoms to Immediately Report****

Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing.