Preoperative Instructions


If your surgery is before noon, do not eat or drink anything (including water) after midnight the night prior to your surgery.

If your surgery is after noon, do not eat or drink anything (including water) 10 hours prior to your surgery.

  • You must arrive at the hospital at least 2 hours prior to your scheduled surgery time. The Hospital will contact you before the procedure to give an accurate time,
  • You will not be able to drive yourself home. Please make arrangements for someone to drive you.
  • Your Anaesthetist may call you the night before your surgery to answer any questions you have regarding anaesthesia. 
  • Do not take any aspirin or any aspirin-containing products at least 7 days prior to your surgical procedure. This includes any anti-inflammatory medications such as Ibuprofen. If you have any questions regarding this or any medication you are currently taking on a regular basis, please call.
  • Please take steps to protect your skin from exposure to the sun.
  • Avoid cutting toe nails or shaving around the time of the surgery. Any cuts in the skin may result in your surgery from being cancelled.

 

THE DAY OF YOUR SURGERY

  • Wear loose, comfortable clothing so that you can change easily after surgery.
  • Do not wear makeup, nail polish or jewellery.
  • Bring your health insurance card and insurance forms with you.
  • Please leave all valuables at home.
  • Please bring all X-rays, MRI scans, etc. that may relate to your surgery. 

 

AFTER YOUR SURGERY

After your surgery, you will be taken to the post operative care facility where we will make sure that you are comfortable. You will then either be discharged home or transferred to the ward depending on the procedure you are having.

Once you have returned home, it is highly recommended that someone stay with you, at least for the first few nights.

FAQs


 

When can I return to work?

If you work in an office setting, you may be able to return to work once the pain settles. For ACL and arthroscopies this is usually 7-14 days. For hip and knee replacements this will take around 4-6 weeks. However, if your occupation requires a lot of walking or heavy manual labour, your return to work may be more prolonged, and may require a period of time on restricted duties.

 

 

When can I return to my normal sporting activities after an acl?

Most people return to sport  between 9 to 12 months. This will depend on the appropriate completion of the rehabilitation program.

 

 

When do I commence physiotherapy?

Physiotherapy usually starts as soon as possible within 2-3 days after surgery. You may also see a physiotherapist in the hospital who will teach you how to walk with crutches and demonstrate some exercises to do when you go home.

 

 

When can I drive again after surgery?

As a general rule, you cannot drive until you are off crutches and are not taking pain-killers that can cause drowsiness such as Endone. 

 

 

Will I have pain after the operation?

Most people will have mild to moderate pain in and around the affected area for 2 weeks after surgery. This is generally well controlled with regular oral medication, ice and rest.

 

Complications


If the situation is an emergency call 000

Below is information to help mitigate the risk of complications occurring.It is important to realise that complications can occur and are usually unpredictable. All due care is taken before, during and after the operation to try to ensure that complications do not occur. Should a complication occur, you will be informed and advised on the most appropriate treatment required to optimise the outcome of the initial surgery. If you have any questions or concerns during your recovery, it is important to contact your surgeon or ring the hospital where your surgery occurred.


 

Infection control

Infection following this procedure is uncommon (<1 in 250). This can either be a superficial (minor) infection involving the incisions, or a deep infection involving the knee joint and bone. If a deep infection occurs, admission to hospital is required as are intravenous antibiotics. A knee arthroscopy is sometimes performed to wash the infection out. Antibiotics are given prior to the operation to reduce the risk of infection. There is a higher infection risk in smokers and as such it is highly recommended you cease smoking approximately two weeks prior to your surgery and 6 weeks after. It is also important to prevent any cuts, rashes or abrasions developing around the knee joint prior to surgery as they increase the risk of infection, and your surgery will have to be delayed until they have resolved.

 

 

Blood clots

Deep Vein Thrombosis is the risk of developing a blood clot in a calf muscle vein and occurs in approximately 1 in 50 patients. Very rarely these blood clots can break away and travel to your lungs. This is called a pulmonary embolus. The risk of developing a pulmonary embolus is exceedingly rare. If you develop calf pain or tenderness following your surgery, you should contact your surgeon or family doctor immediately. An ultrasound examination will be performed of the calf to assess for a blood clot. To minimise the risk of a blood clot, it is important to notify your surgeon if you have any hereditary risk factors for blood clot formation, or if you have experienced a blood clot in the past. You should also cease smoking as this increases the risk of this complication. The combination of the oral contraceptive pill or HRT with smoking increases the risk of DVT as well. These factors should be discussed with your surgeon prior to your operation.

 

 

Bleeding

Occasionally, minor bleeding can occur which normally settles with compression and rest. Major bleeding is exceedingly rare. If you are experiencing bleeding please do not hesitate to seek medical advice.

 

 

Nerve or Vascular Injury

There is a very rare complication but can result in either numbness, or loss of power of the muscles that move the foot and ankle (foot-drop) or damage to the circulation of the lower leg.

 

 

risk Re-rupture or tear of the graft

This can occur any time following surgery, but the highest risk in the first 2 years, when the graft is maturing and neuromuscular control is still sub-optimal. The greatest risk factor for this is age under 18. It is critical you comply with your rehabilitation protocol to ensure you do not damage the graft during the healing phase.

 

 

Numbness around the cuts

It is common to have numbness around the surgical incisions, but especially on the outer lower side of the leg. This numb patch usually resolves over several months. Occasionally a permanent patch of numbness can be experienced but does not become problematic.

 

 

Hamstring-related problems

The hamstrings regenerate in most people to a point where no subjective difference in power is noted. During the first 6 weeks after surgery, you may experience tears or a pops as though it has been injured. This is common and occurs from injury to early scar tissue that is forming.

 

 

joint Stiffness

There is a risk of developing stiffness following any surgery. If this occurs, you may require a second operation where the affected joint is either manipulated or scar tissue is removed arthroscopically. In order to prevent stiffness following the operation, it is important to have good range of motion prior to surgery and perform regular stretching exercises. Most importantly, you must participate in the post-operative rehabilitation program under the care of your physiotherapist.

 

 

Hardware
related-complications

As metal buttons and screws are required to hold the graft in position, these may become prominent and cause irritability of either the skin or tendons. Sometimes, screws or buttons may need to be removed.

 

 

Ongoing swelling, pain or instability

Despite the surgery being performed appropriately, there is a chance that you have ongoing pain or swelling in your knee from injury to other structures in you joint. 

 

ACL Rehab


Recovery after ACL reconstruction requires a thorough rehabilitation programme to ensure both optimal function of the knee and prevention of further injury.

The long term goal should be both a return to sport, but also correction of problems that existed prior to injury, potentially making you a better athlete than before your ACL injury.

The rehabilitation program must consider multiple factors. Following implantation, the body uses the ACL graft as a framework in which the new ligament will form.

This biological process takes in excess of 12 months. As such, time plays a significant role in your rehab.


The phases of recovery after ACL reconstruction can be considered to broadly follow 6 stages. The goals of each stage should be achieved before progression to the next stage.

1.  Prehabilitation before surgery

2.  Acute Recovery

3.  Muscular Control and Coordination

4.  Proprioception and Agility

5.  Sports Specific Skills

6.  Return to Play