Mr Anthony D Clayson BMI Healthcare
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Patient Protocols
Anthony D Clayson Anthony D Clayson
ACL (Anterior cruciate ligament) protocol
Day of surgery
Your leg will be placed in a soft cotton dressing and wrapped with a bandage to help control the swelling and a drainage tube will be placed into the knee to prevent collections of blood from building up in the knee. This tube will be removed on the morning after your surgery. Patients will have continuous anaesthesia during and after surgery to reduce post operative pain. Your leg will be placed in a cricket pad splint immediately following surgery to help give support when you stand up for a few days after surgery and then can be removed
Extremely important for the knee to achieve full extension. That is extension equal to that of the normal side as soon as possible after surgery.
  1. Continue pain relief.
  2. STATIC ISOMETRIC QUADRICEPS exercises and straight leg raises in the splint should be commenced as soon as possible following surgery.
Day after surgery
  1. Drain removed.
  2. Pain controlling medication continued.
  3. Dressing reduced and splint removed to commence knee flexion.
  4. Ice will be applied using a Cryocuff sleeve to reduce swelling.
  5. Start mobilisation with the assistance of a physiotherapist. Your physiotherapist will teach you isometric exercises for the quadriceps and hamstring muscles, passive active-assisted, active knee motion exercises and patellar mobilisation. Gait training with two crutches will be taught. Most patients (except those who have had meniscus repair) are allowed to fully bear weight with crutches for support on the operated leg.
  6. By the end of the first day after surgery, most patients should be ready for discharge from the hospital. At the time of discharge, it is hoped that you will be able to:
  • Get your knee completely straight
  • Bend your knee between 70-90 degrees
  • Achieve straight leg raising with no lag
  • Mobilise with two crutches and climb stairs
Days 2-7 after surgery
It is EXTREMELY IMPORTANT to continue to achieve FULL EXTENSION of the knee 3-4 times per day for 10 minutes at a time and continue to flex the knee.

Out patient physiotherapy will begin at day 5 post operatively and an appointment will be arranged to see Mr Clayson 2-3 weeks after surgery.
Days 7-14 after surgery
  1. Goals:
    a. Maintain full extension
    b. Flex (bend) 90-100 degrees
    c. Decrease the swelling in the knee
    d. Develop better muscular control of the leg
    e. Become more comfortable, enough to get out of the house and decrease your pain medication requirements.
    f. Dispense with crutches

    By far the most important goals in the first two weeks are maintaining full extension, increasing your bending and decreasing pain and swelling.

  2. Sutures are absorbable and do not need to be removed.
  3. If the wounds are healing satisfactorily, you will be allowed to bathe the leg 10 days after surgery.
  4. As far as returning to work, if you have a desk type job, you may return to work when your pain medication requirements decrease and your ability to walk with crutches improves. Usually this is between 10-14 days after surgery. For patients who have strenuous jobs: policemen, firemen, construction workers, labourers, etc who cannot perform desk type work, they will be out of work longer.
When can I drive a car?
Patients who have had surgery on the left knee and who have automatic transmissions, can drive when they can comfortably get the leg in and out of the car. For patients who have had surgery on the right knee or who have standard transmissions should not drive until you have good muscular control of the leg. Usually this will take about 3 weeks.
Week 2 after surgery
  1. Expected range of movement full extension to100-110 degrees flexion. Remember it is extremely important to maintain full extension.
  2. Weight bearing increases as tolerated (except for patients who have had meniscus repairs who will remain toe-touch weight bearing for 4 weeks).
  3. Continue formal physiotherapy sessions.
Week 3 after surgery
  1. Your expected range of movement should be full extension to 110-120 degrees.
  2. Weight bearing to increase to 100% body weight. Dispense with crutches 2-3 weeks after surgery. Commence proprioceptive work for balance training.
Weeks 4-6 after surgery
  1. Start to push for full range of movement. Wall slides and prone leg extension can be used to improve the range of movement.
  2. For meniscus repairs, weight bearing to start at week 4. WEIGHT BEARING SCHEDULE FOR MENISCUS REPAIRS
    a. 25% body weight Week 4
    b. 50-75% body weight Week 5
    c. Full weight bearing Week 6
  3. Start step ups, calf raises and partial squats.
  4. Continue stationary biking, start to increase resistance as tolerated.
  5. Start swimming program prone position with kick board. Flutter kick only!
  6. Start isotonic exercises with free weights:
    a. Quadriceps 45-120 degrees h
    b . Hamstrings 0-120 degrees
Three sets of 10 repetitions, minimal of 3 times per day.
  1. Start cross trainer.
  2. Start stairmaster.
  3. Start rowing machine.
Weeks 6-10 after surgery
  1. By week 6 your range of movement should be 0 degrees extension and at least 125-130 degrees flexion.
  2. Continue biking, swimming programme.
  3. Continue quadriceps isotonic exercises blocked at 45 degrees
  4. Start isotonic exercises for hamstrings only.
  5. Start running at 6 weeks.
Weeks 10-12 after surgery
  1. Continue swimming, biking, cross trainer and stair master.
  2. Continue hamstring iso-kinetic exercises.
  3. Start leg press both legs for quadriceps strengthening.
  4. Continue quadriceps and hamstring isotonic strengthening exercises.
  5. Start running and twisting at 12 weeks.
  6. Start treadmill 7. Start mini-trampoline 8. Start leg curls full range
Weeks 12-16 after surgery
  1. Commence shuttle runs with twisting, floor touching, sideways running.
  2. Commence sport specific drills.
4-6 months after surgery
Commence sport such as tennis, netball, basketball if adequate progress with rehab
6 months after surgery
Commence sport such as rugby if adequate progress with rehab
9-12 months after surgery
Commence any sport depending on instructions and the type of sport you perform.
 
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CONTACT US
BMI The Alexandra Hospital
Mill Lane
Cheadle
SK8 2PX
Tel: 0161 4956884
Fax: 0161 4286367
Email: clayson@uk-consultants.co.uk
Directions to: The Alexandra Hospital
Directions to: The Highfield Hospital
 
 
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