Tear > Treatments
Reconstruction: Quadrupled Hamstring
Autograft or Allograft
Preparing for Surgery
If you and your physician have
decided on quadrupled hamstring autograft or allograft
surgery to repair your torn ACL (anterior cruciate ligament),
the decisions you make and the actions you take before
your surgery can be every bit as important as the procedure
itself in ensuring a healthy recovery.
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, practice walking with your crutches in case
you need to use them after surgery.
a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
Day of surgery
At most medical centers, you will go to "patient
admissions" to check in for your ACL reconstruction
surgery. If your surgery is going to be inpatient, there
may be a separate department, so be sure to ask your
doctor. After you have checked in to the hospital or
clinic, you will go to a holding area where the final
preparations are made. The paperwork is completed and
your knee area may be shaved (this is not always necessary).
You will wear a hospital gown and remove all of your
jewelry. You will meet the anesthesiologist or nurse
anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
Then, you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
for someone to drive you home when you are released.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
A common method for ACL reconstruction
uses the hamstring tendons, which connect muscles in
the back of the thigh to the shinbone (tibia). An autograft
is a graft taken from the patient. An allograft is taken
from a cadaver. Consult your physician about the advantages
and disadvantages to each type of graft.
anesthesia is typically used for surgery, though in
some cases a spinal or epidural anesthetic is used.
The anesthesiologist will administer the anesthesia
to put you to sleep once you are in the operating room.
procedure, which usually lasts less than two hours,
normally requires one incision to remove the tendons
(if an autograft is used) and several small punctures
to accommodate the arthroscope and surgical instruments.
With an allograft, the surgery may be shorter because
the graft does not have to be removed from the patient.
two hamstring tendon grafts are looped around each other
and are then fixed to the upper leg bone (femur) and
lower leg bone (tibia) with screws or posts, or with
sutures tied around a post. The decision whether to
use screws or posts is usually a matter of the surgeon's
are sewn up and the patient is taken to the recovery
After ACL reconstruction surgery,
you usually stay in the recovery room for at least two
hours while the anesthetic wears off. You will be given
adequate pain medicine, either orally or through an
IV (intravenous) line, as well as instructions for what
to do over the next couple of days. In addition, you
will be given an appointment to return and a prescription
for pain medicine. Your knee will be bandaged and may
have ice on it. There will likely be pain, and you can
expect to be given pain medication as needed. Be sure
to ask for medication as soon as you feel pain coming
on, because pain medication works best on pain that
is building rather than on pain that is already present.
The nurses will not give you more than your doctor has
prescribed and what is considered to be safe. You should
try to move your feet while you are in the recovery
room to improve circulation. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital or, if necessary,
be admitted for an overnight stay. It is likely that
you will be able to bear some weight on your leg, but
your surgeon may suggest that you use crutches or a
cane for between two days and three weeks. Within two
weeks, the majority of patients should be able to walk
carefully without crutches.
After ACL reconstruction surgery,
some patients remain in the hospital for as long as
24 hours. As soon as possible after surgery is completed,
you will begin doing continuous passive motion exercises
while in bed. Your leg will be flexed and extended to
keep the knee joint from becoming stiff. This may be
done using a continuous passive motion (CPM) machine.
The CPM is attached to your bed and then your leg is
placed in it. When turned on, it takes your leg through
a continuous range of motion. There will likely be pain,
and you can expect to be given pain medication as needed.
Be sure to ask for medication as soon as you feel pain
coming on, because pain medication works best on pain
that is building rather than on pain that is already
present. The nurses will not give you more than your
doctor has prescribed and what is considered to be safe.
Ice also helps control pain and swelling.
Your rehabilitation program begins
the moment you wake up in the recovery room and continues
at home, to restore strength and range of motion to
your knee. Here is what you can expect and how you can
cope during the first days after surgery:
will likely feel pain or discomfort for the first few
days. Take pain medications as your doctor advises.
These could be over-the-counter painkillers, such as
ibuprofen or acetaminophen, or stronger, presecription
much as possible, keep your knee elevated above heart
level to reduce swelling and pain. Icing your knee for
20 or 30 minutes two or three times a day during the
first two days after surgery also will reduce pain.
your surgeon when it is safe to take a shower.
dressing on your knee is usually removed the day after
surgery. There may be some minor drainage for two days.
Sterile dressings or bandages may be used during this
the first week after surgery, most patients are encouraged
to lift their leg without assistance while lying on
their back. These are called straight leg raises. By
the end of the second or third week, they normally are
able to walk without crutches.
soon as possible after surgery, you should begin doing
exercises using a continuous passive motion (CPM) machine
while in bed. Your doctor can arrange to get you a CPM
machine, which helps flex and extend the leg and prevents
the joint from becoming stiff due to inactivity.
people may experience fever of up to 101 degrees during
the first few days after surgery. This is usually nothing
to worry about. The fever will go away with coughing,
deep breathing, and a fever reducer such as acetaminophen.
See your doctor if you have any fever after three or
four days that is accompanied by redness around your
Your physician may prescribe visits
to a physical therapist to begin supervised strengthening
exercises as soon as possible after your ACL reconstruction.
Recovery from a torn ACL takes an average of between
four and six months with 45-minute exercise sessions
three days a week. Though everyone's rehabilitation
program is slightly different, physical therapy for
a torn ACL follows a general pattern. The first three
weeks are usually spent restoring a full range of motion
to your knee and recovering to the point of being able
to walk without crutches. Movement may initially be
painful, but it is important to not allow your knee
to stiffen. Rehab progresses to resistive exercises
to strengthen muscles around the knee. During this time,
you should be able to resume functional activities like
stair climbing, single leg support, swimming, and driving.
After about three months, the emphasis will change from
strengthening to functional training, as you begin exercises
specifically geared for your activities and lifestyle
to regain balance and control over your body.
These may include more vigorous warmups on a stationary
bike, elliptical trainer, or treadmill. You should be
able to return to normal activities after about four
months. Physicians usually suggest that you continue
strength training even after your knee has been rehabilitated.
Your doctor will likely check your knee for strength
and stability. After your physician or physical therapist
measures knee strength, you may be able to exercise
at full strength and compete in your favorite activities.
Strengthening your hamstrings and quadriceps
muscles may help prevent knee injury. The more aggressive
and dedicated you are during rehab, the better chance
you have of a stable knee. If you have done appropriate
rehab, you ideally should have a stable knee and be
ready for sports six months after surgery. The goal
is to have a knee that is as stable as it was before
the surgery. Many of the exercises and activities that
are popular for fitness put stress on your knees. To
prevent further ACL injuries it is important to learn
knee-sparing exercise techniques by dividing your activities
into three components:
living - the average person takes between 12,000 and
15,000 steps a day, exerting a force between two and
five times your body weight on your knees. After a knee
injury, take it easy on your knees during the day whenever
possible to save them for activities and exercise. Avoid
stairs when there is an elevator, take the shortest
path when walking, and consider wearing athletic shoes
designed to absorb shock.
strengthening/conditioning - activities themselves are
not a substitute for conditioning. It is essential to
adhere to the muscle strengthening program you learned
in rehab throughout the remainder of your life. The
best strengthening programs are low-impact and non-weight-bearing,
like stationary bikes and certain weightlifting programs,
so that the knees do not have to absorb shock.
- your sport or activity of choice helps maintain mental
and physical well-being, but it is not a conditioning
program. Sports that require twisting and quick direction
changes put great strain on your knee.
A small amount of pain is normal during
physical activity, but if you feel so much pain in your
knee to warrant taking a painkiller before an activity,
you should consider cutting back or stopping. Do not
play through the pain after an ACL injury - it may be
a sign that your activity is putting too much stress
on your knee.
Some people feel safe wearing a knee brace after
an ACL injury, but if the brace is too tight, it can
cause added pain after an activity. If you do wear a
brace to prevent injury, wear one that has a kneecap
hole or padding. There is no evidence to suggest braces
prevent injuries, meaning they are not substitutes for
increasing your muscle strength. Always consult your
physician before buying or using a knee brace.