My Surgery: Knee Anterior Cruciate Ligament (ACL) Repair

You must come for your pre-admission appointment before your surgery. If you don't come for your pre-admission visit, your surgery will be cancelled (unless you were given other instructions).

In the weeks before your operation, you will have a pre-admission appointment. This appointment could take 2 to 4 hours, or sometimes longer.

Pre-Admission Clinic
Toronto Western Hospital
Main Pavilion – 1^st Floor
TWH Maps & Directions 

• You will have blood tests and routine skin swabs. The swabs are taken from your nose and other areas of your body to check for germs that can cause infections.
• You may also need an electrocardiogram (ECG) to check your heart and a chest x-ray to check your lungs.
• You will meet many health care providers during your pre-admission visit. Please feel free to ask them any questions that you may have.
• A pre-admission nurse will review your health history and give you information to prepare you for your operation, including directions for cleaning your skin, eating before your operation, taking your medications and pain management.
• A pharmacist will review your medications.

Depending on your needs, you may also meet:

• An anesthetist who will review your health history, discuss your anesthetic plan and pain relief after surgery.
• A member of the medicine team, if you have other complex health problems.
• A Clinical Nurse Specialist (CNS), or Nursing Coordinator, who specializes in the care of patients having your specific surgery. They will review any preparation that is required before your surgery, plans for discharge home after surgery and specific instructions regarding your recovery.

1. DO NOT eat any solid foods or milk products after midnight on the night before your operation.
2. Drink clear fluids only after midnight on the night before your operation. Do not drink any fluids within 5 hours of your surgery.
3. Do not drink alcohol 24 hours before your surgery.
4. Examples of clear fluids you can drink:
   • Apple juice
   • Beef or chicken broth (no noodles or vegetables)
   • Orange juice (without pulp)
   • Grape juice
   • Jell-O or popsicles
   • Cranberry juice
   • Pop (such as Ginger-ale, 7-Up, Coke)
   • Lemonade
   • Water
   • Coffee or Tea
5. Take a bath or shower the night before your surgery and the morning of your surgery. If your doctor has asked you to use a cleaning solution when bathing, make sure to follow the instructions.
6. Remove all nail polish, shellac, gel or acrylic nails from ALL of your fingers and toes.
7. Remove all your jewellery and body piercings and leave them at home. If you cannot remove your jewellery, have a jeweller remove or cut it off before coming for surgery.
8. Do not shave the hair around the area we will be operating on for a week before surgery.
9. Stop smoking at least 5 hours before surgery, but it is better to stop completely.

TIP: By drinking warm fluids such as tea or broth you may not feel as hungry.

• Your health card (OHIP). If you do not have an OHIP card, please bring another form of government-issued photo ID (such as a driver's license, passport or other provincial health card)
• All the medicines you take in their original bottles (or a full list from your pharmacy)
• Clean, loose-fitting clothes and flat shoes
• An Ortho brace and crutches, if your surgeon has asked you to use them after surgery
• Hearing aids, dentures and glasses, if you need them
• Insurance or drug card to buy any prescription medicine
• WSIB number
• Loose-fitting pants, track pants with wide bottoms, or loose-fitting tear-away pants. Do not wear tight fitting pants or blue jeans.

Leave your valuables at home such as jewellery, watches and credit cards. The hospital is not responsible for lost or stolen items.

• We will prepare you for the operation.
• The operating room nurse and surgeon will talk to you before you go into the operating room.
• If you did not see the anesthetist in the Pre-Admission Clinic, you will meet them before your operation.
• We give you a hospital gown, pajama bottoms, a robe, a hair cover and slippers to change into. We also give you a locker for your belongings.
• Your nurse checks your blood pressure, pulse, temperature, breathing, blood sugar and height and weight.
• We will mark the area where we are doing your operation.
• We will give you an intravenous (IV) drip. This is a small needle that we put in a vein in your arm. We use it to give you one or all of the following: fluids; antibiotics; pain medications.
• You may be given a pre-operative anesthetic block to decrease the post operative pain. The anesthetist will discuss this with you.

On this page, you can read all about what to expect during your hospital stay.

• You will wake up in the Post Anesthetic Care Unit (PACU) and stay there for 1-2 hours.
• You will be attached to some or all of these tubes:
  IV – We usually take the IV out as soon as you can drink fluids and pass gas.
  Oxygen – Oxygen helps you breathe. We use either nasal prongs or a clear plastic mask.
• We will check your vital signs, level of consciousness and dressing.
• You will receive pain medication.
• Once you are eating and drinking, we will prescribe pain pills that can be taken as needed.

• You will be ready to go home on the same day, or the day following your surgery.

Call your surgeon's office or go to the nearest emergency department if the following happens: bleeding that won't stop, pain that worsens or doesn't go away, swelling or loss of feeling in your foot, or fever.

• Always keep the wound or dressing clean and dry according to the specific directions given to you.
• Cold therapy (using ice packs) helps to bring down your pain and swelling after surgery. Ice packs can only be used on your knee if you have the thin dressing. Ice packs cannot be used with the large, white dressing.
  • Put the ice pack on your knee for 15 to 20 minutes every hour while you are awake. Do this every day for the first 5 to 10 days after your surgery.
  • Do not put the ice pack directly on your skin, and be careful not to get your dressing wet.
  • If you bought the Cold Compress Cuff or Cryocuff, use it as much as possible for the first week, and then as needed. Follow the directions included with the Cuff.
• If you have a Game Ready device, please set it up and use it according to the specific instructions given to you.
• If you have the large dressing (called a Jones dressing), your surgeon will remove it at your first follow-up appointment. This can be anywhere from a few days to up to 10 days after your surgery. A Range Of Motion (ROM) brace may be put on at that time, although this is optional.
• Do NOT remove the dressing unless instructed to do so by your surgeon.
• If you were instructed to remove your dressing:
  • Take off your dressing 5 days after your surgery.
  • If you have stitches, put a Band-Aid over your wound once you have taken off the dressing. You will need to wear Band-Aids for the next 7 to 10 days (until the stitches are taken out).
  • If you have steri-strips, leave them in place until they peel off on their own. You do not have to wear Band-Aids over the steri-strips.
  • Your stitches should be taken off in 12 – 14 days.
    • Make an appointment with your family doctor to have this done or make an appointment at the Fracture Clinic (416 603 5858) or Sports Medicine and Arthroscopic Surgery Clinic at the Toronto Western Hospital.
    • You may be given a pre-booked appointment at discharge. Please be sure to keep the appointment.

 

Eating/Eliminating

• You can gradually return to eating and drinking as normal. Start slowly by having fluids and soup on the first day of the surgery. Then return to your normal diet the next day.
• If you are feeling nauseated (sick to your stomach) or you are vomiting, you can get anti-nausea medicine (such as Gravol, used orally or rectally) from your pharmacy without a prescription. Take it as directed and keep drinking fluids until the nausea passes. Then slowly return to eating your normal diet.
• Pain medication can cause constipation. To prevent constipation, drink plenty of water and eat foods that are high in fiber. If you have not had a bowel movement for 72 hours, take Milk of Magnesia, which you can get from your pharmacy without a prescription.

 

Lifestyle

• Rest on your first day home from hospital.
• If you had a Regional Block (if your knee had been frozen) it may take a few hours for the feeling to return. Don't walk or move around more than you have to until all the feeling and movement returns.
• When you are sitting or lying down, raise your foot up on 1 or 2 pillows. This prevents swelling and bleeding. Rest your heel on the pillow.
• Start taking short walks around your home. If you were given an ROM brace, you must always wear it while you are walking. Your surgeon will decide what the range of motion will be.
  
• If you have a brace, you can only remove it when: lying in bed, changing your dressing, or washing your leg.
• When you are up walking you can use crutches or a walker.
• You may put as much weight as tolerated on your operated leg. If you have never used crutches before, follow the instructions in the "Using Crutches"  pamphlet.
• Slowly begin to do more of your everyday activities.
• You can walk up and down stairs but remember to hold onto the rail at all times.
• Your surgeon will let you know when to begin physiotherapy.
• Your surgeon will tell you when you can go back to work and sports. The time you have to wait depends on your job and the sport you play.

 

Heavy Objects/Lifting/Exerting

• You should not lift anything heavy or work out until after the first postoperative visit. You will be given instructions then.

 

Showering/Bathing

• You can take a shower 3 days after your surgery. You must cover your operated leg or dressing with a plastic waterproof cover or a plastic bag. Make sure NOT to get your dressing wet.
• Remove your ROM brace when you take a shower. Be careful when stepping out of the shower. Pat the wound dry and put your ROM brace back on as soon as you get out of the shower.
• NO baths or swimming until your surgeon says it is safe to do so.
• If the dressing gets wet or contaminated, you may have to change it. Call you surgeon for specific instructions.

 

Medications

• It's normal to feel pain after having surgery. Your pain should get better after a few days. We will give you a prescription for pain medicine, and possibly for swelling. Take the prescription to a pharmacy and follow the directions for taking the medication.
• After the first 24 hours, you can gradually decrease your pain medicine as you feel more comfortable. (Take less and less pain medicine until you don't need any.)
• During the surgery, your surgeon may have put a tourniquet on your thigh and inflated it to control bleeding. The pressure from the tourniquet can sometimes cause discomfort and bruising of your thigh. This is normal and will get better with time.

 

Driving

• You cannot drive for the first 24 hours after surgery.
• You cannot drive while taking pain medication.
• If your driving leg was operated on, it will take 6 weeks for full reflexes to return. During this time your follow-up visits will address the issue of when it is safe to resume driving.

• Do not put pillows directly under your operated knee. Place the pillows under your calf or foot.
• Do not cross your legs.
• If you have a brace, Do NOT walk without your brace on your operated knee.
• Do not change the settings of your ROM brace. Do not move your leg beyond the ROM setting on the brace.
• Do not stand for long periods at a time.
• No tiring physical activities, exercises or sports until your surgeon tells you it is safe.
• Do not use heat packs on your operated knee.

Call your surgeon's office or go to the nearest emergency department if the following happens:

• You have bleeding that does not stop or soaks the dressing.
• Your pain becomes very bad and it doesn't get better when you take the pain medicine that we prescribed.
• Your foot or ankle is very swollen or you have lost feeling.
• Your toes are cold or have changed colour, or you can't move your toes.
• Any signs of infection such as drainage, wound discolouration, increasing pain or a high fever.

The surgeon's office is your first place to call for post-operative questions. The phone number should be available on your postoperative discharge note, or is available on our contact page.