Nicholas K. Sablan, M.D.

PCL Multiligamentous Knee

Post Operative Instructions after PCL/Multiligamentous Knee Reconstruction Helpful Hints & Important Precautions for Patients

Diet

Medications:

Before surgery, you will likely receive a nerve block that will last about 8 to 12 hours. It is important to begin taking your pain pills before this medicine wears off.
The first medication I use is Percocet (Oxycodone/Acetaminophen) which is a strong narcotic pain medication combined with Tylenol. It will begin to work within 15 minutes after taking it, with a maximal effect in one to two hours. Normally, Percocet is taken 1 pill every 6 hours, but if the pain is severe, it can be used 2 pills every 4 hours.

Common side effects of the medications are nausea, constipation, itching, and drowsiness.
The best way to prevent nausea is to take the medicine with a little food, start with just one pill, and be patient while the medicine begins to work. Usually, after the first few doses, the nausea will go away. I also prescribe an anti-nausea medication called Zofran (Odansetron) to be taken if you have persistent nausea after surgery.
You will also be given a prescription for Naprosyn, which is a strong anti-inflammatory medication. Take this twice a day with food in addition to the Percocet. Both medications will work synergistically in pain relief. Do not take if history of stomach ulcers or kidney dysfunction.
I strongly recommend you take an over-the-counter stool softener starting the day of surgery such as Colace 100 mg 1 tablet a day and a laxative such as Sennokot DS 1 tablet a day to avoid constipation.
Take Benadryl one half hour before your narcotic if you experience itching.

Do not drive or operate heavy machinery while taking Percocet or other narcotics.
You should take 325 mg Enteric coated Aspirin once a day for two weeks to help prevent blood clot formation.
Transition to Tylenol as your pain subsides, but pay attention to the dosage as Percocet has 325 mg of Tylenol in each pill. Patients with normal liver function should not consume more than 3000 mg of Tylenol per day.

Bandages & Sling:

Your post-operative dressing has two layers you need to understand to care for your surgery site properly. Your incisions were closed with absorbable stitches that are covered with small white tapes called Steri-Strips. Your Steri-Strips should be left in place until I see you at your first post-operative date.

The second layer is a large white fluffy dressing as well as ABD pads that are loosely held in place with tape and the overlying compression stocking. Leave this in place until first post-operative visit.
As the surgery is done arthroscopically and water is used, occasionally there will be a small amount of blood mixed with water in this dressing. This is nothing to worry about, however if you see a lot of bleeding please call Dr. Sablan. If you notice blood on your dressing, you may remove it after three days and leave the steri-strips in place. Replace with a new ABD dressing and re-apply the compression stocking. If your compression stocking has blood on it, please exchange for a new one which should have been given to you.
Unless directed otherwise, keep your dressing and compression stocking on at all times until your first post-operative visit.

Washing & Bathing:

You should be careful to keep the wound clean and dry after surgery.
Do not take a bath until after the first post-operative visit.
It is OK to go into a swimming pool after the first post-operative visit, but no lakes or ocean until four weeks after surgery.

Ice & Activity:

One important goal following surgery is to minimize swelling around your surgery site. The best way to achieve this is with the frequent application of ice. This is most important during the first 48 hours following surgery. The ice pack should be large (like a big zip-lock bag or bag of peas) and held firmly on the area of your surgery. Apply for 15 minutes every hour while awake if possible. Look for signs of frostbite.
You may be given a cold compression unit, which can be used at all times in place of ice.

Crutches will be given to you before surgery if you do not have them already. Use the crutches at all times before the first visit if you are up walking. Most patients need crutches for 4-6 weeks after surgery.
You will have a brace locked in full extension (straight out). Do not change the hinge settings until directed by Dr. Sablan. Keep the brace on at all times while sleeping and walking.
You may remove brace only while showering, icing your knee, during towel roll exercises, or during range of motion exercises.
You may put flat foot touch-down weight bearing (20 lbs) on the operated leg unless directed.
Do not place pillows under the operated knee, as it can lead to stiffness.

You may return to sedentary work only or school in 7-14 days after surgery if your pain is tolerable.
Do not drive unless otherwise directed.
Avoid long-distance traveling in cars or by airplane during the first week after surgery to avoid increasing your risk of developing blood clots.

Exercises

With your brace off, place a towel roll under your ankle and tighten your thigh muscles to get your knee to straighten out. This is very important and should be done at least four times a day for 20 minutes, depending on your tolerance. This is also a good time to ice your knee.
Move your ankle back and forth many times during the day to help your circulation.

Physical Therapy

The goal of physical therapy is to first assess how your body responded to the surgical procedure. They help you feel comfortable with your surgery and ensure you aren't afraid to start doing things. Your therapist will start range of motion and strength exercises on your first visit.
You will start physical therapy after your first post-operative visit.

Follow-up appointment:

We try to give all of our patients a follow-up office visit at the same time we schedule your surgery.
Typically I want to see my patients in the office 5 to 10 days after surgery.

FOLLOW UP APPOINTMENT:

What to watch out for:

∞ Pain that is increasing every hour in spite of the pain medication

∞ Drainage from the wound more than 2 days after surgery

∞ Increasing redness around the surgical site

∞ Pain or swelling around your surgery

∞ Fever greater than 101.5 degrees.

∞ Unable to keep food or water down for more than one day