What to expect after surgery in hospital
Most ACL reconstruction and Meniscal Resection procedures are done under general rather than local anaesthetic, so you'll be unconscious during the surgery.
Once you have recovered from the anaesthesia, patients may go home the same day. However, there may be occasions when surgery is performed as an inpatient, and you will stay in hospital overnight.
Your knee will be bandaged, and you may also be given a Cryo/Cuff (a waterproof bandage that contains iced water to help reduce swelling) to wear. Your knee will feel sore, and you should expect swelling and bruising to develop within 2-4 days after your surgery.
You may be given medication to control the pain and thin your blood to help prevent clotting.
While you’re in hospital you should rest and keep the leg elevated.
How long will I be in hospital?
Most patients are discharged from hospital between 1 and 3 days after Meniscal and/or ACL surgery. Some hospitals now offer the surgery as a day case procedure, meaning that you will be able to go home the same day, provided that the surgical team are satisfied that it is safe for you to do so.
Before you leave the hospital, an occupational therapist may assess your physical ability and your situation at home and make arrangements for any special equipment.
How soon will I be up and about?
Rehabilitation starts immediately. Generally, you’ll be helped to stand within two to four hours after your operation. The hospital staff will help you get up and start walking with crutches as quickly as possible. They’ll help you practice walking with crutches and explain how much weight you can safely put on your injured leg. Depending on your surgery, your surgeon may ask you to wear a knee brace or splint to help protect the graft.
If you’ve had minimally invasive surgery or an enhanced recovery programme, you will be able to walk on the same day as your operation.
Though you should be able to move about by yourself with your crutches, while you’re in hospital you should rest as much as possible, with your leg elevated– for example, by putting a pillow or two under your heel when you're lying-in bed.
References
Preparing to come home
You will need to ensure that the arrangements you made for your transport home are still in place. Your care team will explain the discharge process to you. It’s important that you are as ready as possible to leave hospital and stay healthy once you're home, so make sure to ask any questions and raise any concerns that you may have.
Let your care team know if you will not be staying in your own home following discharge.
Your care team may give you a discharge summary which should contain the following information:
The procedure you have had done.
Medicines you are taking.
Details of any wound care arrangements.
Dates or schedules of outpatient appointments.
Specific post-operative instructions.
In addition, you should clarify the following details with your care team – as this information is important, you should take notes:
Any ‘red flags’ to look out for, and what to do if you notice them.
Any specific dietary requirements.
How to care for your wound, and what happens if the dressing starts to come off.
When and how to obtain additional or alternative medication.
Do’s and don’ts for your knee.
You may also need a “Statement of Fitness for work” from your GP or hospital doctor to provide to an employer
Write down the name and phone number of someone on your care team who you can call with any questions after you leave the hospital.
If you are taking additional medication home, it’s important that you are clear about how much to take and how often.
Before going home, you need to be able to:
Get in and out of bed independently.
Control your pain.
Eat and drink normally.
Walk comfortably with an aid.
Go up and down the stairs.
Do your exercises independently.
Understand how to protect your knee while it heals
You must also make the following arrangements to help you at home, assuming you haven’t done so already:
Any additional help or support at home, such as visits from a district nurse or paid home help.
Any required equipment is fitted, such as a raised toilet seat.
Any home adaptations are made, like grab rails in the bathroom.
References
NHS 2022, Arranging Care Before You Leave Hospital
Arthritis Foundation, Prepare for Going Home After Surgery https://www.arthritis.org/health-wellness/treatment/joint-surgery/after-surgery/prepare-for-going-home-after-surgery
What to expect after surgery at home
After your return home
Following your surgery, you will need to continue to wear your elastic stockings – usually for 6 weeks - to reduce the risk of a blood clot developing, although this may be dependent on the anti-clotting medication you are given.
You will experience some soreness, tenderness, tingling, numbness, and itching around the incision, especially for the first few days, and it is likely that you will need some pain relief to ease the discomfort.
Swelling and bruising is normal after an operation. It’s usually nothing to worry about and will settle in due course.
However, the amount of swelling varies from person to person. Some patients can find it quite troublesome for several weeks. Swelling around your knee will increase your pain and make the joint stiff. Follow the post-op exercises, and keep your knee elevated to manage swelling and drainage when watching TV or working at a computer.
You can use a cryo/cuff or ice pack over the knee to help control the swelling, as directed by your occupational therapist.
Will I be able to walk on my own?
It’s important to regain your mobility as soon as possible after your surgery. It is normal to experience some discomfort when you first start walking and exercising after surgery, as your legs and feet may be swollen.
You may need to use crutches or a stick to take some of the weight off your knee. Though you should be able to walk without them after 2 or 3 weeks. If you have been given a knee brace, your care team will tell you how long you will need to wear it – it’s usually around 6 weeks at the most.
References
Physiotherapy
You may already have had some physiotherapy following your injury, but if it was severe enough to require surgery, the benefits are likely to have been limited and temporary.
However, after your operation, things will be different. Physiotherapy will be a key part of your recovery, and you should expect to see significant and lasting benefits from it.
Physiotherapy’s primary purpose is to help you improve mobility and restore strength and movement in your knee by strengthening its supporting muscles. It will help reduce post-operative pain, improve the quality of your movement – particularly your gait and walking speed – and give you a better overall outcome from your surgery.
Your post-surgical rehab programme will include a series of exercises designed by a Physiotherapist, especially to support your recovery. This app will tell you what they are and how often to do them and show you videos with clear and simple explanations that demonstrate how to perform them correctly.
Not only will this improve the speed and effectiveness of your recovery, but it will also improve your quality of life by making daily tasks and activities easier, like walking, going up the stairs, getting in and out of bed and on and off the toilet.
However, while it’s normal to want to recover as fast as possible, the key is not to do too much too soon. Follow the videos on this app as closely as possible unless otherwise instructed by your physiotherapist. While you may have good days and bad days, you should start to feel gradual improvement over time.
Wound care
After surgery, it is most likely that your wound will have a waterproof dressing which can remain in place for an average of 7-14 days. This will enable you to shower without getting it wet. When showering, place your back to the shower to avoid the shower directly going onto your dressing. If the dressing becomes wet and starts to peel off, you can replace it with a clean dressing, taking care not to touch the incision site and the inside of the dressing. Make sure the hospital gives you a spare dressing to take home.
Signs of infection
You must seek urgent medical advice from your doctor if you start to notice the following:
the dressing is continuously leaking or saturated due to excessive bleeding.
the surrounding skin has become red and is spreading outwards.
an increase in pain or odour.
a change in the size of the incision.
the dressing has moved, and the wound is now visible.
a yellow or green foul-smelling discharge.
blisters developing around your surgery site, fever or shivering.
References:
Precautions to protect your knee after surgery
Your surgeon may give you a list of movements to avoid after your surgery to ensure proper healing or avoid stressing the knee joint before it has recovered sufficiently from the procedure or the muscles are strong enough to support it.
How long will it be before I feel normal?
It can take anything from 6 months to a year to fully recover. (If your surgery has also included a Meniscal Resection, this will not increase your recovery time, and the rehabilitation process will be the same.)
Recovery time will vary from person to person and depends on a number of factors, including the severity of the tear, the procedure used, whether there have been any post-surgical complications, as well as your age, lifestyle and your overall health and fitness.
But you can help yourself – the more actively you participate in your recovery and rehabilitation process, the sooner you’ll get there, and the sooner more aspects of your life will begin to feel more normal.
Don't be tempted to test your knee to see what difference the surgery has made. It’s important to follow your recovery programme.
References
Follow up appointments
Before your discharge, you will usually be notified when your follow up appointment with your surgeon will be. In some cases, the appointment details will be sent in the post.
At your follow up visit, your surgeon will ask about your pain and your progress with mobility and exercise. Your physical exam will include a careful check of your knee stability and range of movement, the amount of swelling, and the healing of your surgical wound to rule out any signs of infection.
Getting prepared for your follow-up appointment
In preparation for your appointment, make sure you write down all the questions you want to ask or any issues you wish to discuss with the surgeon. Take those notes with you on the day, and then tick off each point during your appointment. Don't be afraid to ask questions about things that are not clear; it’s appropriate to ask your care team to explain things to you until you are sure you understand them
You may want to take someone with you for support. Be sure to bring all your medications with you to your appointments. If you are struggling with pain control, it is useful to keep a pain diary over the course of a week leading to your appointment.
Are you supposed to have any blood tests or scans before the appointment?
Your hospital paperwork should tell you if there are any tests, scans or x-rays you need to have before your appointment. If you have any questions about having these done, contact your care manager or your doctor.
Travelling to the appointment
Depending on how soon after the surgery your appointment is scheduled, you may not be able to drive yourself to the hospital, so you may need to ask a friend or family member to take you.
If you do not have anyone to take you, ask your care manager or doctor's office to help you get transport. Be sure to ask a few days before your appointment. Aim to arrive early, so you are relaxed but be prepared for a delay in being seen.
Do you need an interpreter?
Many surgeries and hospitals will have interpreters in person or on the phone. Even if you speak English well, medical terms can often be hard to understand if English is not your first language. Ask for an interpreter as soon as possible if you need one.
Examples of questions to ask
Write down any questions you want to ask your doctor so that you don't forget. Here are a few ideas:
Is my recovery on track?
How soon can I stop or start to reduce my pain medication?
What are the signs to watch out for at this stage?
How soon will I know how fully I will recover?
What is the risk of the injury recurring, and what can I do to prevent it??
What problems do I need to look out for with my wound as it heals?
When will I likely be ready to get back to work?
What else can I do to help myself recover well?
How much longer will the post-operative precautions (if any) last?
References:
NHS, 2022, What to Ask Your Doctor https://www.nhs.uk/nhs-services/gps/what-to-ask-your-doctor/
NHS, 2022, Outpatients and Day Patients https://www.nhs.uk/nhs-services/hospitals/going-into-hospital/outpatients-and-day-patients/
When can I do housework?
For the first 4-6 weeks, you should be able to manage light chores, such as dusting and washing up. Avoid heavy household tasks such as vacuuming and changing the beds.
Air Travel
During a flight, legs can swell up due to a combination of air pressure changes and immobility. This increases the risk of developing blood clots. This risk is high during the first three months after surgery, particularly with long haul flights.
Sleeping positions
Depending on the surgical technique used, you may be asked to avoid certain sleeping positions or to sleep with a pillow between your legs for a length of time. Check with your surgeon or physiotherapist before leaving the hospital.
Is this my new normal?
Most people who have Meniscal and/or ACL surgery find that their knee function returns to normal, or close to normal, after surgery.
This takes time. How long it takes will depend on a number of factors, including
your age
your normal lifestyle
the kind of work you do
your overall health and medical history
the surgery itself and any complications you may have had
In the weeks following your operation, your new normal may feel a long way from life as it used to be. But as time passes – and your wound heals, your swelling subsides (that in itself can take up to 3 months), and your knee strengthens - it will become more and more like your pre-injury normal.
Everyone recovers differently. But for everyone, the key to a successful recovery is as much mental as it is physical.
It’s not just about doing your exercises. It’s about having the willpower to do them properly, day in, day out, even when they’re boring, time-consuming, or uncomfortable. It’s also about having the patience not to try to speed up your recovery by doing too much too soon (as you’re more likely to have the opposite effect).
It’s not just about making progress every day (though you will be progressing, even on the days when it doesn’t feel like it.) It’s also about accepting that you will have good days and bad days as you recover. Setbacks happen; accept them, don’t be discouraged, move forward, and before you know it, your new normal will be feeling pretty good.
Post-surgery Q&A
Why have I still got swelling? It is important to exercise, but it is also important to rest the leg. Sometimes ongoing swelling can indicate that you are overdoing your rehab exercises or that you should allow longer rest times between rehab sessions.
What can I do about it? Reduce the amount of rehab that you are doing, rest more with the leg in an elevated position.
Why is my scar warm? This is totally normal. In scars, the healing metabolism is increased. Therefore, it will be warmer.
What are the signs of Infection? Redness, progressive effusion, fever, shivers, secretions from the wound secretion, soreness where the edges of your wound meet.
How far should I walk? As far as feels comfortable. If the knee swells later in the day, the distance was too much. Reduce it for your next walk.
Why do I get pain down my leg? This can have multiple reasons. But if the pain doesn't tend to decrease over time, see a doctor.
Why do I stiffen up? Stiffness can be related to not having enough rehab training. It can also be a sign of arthrofibrosis scar formation in the joint. If you are experiencing increased stiffness with increasing skin temperature, you should contact your care team.
Is it normal to have disturbed sleep? It’s not unusual. Sometimes this might happen after anaesthesia. Sometimes it’s stress-related – surgery and its aftermath can be worrying.
I have a numb patch – is this OK? This is not something to worry about. This might be due to the swelling irritating nerves in the skin. Sometimes it takes as much as three months to pass.
How long will my ACL/ ACL & Meniscal resection last? If your surgery has gone well, it should last the rest of your lifetime.
Why does my joint click? As long as the clicking sensation is without pain, there is nothing to worry about. Most of the time, it will go away within weeks. It is likely caused by your synovial fluid, a thick liquid located between your joints that cushions the ends of bones and reduces friction when you move your joints.
When should I stop using a stick/crutches? You should be able to stop using crutches after about two weeks. However, if you feel uncomfortable without them, it’s OK to continue to use them a bit longer.
Will I set off the security scanner at the airport? No.
Will it get better? In the vast majority of cases, yes. If you have problems or setbacks, your care team are there to help.
Congratulations – the finish line is in sight
You are reaching the end of your time with the Huma App.
By now, you should have seen significant improvement in your knee. But if you have not received the level of recovery you were expecting, and if you think you are experiencing higher levels of pain than is usual, please contact your care team.
Please do not forget to complete any remaining tasks on the App, such as the final questionnaires.
Once you have completed everything, you will no longer receive new questionnaires or notifications. However, you will still be able to use the Huma App and access the information library.