Multi Ligament Reconstruction

Please see immediate post-op instruction sheet that Dr Borque will give to your family member or whomever is accompanying you the day of surgery. This will give you your weight bearing status, motion restrictions, brace parameters, and date of your first therapy visit.

Dressing and Wound Care

It is not uncommon to have a small amount of bloody drainage on the dressing within the first 48 hours after surgery. This typically does not require treatment and should not cause concern unless it is expanding.
You may remove your dressing in 24 hours, unless instructed otherwise. Please leave the Steri-Strips in place and do not place any antibacterial ointment over the wounds. You may cover with regular band aids if desired. No further dressings are necessary unless there is persistent drainage. Please bring thigh high TED stockings to your first PT visit. Your physical therapist will help you put these on. You will wear this for 2 weeks to help keep the swelling down and protect against developing blood clots.
For the first 3 days, in the shower please cover your wounds with a plastic bag in order to keep it dry. You may get the wounds wet after 3 days, but do not scrub the wounds for 2 weeks and do not submerge underwater in a bath tub, hot tub, or swimming pool for at least 3 weeks. Pat dry with a towel afterwards.

Achieving Full Extension / CPM Machine

Achieving full extension is the most important goal immediately after surgery. Beginning the night of, or the day after surgery, begin knee extension exercises by firing the quad muscle to drive the back of the knee into the bed and hold it or 3 seconds. Do sets of ten and do as many of sets daily as you can.

Physical therapy will start within 3 days of surgery, ideally post op day 1. This will be arranged when your surgery is scheduled. If 3 days before your surgery, you have not been notified of your physical therapy appointment, please contact Dr. Borque’s office.
If Dr. Borque thinks you would benefit from a CPM machine, it will be ordered and it will be either given to you at the hospital or the technician will deliver it to your home. The technician will have instructions from Dr. Borque and will teach you how to use it. You should start using it the first day after surgery at the specified settings for a goal of 8 hours per day. You should increase the flexion 6 to 10 degrees each day, as tolerated. Limits on CPM motion will be listed on your immediate post-op instruction sheet given to you the day of surgery. A representative will contact you at least 24 hours prior to surgery to set this up.
At your first therapy session, your therapist will teach you how to mobilize your patella (knee cap). You should perform these daily to prevent scar tissue developing under the knee cap.

Swelling Control

Swelling is common after any injury or surgical procedure. Decreasing swelling through elevation ABOVE your heart, AND avoidance of activity is the key to success.
Swelling control is also very important for muscle (quadriceps) and motion recovery. Minimizing quadriceps atrophy is very important for the recovery of your knee.
We recommend use of a Game Ready cold compression machine. This is what is typically used by professional athletes after ACL surgery to help minimize swelling and stimulate recovery. A representative will contact you prior to surgery to get this to you. It is normally not covered by insurance but is a good investment. If you decide not to get this the representative can guide you to other cryotherapy options.
You may begin elevating your surgical site ABOVE your heart with pillows and use an ice pack if you decide against the other cold therapy options mentioned above. If using ice please be careful not get your dressing wet. When elevating, please try to keep the pillows under your heel (rather than your knee) as much as possible while this is less comfortable, it helps achieve full extension of the most important goal in the first 2 weeks post-operatively.
If the swelling becomes so large that the dressing begins to become tight, then please loosen the outer layer covering your wound so you can fit at least two fingers underneath it.
If your swelling is still not decreasing with the instructions listed above and you are experiencing severe pain at the site of swelling then please call us immediately.

Activities

You must use your crutches when up and about. You may place your foot down for balance but should not put any weight on the operative leg until cleared by Dr. Borque. Your physical therapist will review your weight bearing status with you at your first appointment as well.
You will be placed in a brace in the operating room. This brace is to be worn at all times, including while sleeping. Dr. Borque will set the range of motion on the brace specific to your injury and surgery. Your therapist will review these settings with you at the first appointment.
If your PCL was injured, you may benefit from a specialized PCL brace. Dr. Borque will discuss this with you before surgery and order it before surgery. You will be placed in a standard brace in the operating room and will transition to the specialized brace as soon as tolerated (usually at the first therapy session). This brace is to be worn AT ALL TIMES (showering is the ONLY time is can be removed). While showering, the knee should remain straight with the quadriceps firing at all times to keep the knee locked straight. The brace should then be re-applied before exiting the shower. This brace protects the PCL and allows it to heal with the right amount of tension.
If using the specialized PCL brace, please contact our office immediately if you become experiencing new numbness in your foot or the inability to lift the great toe. While rare, this could mean the brace is applying pressure to a nerve and the brace may need to be adjusted or sometimes discontinued.
If your PCL was injured, please keep a pillow under the top of the shin bone (just below the knee) at all times until the specialized PCL brace is on. It is very important that this pillow is not be behind the knee itself or the thigh bone.
Your knee was injected with numbing medicine at the conclusion of your surgery, this will last 8-12 hours, please rest the first 2-3 days after surgery.
Do not engage in activities which increase pain or swelling in you affected joint.
Return to school 2 to 3 days after surgery; return to work depends on your type of employment.

Medications and Pain

Multi-ligament knee injuries are large injuries, and extensive surgery is usually required to address them. Pain is to be expected after any surgery. We prescribed you a narcotic for your post-operative pain. Please follow the directions given on the bottle by the pharmacist.
Your medications will be sent to the pharmacy by noon the day before your surgery. Please pick up your medications before the day of surgery, to avoid any issues with the pharmacy being able to fill your medications.
The following prescriptions have been sent electronically: Norco 5/325mg (for pain- take as needed). Zofran 4mg (for nausea or vomiting- take as needed). Colace (for constipation- take as needed). Please ensure you are not allergic to any of the medications prior to filling the prescriptions.
Based on your age Dr. Borque might also prescribe 325mg enteric-coated Aspirin daily for 2 weeks. If so, this will be sent to your pharmacy.
Please take the medications you were prescribed when you arrive home after surgery. You may safely combine these medications, though you may find that you do not require pain medication beyond the first week after surgery.
Nausea, constipation, headaches, drowsiness, and itchiness are common side effects of the pain medications. Please use the medication prescribed for nausea or constipation. If the side effects become unbearable, discontinue pain medication use and call our office.
If you are having difficulty sleeping you may take Benadryl 50mg or Melatonin over the counter.
Tylenol may be taken for a low-grade fever which is common in the first few days after surgery. As long as your temperature does not exceed 101.1 degrees than you can proceed with post-operative care. Please notify us if your temperature exceeds this.
Typically, your pain should be managed with the medications given; however, if you have excessive discomfort contact Dr. Borque’s office.
Pain medications CANNOT be refilled by our office after 4:00pm on Fridays. Please make sure you have enough pain medication to last through the weekend.
Do not drive or operate heavy machinery when taking these medications.

Nerve Block

If you have a nerve block to further control your pain, please refer to the handout that the hospital gave you at discharge with any questions regarding this. You can contact the pain nurse at 281-276-8484 with any questions regarding your block, Monday-Friday 7AM-2PM. After 2PM and on the weekends, please call 281-276-8204.
Your nerve block will last approximately 48 hours after it is inserted. The anesthesia nurse at the hospital will explain how and when to pull the pain pump on the day of surgery. If any bleeding occurs when you remove this block please apply pressure until the bleeding has stopped.

Swelling

Swelling is common after any injury or surgical procedure. Decreasing swelling through elevation ABOVE your heart, AND avoidance of activity is the key to success.

You may begin elevating your surgical site ABOVE your heart with pillows and use an ice pack, but please use sparingly as to not get your dressing wet. When elevating, please try to keep the pillows under your heel (rather than your knee) as much as possible while this is less comfortable, it helps achieve full extension of the most important goal in the first 2 weeks post-operatively.

If the swelling becomes so large that the dressing begins to become tight, then please loosen the outer layer covering your wound so you can fit at least two fingers underneath it.
If your swelling is still not decreasing with the instructions listed above and you are experiencing severe pain at the site of swelling then please call us immediately.

Diet

There are no specific restrictions on your diet after surgery, however, it is prudent to start with clear liquids and advance to solid food as you are able.
Be sure to drink plenty of liquids and avoid alcohol the evening of surgery.

Additional Factors

PLEASE GO TO EMERGENCY ROOM IF: you experience shortness of breath, chest pain, loss of consciousness, severe pain that cannot be controlled with the medication given to you, excessive bleeding that cannot be controlled, or inability to urinate.
Some people do experience a sore throat after surgery along with a minor form of laryngitis. This is most likely due to anesthesia using a tube to help you breathe during surgery. If you do become concerned about your sore throat or feel as though this might be a new sickness please inform your primary care physician.

For any questions or concerns please contact Ashley or Maribel, Dr. Borque’s assistants, at 281-275-0580 or 281-275-0416.