1. Axe

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Preparation

General PEARLs

• Pre-surgical rehab is an essential part of recovery and can improve immediate outcome so if it is a resource available to you- use it!
• Learn the basics of your procedure such as reconstruction technique, graft type, surgeons recovery timeline, where you will do your rehab, and what you should expect going into and coming out of surgery. Knowledge is power and can give a sense of control and set reasonable expectations in a situation that is otherwise out of your control.
• Seek out positive experiences and recovery stories from other people who have had your procedure and gather as much advice as possible from resources such as ACL. Know that some people will have negative experiences, everyone is an individual, and that much of your long term recovery is in your control.
• Expect and learn to advocate for yourself or the person you are taking care of. Be vocal and honest with any needs you may have and understand that issues may come up in the immediate post-operative time that you as a patient or caregiver may have to contact your surgeon to resolve. Familiarize yourself with who to call and when *before* you leave after surgery, as well as being quick to call with any questions or problems that arise. It is better to be told that what you are experiencing is normal than to sit with the anxiety of the unknown.
• Create a folder with all relevant information: Surgeons name, procedure information, follow-up appointment dates and times, phone numbers, emergency contacts, facility of choice in an emergency situation, and any other important information. Maintain this folder throughout your recovery and add paperwork as it comes.

Days Leading Up To Surgery

• Contact support people and confirm any arrangements that have been made including but not limited to: Who is taking you to/from surgery, child or pet care, transportation to first PT appointments, meals, etc.
• Recommended Items we found essential:
  • Ice Machine (Polarcube, etc) if at all possible
    • Recommend checking facebook marketplace or other second hand options, as they cost hundreds new but can be found for $40 or so used.
    • Studies have shown these do actually reduce pain and lend to earlier mobilisation and our experience has shown this to be essential not just immediately post-op but in the weeks and months afterwards so if you *can* obtain one you absolutely should.
  • Large sweatshirt and oversized shorts for surgery day, especially if you wear a bra, as putting clothes on after surgery can be a struggle and it’s easiest to just throw on a sweatshirt and shorts that fit over your post-op bandages and brace.
    • In particular, we found a blanket hoodie to be very useful both for going home and the first few days as it could stay on when moving around/when napping.
  • Neck Pillow
    • Helps with reading or other activities during long hours spent in bed or on the couch and really helped in the first two days to prevent neck strain and provide head positioning during napping.
  • Large pillows for body positioning and elevation of the leg
    • We found cheap, giant, dog beds from places like TJ Max or Marshalls to be more affordable than specialty products
    • A large, thin, dog bed (or blanket) rolled into a tube and secured with stretch bandage or tape around the surgical leg and brace helped significantly with comfort during sleep so that the leg was padded, comfortable, and the other leg didn’t get roughed up from the brace.
  • A shower chair
    • Can be found used at second hand stores like Goodwill, or cheap online
    • Easy substitute is a chair covered in a trash bag
    • Allowed showering the second day post-op which was a huge mental boost and relieved physical discomfort and achy muscles
  • Extra large leg cast cover
    • Can be found cheap online
    • Placed around outside of brace covering the entire leg initially, we then found it easier to place on the leg and place the brace outside of the cover for the remaining healing period for the incisions: We did this after the first PT appointment when it was safe to take off the brace for short periods while laying down. We acquired a second post op brace from a friend (you can find on eBay for cheap) and it was amazing to have, as we could let it dry after showering and immediately put her post op brace back on.
  • Foldable stool
    • Great for elevating the leg during transfers, while on the toilet, etc.
  • Lap Desk
    • Great for eating on the couch or in bed, but we also found it useful as a side table for holding drinks/meds/remotes/books that could be taken to whatever room they landed in at the time
    • A small table works as well, really just anything that can be used to set things on within arms reach
  • Assortment of sodas, water, seltzers, snacks, etc.
    • There is no way to know what you will want and when, but when you want it it’s nice to *have* it available
    • Appetite often decreases after surgery so make sure to have favourites on hand so that when you *are* hungry you have it immediately before your body changes its mind
  • A big bucket
    • We used a soft plastic beach type bucket from the dollar store, it was extremely useful to have to put small items in, a small towel, a spare water bottle, extra meds, baby wipes, etc.
    • Also doubled as an emergency puke bucket, as you never know when a sudden bout of nausea might hit in the first day or two after surgery
  • Extra reusable ice packs and bags of ice
    • Your home ice maker will not be able to keep up with the demands of constant icing the first week or so
    • Reusable ones are great for ‘hot spots’ and short trips where you can’t take the ice machine
  • Extra steri-strips and assortment of bandages
    • Sometimes there’s extra leakage, sometimes your steri-strips come off and you need to slap a new one on, sometimes you’re allergic to the ones they put on you at the hospital. Always consult a medical professional, but it’s handy to have these on hand just in case.
    • We also used a bulky padded bandaid to keep the brace off the healing incisions once the large post-op dressing was taken off which helped immensely.
  • Compression sleeves
    • Aside from helping with swelling these also provided a layer of protection under the post-op brace
    • We found cheap ones at Wal-Mart (copper brand) but also just bought a cheap pair of leggings a size down and cut off one of the legs to use before getting a more expensive one once swelling had fully subsided after a few weeks. Your leg will change so cheap works great at first, then you can get something a bit more substantial when you know what you’ll need long term. Now she wears high compression socks to sleep 3 months out.
  • Slide on shoes
    • Self explanatory, bending down to put on shoes becomes a chore after surgery. Avoid flip flops or other styles that can become a trip hazard.
  • Baby Wipes/Dude Wipes/etc.
    • Wiping down after you get home from surgery can help prevent that icky feeling and restore some sense of normalcy, then can be used over the next few days before you can shower more normally
  • Lotion and chapstick
    • Hospitals dry out your skin big time, and lips are often cracked post surgery from intubation/LMA placement
  • Small, easily labelled tupperware containers
    • Regular pill containers are too small to hold pain meds, OTC pain meds, anticoagulants such as aspirin, supplements, and edibles or other small things you take with your medication. We got small tupperware boxes with lids from the dollar store.
    • We found it very convenient to have six sets of meds set up and labelled with times which meant we never missed doses and could leave the next dose of meds at bedside, take them with us when going to appointments, and keep up with what had been given and when.
  • Small notebook to record med times and other important information
  • Two extra changes of clothes already setup and ready to go
  • Compression device
    • We are athletes so we already had leg compression sleeves but these days off brand versions can be bought online cheap. Studies have shown these lead to reduced pain, increased mobilisation, reduced the chance of blood clots, and there is even some evidence they help with bone healing.
    • We used it 3 days post op and beyond and her range of motion was significantly improved after the first time.
  • A yoga strap
    • Excellent for strapping to the brace and moving the surgical leg
• If possible, pick up post-op medications prior to surgery to prevent any unexpected delay in obtaining them. If this is not possible, verify that the prescription can be filled the day of the surgery by your selected pharmacy and that it has been filled prior to leaving after your surgery. Controlled substances cannot be transferred to another pharmacy without a new prescription sent directly from the provider. You do not want to be trying to get in contact with a physician in the hours after surgery, unable to manage pain, before the pharmacies close for the night.
• Do a thorough clean of your living area, it will make the time after surgery when you cannot independently do normal activities more bearable and a neat organised space is easier to function in when your body is not cooperating. Take special attention to removing tripping hazards and clearing a wide path from wherever you plan to spend your recovery and the bathroom.
• Plan to spend the first couple of days in one spot and on one floor and set up that area the day before surgery. If you have a downstairs bathroom a floor mattress or well setup couch can be your landing pad until you are more mobile and is the easiest during the immediate post-op period. That being said, if you don’t, it’s easier to get upstairs by sliding up on your bum immediately post-op when your pain is still well controlled than realise that you have no bathroom downstairs a few hours later when the pain has started to set in. Wherever you intend to land, plan on staying there at least a couple of days and bring all your supplies to that area. Plan to lay with your surgical leg on the outside of what you are laying on, this makes transferring easier.
• Have your recovery bed setup the day before surgery and prepared for when you return before you leave the day of, including blankets and your supply table setup.
• Meal prep, whether that means cooking or getting easy to make microwave meals is up to you. You won’t feel like cooking and neither will your caretaker the first few days. High protein, easy to eat meals are key! We had chicken and broccoli casserole, egg and sausage frittata, and lots of applesauce the first few days and it was a lifesaver not to have to think about meals.
• Spend some time mentally preparing for the long haul of recovery and make long term plans that fit within your timeline. For example, we planned to attend a rugby game five days after surgery *but* planned nothing else for that day and the next day. We also planned hiking trips the next fall, and other events appropriate for her timeline along the way that could be looked forward to and keep up morale. Remember that this is temporary and that it is okay to be recovering and resting, expect hard moments and days but keep things planned so you don’t get stuck in those down places.
• Eat your favourite meal and eat well the day before surgery. Your body needs fuel to recover and fasting the day of surgery sucks. As weird as it sounds, after multiple surgeries, the pre-surgery night meal of whatever I want is one shiny thing in a crappy situation to hold on to.
• Plan for what you want your first meal to be and consider making a playlist for the ride to and from surgery. Small things, again, help maintain a sense of control and comfort in a situation where you are largely out of control and these things can be done with friends or support people in the days leading up to reduce anxiety and pass time.
• Hit the gym, take a walk, do a hike, visit places or do things you enjoy but won’t be able to do in immediate recovery! We took my partners knee to one last tournament before her surgery, it helped pass time and kept spirits high.

Day Of And Immediate Post-Surgery Phase

• Maintain fasting starting at whatever hour you are told. Some people can drink clear liquids up to a certain point, others are completely nothing by mouth. Your instructions will guide you on this.
• Before leaving home double check that everything is set up how you need it and place a blanket, pillow, drink, and snack of choice in the car. You may or may not need it but if you do it is important to have. Make sure your ice packs are in the freezer ready to go!
• Bring your own post-op snack if you are picky or have food allergies, otherwise you’re stuck with whatever graham cracker and applesauce combo the facility gives you.
• Go with the flow, or as I always say “surrender”. Feel what you feel, have a cry in the car before you go in, listen to your playlist, bring your blanket or other comfort items into pre-op, tell your support person what’s going through your mind, tell your pre-op staff how you’re doing, ask all the questions, and most importantly just do what you have to do. For some people surgery can be overwhelming and the loss of control frightening, but fighting only makes it worse, so whatever you are just be it. I’m pre-op pacer myself, but some people just snuggle up under some warm blankets and wait. Either way, just let the waves take you where they go and know you’re along for the ride. Remember that future you with a healthy joint thanks you for what you’re doing today.
• Speak frankly with your anesthesiologist and utilise any pain control or anxiety control options given to you. There is no award for least meds taken or toughest patient of the day. If a nerve block is available, know that you can request sedation for its placement, and utilise that option if at all possible.
• Caregivers should bring something to keep them entertained and be prepared for a long period without update once surgery has started. Honour your feelings as well, it can be tough to watch someone you care about go through this! Consider having someone to act as a support person for you as well through text or phone, that way you can divert your own worries or struggles to them and away from the person having surgery while still making sure you are also taken care of.
• Make sure that pain is well controlled before leaving after surgery. You have more options there than you will at home and getting things under control once pain has become unbearable can be very difficult.
• Make sure you note when the next dose of medication is due, what medication they should be taking, and write it down.
• Double check contacts from your surgeons office and add any post op paperwork to your folder in case you need the information later.
• If your post-op meal requires picking up, or your prescription, try and do that immediately after leaving surgery even if you are not hungry yet. This is the most comfortable you will be for a while and your support person will be unable to leave for at least that day and night. I have been known to peruse the big gas station after surgery in search of snacks, my partner however simply waved to the nice people at the drive through and napped the rest of the way home before eating some hours later.
• Once you get home crash wherever you plan on spending the rest of the time. Don’t have friends or family over that first day. Just go ahead and sleep through the rest of the anaesthesia and get comfortable.
• Try and keep your home cool, and consider keeping the room dim for the first few hours if not days. Sleep is precious and pain meds can make you hot, and getting hot can lead to nausea. It is better to have the home cool and the person snuggled under blankets and comfortable than be trying to cool someone down who just had surgery and got too hot and is now dizzy, nauseous, and miserable. The least stimulation for the first little while the better, and naps will happen throughout the rest of the day and over the next few days. A cool, dim place lets this happen much easier than a bright, warm place where they might be overstimulated or awakened by noise or activity.
• If allowed, try and activate the quad muscle immediately after returning home and once every few hours by having them squeeze it and feeling for contraction while in the brace. Some people will be able to begin range of motion exercises immediately and if so, make sure to do them as soon as allowed even if that means just helping them by doing gentle manual range of motion movements in the brace.
• If it’s not already on, begin continuous icing as soon as you come out of surgery either by meticulously timing the replacement of ice packs or with the ice machine. Make sure to check the ice machine, replace ice as often as needed, and keep it on *continuously* for the next few days. For us this meant I checked it at every medication dose throughout the night and added ice during that time as well. We went through frozen mini water bottles and bags of ice like crazy the first week.
• Elevate the surgical leg as high as possible, placing support under the heel and calf but not directly under the knee to promote extension and prevent more headaches with gaining range of motion later on.
  • We found that icepacks directly under the knee helped tremendously with the discomfort associated with this.
• Anticipate that bathroom trips will not be fun or easy and take them extremely slow. As a caregiver allow the person to guide you on what they need and don’t need your help with and avoid grabbing or moving someone unexpectedly. Standing, acclimating to being upright, and then proceeding to the bathroom is the best way to do things and rushing will only result in frustration for both of you. A rolling chair or wheelchair can be helpful, but for some people standing up and sitting down is harder than just moving on to the bathroom. Pay attention as a caregiver and know that it is possible they may need your help getting off the toilet or back from the bathroom so be close by and available should that happen. For the first few days do not lock the bathroom door in case of an emergency.
• Place chairs or things to sit on around your path to the bathroom, kitchen, etc. And consider a small backpack or using a rolling chair to carry items around the house.
• Once you know when your next dose is, set alarms for each time your doses are due. If using the med boxes this makes doing meds and keeping track very easy, as they are each labelled with a time and all we had to do was open the box and take the meds instead of finding each bottle and dosing each med individually each time. As the days went on we were able to re-label and time the boxes as needed and remove meds as needed or adapt to what was needed when sleeping or up during the day.
  • For example day 1 would look like:
    • First post-op doses at 4pm box: 250mg tylenol, 10mg oxycodone, 5mg edible.
    • 8pm box: 250mg tylenol, 10mg oxycodone, 800mg ibuprofen, 10mg edible, 12.5mg diphenhydramine (itching and sleep), stool softener, and regular night time meds.
    • Midnight box: 250mg tylenol, 5mg oxycodone, 5mg edible.
    • 4AM: 250mg tylenol, 5mg oxycodone, 800mg ibuprofen, edible (if nauseas or restless).
    • 8AM box (preparing to get up): 250mg tylenol, 10mg oxycodone, 5mg edible, aspirin, stool softener, normal morning meds.
    • 12pm: 250mg tylenol, 10mg oxycodone, 5mg edible, 800mg ibuprofen.
    • Repeated on time, reducing pain med dose as tolerable, and refilling boxes 1x a day.
• If possible do scheduled tylenol (paracetamol) and ibuprofen (or another NSAID), alternating them on the dosing schedule, and take them religiously even through the night. This also goes for additional pain medications, which you will also need to wake to take through the night if you are prescribed for at least the first night.
• Staying on schedule might mean waking up in the night, but it’s better to be awoken to take meds than to wake up in pain and spend several hours trying to get it under control. You may find you seldom need them if your nerve block is in place, or you may just not need very much at all during your recovery. It is easier to trial run this after the first day by stretching out the time between doses from 4 to 6 to 8 and then potentially off entirely, but everyone will have their preferences.
• Eat a small snack with every med dose and keep emergency meds (extra pain med doses, nausea meds, etc.) at bedside as well as the next set of meds due so they can be taken when it is time.
• We found that edibles were a great addition to pain and nausea control after surgery. There are medication options available and having at least one option for nausea is advisable for the first few days after surgery when anaesthesia and medication can really make you want to puke.
• Expect absolutely nothing in the first few days post-op. Some people will feel well enough to move around, others will not be able to do anything but get up to use the bathroom. Expecting nothing is better than expecting more and being disappointed or frustrated. I would highly suggest not making plans until your first follow up 7 or so days after surgery.
• Be obsessive about icing, meds, any PT you have been given, and keeping track of appointments. Give yourself the best start to your recovery that you can and you will thank yourself later!

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