Q: My brother has been operated for anterior cruciate ligament (ACL) tear. His stiches have been removed and he is using a Continuous Passive Movement (CPM) machine in the hospital. For how many days should he use the CPM machine for knee bending? Should he go for physiotherapy to avoid stiffness of his left leg? His operated leg and toe are swollen, how can that be treated? Is it ok to apply ice bag?

A:Your brother will have to be careful while doing his physiotherapy after the surgery. The process of ligament reorganization is very slow. 1) There is no hard and fast rule for doing the CPM machine for a particular number of days. It is used to facilitate the knee flexion as active flexion would be painful. Basically the knee flexion is restricted to maximum of 90 degrees up to 4 weeks after the reconstruction. 2) (a) Special care should be taken for building up the quadriceps muscles as well as the hamstring muscles. Doing quadriceps isometrics alone may put excessive strain on the reconstructed ACL and are therefore not advisable. (b) Avoid passive extension of the knee joint as it may overstretch the surgical reconstruction. It may require 4-6 months to gain full extension. (c) Later quadriceps exercises will have to be continued for a longer period as hamstrings regain normal muscle power and endurance sooner than quadriceps. (d) Progressive active range of knee flexion can be achieved by self-assisted dragging of the heel while sitting with back supported against the wall or head board of the bed. (e) Assisted straight leg raising can be started and gradually progressed to do the same with weights. (f) Sitting at the edge of the bed to bend and extend your knee will also help after the initial pain has subsided. (g) Progress to assisted kneeling assisted squatting, spot jogging, gait training, stair climbing and descending, sitting cross legged is all done towards the end as the reconstructed ligament matures. 3) If there is swelling on the operated leg, please take care. It suggests excessive strain on the joint. You should see to it that leg is elevated on the pillows and ankle and toe movements are done to bring the swelling down. You can also get interferential therapy done at the physiotherapy clinic for the same. You can use ice for 15 minutes twice a day.