ACL Surgery: Safe Showering Practices and Post-Operative Care

How to shower after ACL surgery?

Showering after ACL surgery requires careful adherence to your surgeon's specific instructions to prevent infection and protect the delicate healing incision and reconstructed knee. Prioritize safety by ensuring a stable environment, protecting the wound from moisture, and moving cautiously to avoid falls or undue stress on the recovering joint.

Understanding Post-Surgical Care and Infection Risk

Following Anterior Cruciate Ligament (ACL) reconstruction, your body begins a critical healing process. The surgical incision is a direct pathway for bacteria, making proper hygiene and wound care paramount to prevent infection, which can severely compromise surgical outcomes and recovery time. Beyond infection, maintaining stability and avoiding slips or falls is crucial to protect the newly repaired ligament and prevent re-injury.

When Can You Shower After ACL Surgery?

The exact timing for when you can safely shower after ACL surgery is highly individualized and must be explicitly cleared by your surgeon or medical team. General guidelines often include:

• Initial 24-48 Hours: Most surgeons advise keeping the incision completely dry during this period, especially if the initial dressing is not fully waterproof or if there are any drains in place. Sponge baths are typically recommended.
• With Waterproof Dressing: If your surgeon applies a waterproof dressing (often clear, adhesive film), you might be cleared to shower within 24-48 hours. This dressing is designed to repel water and protect the incision.
• After Dressing Removal/Staple Removal (Typically 5-14 Days): If you do not have a waterproof dressing, or once the initial dressing is removed, you will likely need to wait until your surgeon gives the explicit go-ahead. This often coincides with the removal of staples or sutures, once the wound is sufficiently closed and dry.
• Avoid Submersion: Regardless of the showering timeline, do not take baths, use hot tubs, or swim in pools until explicitly cleared by your surgeon. Submerging the incision increases infection risk significantly.

Essential Preparations Before Showering

Thorough preparation is key to a safe and effective post-operative shower.

• Consult Your Medical Team: Always confirm showering protocols, dressing requirements, and any specific precautions with your surgeon or physical therapist before your first shower.
• Gather Supplies:
  • Waterproof Wound Protector: If your current dressing is not waterproof, or if you need to re-cover the incision, use a commercially available waterproof wound protector or a plastic bag secured with waterproof medical tape.
  • Shower Chair or Bench: Highly recommended to reduce the risk of falling and to minimize weight-bearing on the operated leg.
  • Non-Slip Mat: Place inside and outside the shower/tub.
  • Grab Bars: If available, ensure they are securely installed.
  • Handheld Showerhead: This provides greater control over water flow and direction.
  • Clean Towels: Have multiple clean, soft towels ready.
  • Mild, Unscented Soap: Avoid harsh chemicals or heavily fragranced products near the incision.
  • Fresh Dressing Supplies: Have new sterile dressings, gauze, and tape ready for post-shower wound care.
  • Clean Clothes: Ready for immediate dressing after drying.
• Clear the Path: Ensure a clear, clutter-free path to and from the bathroom.
• Assistance: For your first few showers, especially if you feel unsteady or are still on pain medication, have a trusted person nearby to assist if needed.

Step-by-Step Showering Protocol

Follow these steps carefully to ensure a safe and hygienic shower experience:

1. Protect the Incision: If your incision is not covered with a waterproof dressing, apply a waterproof wound protector or carefully wrap the entire lower leg/knee with plastic wrap, securing it tightly above and below the knee with waterproof medical tape to create a watertight seal. Ensure no water can seep through.
2. Enter the Shower Safely:
   • Slowly and carefully enter the shower area.
   • Use your crutches or walker to maintain balance until you are seated on the shower chair.
   • Place your non-operated leg into the shower first, followed by your operated leg, which should remain as stable and non-weight-bearing as possible.
3. Adjust Water Temperature: Use lukewarm water. Hot water can increase swelling and make you feel lightheaded.
4. Position Yourself: Sit comfortably on the shower chair. Keep your operated leg elevated or extended as much as possible, avoiding direct water spray on the protected incision unless your surgeon has specifically cleared it.
5. Wash Gently:
   • Use a mild, unscented soap.
   • Wash your body, avoiding direct scrubbing or vigorous rubbing on or around the incision. Let the water run over the area gently.
   • Do not allow soap or water to pool around the incision.
6. Maintain Balance: Move slowly and deliberately. Avoid twisting, turning, or sudden movements that could strain your knee.
7. Keep it Brief: Limit your shower duration to minimize the time the wound is exposed to moisture, even with protection.

Post-Shower Care and Dressing Changes

Immediate post-shower care is crucial for preventing infection and assessing the wound.

1. Exit the Shower Safely: Carefully exit the shower chair and then the shower, again leading with your non-operated leg and using any assistive devices.
2. Gentle Drying:
   • Pat your entire body dry with a clean, soft towel.
   • Do not rub the incision area. Gently pat the skin around the incision completely dry.
   • Remove any waterproof coverings or dressings.
3. Inspect the Incision: Carefully examine the incision for any signs of redness, increased swelling, discharge, new bleeding, or any foul odor. A small amount of clear or light pink drainage is sometimes normal in the initial days, but anything significant or persistent should be reported.
4. Apply New Dressing: As instructed by your surgeon, apply a clean, sterile dressing to the incision site. Ensure your hands are clean before touching the dressing.
5. Dress Comfortably: Put on clean, loose-fitting clothing that doesn't irritate the knee.

What to Avoid

• Submerging the Incision: No baths, hot tubs, or swimming pools until cleared.
• Direct Water Spray on Unprotected Incision: Avoid if your surgeon has not explicitly allowed it.
• Slippery Surfaces: Always use non-slip mats and take extreme caution.
• Hot Water: Can increase swelling and lightheadedness.
• Harsh Soaps or Scrubs: Avoid these on or near the incision.
• Shaving Near the Incision: Do not shave the operated leg until the incision is completely closed and healed, and your surgeon has given approval.
• Vigorous Rubbing or Scrubbing: Especially on the incision.
• Prolonged Showers: Keep them brief.

Recognizing Warning Signs

While proper care minimizes risks, be vigilant for signs of infection or complications. Contact your surgeon immediately if you experience:

• Increased Redness or Swelling around the incision.
• Pus-like or Foul-smelling Drainage from the incision.
• Significant or Persistent Bleeding from the incision.
• Increased Pain that is not controlled by medication.
• Fever or Chills.
• Warmth to the touch around the incision.
• Separation of the incision edges.

Long-Term Hygiene Considerations

Once your incision is fully healed and your surgeon has cleared you for normal activities, you can typically resume your regular showering routine. Continue to keep the incision site clean and dry. Over time, the surgical scar will mature, but it’s always wise to be mindful of its integrity, especially during activities involving friction or sun exposure.

Conclusion

Showering after ACL surgery is a critical step in your recovery, demanding meticulous attention to detail and strict adherence to medical advice. By prioritizing wound protection, maintaining a safe environment, and being aware of your body's signals, you can ensure a clean, safe, and complication-free hygiene routine, contributing positively to your overall rehabilitation and return to function. Always communicate any concerns or questions with your healthcare team.