My five year ACL surgery update

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One of the topics this site is most known for is reconstructive anterior cruciate ligament (ACL) surgery and rehab. The most popular writing being,

–The biggest mistakes ACL patients make

A common question I’ve received is “How is your knee doing?” As I go over in the biggest mistakes post, one should be careful reading too much into other people’s stories. Doing this, by its nature, gives a small sample size. Odds are you will have a different experience. So take this with a grain of salt.

I’m going to break this up by activity category-

• Change of direction
• Straight line running / hiking
• Lifting
• Combinatorial
• Health

This will focus on the last 12 months, roughly the fifth year of my post-ACL surgery life.

 

Change of direction

In March 2016 my girlfriend and I got a hair up our asses and decided to buy some tennis racquets. We went out for nearly two hours, but a lot of that was us moving barely more than a few steps each way, due to being so bad our first time. My knee did great, though it felt odd the first 60 minutes or so. My proprioception wasn’t quite there yet.

-> This was really from my second meniscus surgery, not my ACL.

I gave it a few days to see how my knee responded. No issues. We started playing once a week, 60-90 minutes.

 

About a month after starting tennis I started basketball. I would go to the neighborhood park and play by myself. Based on my ability to play tennis, I could play basketball with other people no problem. The difference is basketball necessitates being at the mercy of others where tennis does not.

If the other person screws up in tennis, that doesn’t potentially end up in someone falling on my leg, or landing under me when taking a shot or me getting arrested once that happened.

 

In June 2016 I decided to go back to my old favorite activity of team dodgeball. It was 10 games, where I missed two weeks. Dodgeball, in terms of change of direction, is similar to tennis. There is a bit more risk regarding other people, but still not like basketball.

I felt great during the games. I didn’t experience any limitations relative to my ability pre-ACL surgery.

What I did notice was this shit beat me up like crazy. I took those two weeks off because my arm needed a break, I strained a calf, my achilles was sore. More about this later.

 

One thing to note above is I did not just one day throw myself into dodgeball with other people. I played tennis in a very scaled down manner -after some months we did get quite active though- would move in a bunch of directions in a controlled manner on the basketball court for a couple months (more change of direction practice), then practiced dodgeball oriented moves by myself for about six weeks, knowing I was thinking of getting back into it.

Merely throwing one’s self into these activities without a gradual build up is a terrible idea. Going out by yourself is a smart move, as once other people are involved the intensity almost always jumps, often dramatically, no matter your intentions. “Oh, come on man! One more game.” It’s reminiscent of “Come on dude. Let’s just have one beer.”

 

Straight line running / hiking

For eight of the previous twelve months I did some form of longer distance running / hiking. For a while this consisted of running a mile as fast as I could one day per week, then a longer hike the other day of the week. Four miles or more.

Then another period it was running twice per week; 3-4 miles per run.

After the 12 months I hiked the steepest day climb in America.

 

Lifting

The main lower body lifts I consistently did were,

• Front squat below parallel
• Box squat slightly above parallel
• Sumo deadlift

Twice per week.

 

Combinatorial- how fast? how much?

When I started doing the above my goal wasn’t to achieve a certain time or lift a certain amount. It was to blend all the more intense activities an ACL patient is likely to be interested in.

One phase of the year:

• Saturday- lift then tennis then hike
• Sunday- off
• Monday- basketball then straight line run
• Tuesday- off
• Wednesday- basketball then dodgeball
• Thursday- lift
• Friday- off

Another:

• Tuesday- straight line run
• Thursday- lift
• Saturday- run
• (next) Tuesday- lift
• (next) Thursday- run
• (next) Saturday- lift

This is much, much harder than trying to e.g. max a deadlift. I’m 6’4″, 190 lbs. Even when I was playing division I football at 235 lbs, my lifts never impressed anybody. I wasn’t doing the above to try that. I’d have to be 300+ pounds. (And on the other side, I’d probably have to be at least 20 pounds less to have an impressive mile time.)

One reason I started this was to see if I could give some encouragement to ACL patients desiring activities like these, ones that are, not coincidentally, hard for ACL patients to get back to. I knew I could do any of them if only focusing on one at a time. Doing them at the same time is a different animal.

Lifting wise I was squatting ~200 lbs for 10 reps; deadlifting 250 lbs for 5 reps. Running wise I was anywhere from just under seven minutes per mile to eight.

I got up to a thirteen mile hike. (The super steep climb I trained for without doing these other activities.)

Again, well aware these aren’t eye popping numbers. I’ve lifted hundreds of pounds more this, and ran minutes per mile faster as a 14 year old. That wasn’t my goal.

 

Health

It was not easy managing these activities and staying healthy. Not only knee wise, but in general. Nothing major happened, but I had never tried to manage this level of work while running a business, post 30 years old, with a baby on the way. It took the better part of the year to accept I don’t heal like I used to. What was once “workout soreness” has now become “take a breather for two weeks.” I’m always working out, but I hadn’t tried to push myself like this physically for five years. It took time to realize old sensations couldn’t be handled the same as when I was in my early 20s. This is how I got an achilles issue. What started as some soreness became realizing I needed a real break from running. (My achilles is 100% now.)

Over the year there were two instances when my knee legit let me know it was there. After the last dodgeball game of the season, a playoff game where things are the most intense, I was fine. But two days afterwards the knee noticeably swelled. It wasn’t painful, but there was fluid in there.

I did still hike two miles that day. Then the day after it swelled is when I did the thirteen mile hike, with no problems during or after. So it was quite a transient issue.

About six months after that I was starting to push the running. After one of those runs the knee swelled up considerably. This is for another post, but there is some scar tissue from the surgery. I pinched the scar tissue between my kneecap and femur (a plica), and it got pissed. Basically, I had been doing too much. A couple weeks later and any pain was gone. That was the one time over the year when my knee had any pain.

After that I thought about the last year and the amount I had done and said you know, that’s a solid year of activity, it’s time for a break. Plus, I had the birth of my daughter coming up, so the timing worked out. I took 10 weeks off, then prepped for the 20 mile hike.

 

Because of my follow up meniscus issue (my repair failed), I had X-Rays and an arthroscope put in the knee at about the four year post-ACL mark. Zero signs of arthritis. So the knee is doing well in that regard.

I’ve had no giving way sensations. The knee is great stability wise.

 

Going forward

I didn’t quite get to what I wanted in terms of being able to do everything in a given week. I’m still debating something along the lines of,

• Some type of heavy lift
  • e.g. squat two-three hundred pounds and or deadlift two-three hundred pounds
• Run a five-six minute mile
• Hike 20-30 miles
• Play tennis for one to two hours

All within seven days. I’m thinking about pushing for that in the next year, but time / energy wise, I’ll see if I have it in me.

One thing I don’t think will be on the list for a longtime is any rec sports. I was surprised how much I didn’t care about being able to play dodgeball for that time period. I thought I was about to start up on a consistent basis again, but I didn’t have any desire to go keep playing once the season was over. Like I said, the general body soreness wasn’t enjoyable and was overwhelming. Stupid shit, like having somebody step on my foot and be sore for months, was too annoying to overlook.

This is not to say my knee is 100% normal. It’s not. It gives sensations that, while 99 out of 100 times are not painful, are there. Due to the surgical history, it’s not as easy to be dismissive of a pop, click or snap. It’s hard not to immediately go, even if it’s in the back of the mind, “Oh crap. Is something wrong again?” Meaning knowing the history of the knee can be more of an issue than the actual knee. I may have the same sensations on the left knee, but I feel them more on the right.

Functionally, the knee is normal during activity. The aspect that’s different is the ability to mindlessly go do things, and the frequency of them. The idea of going and playing pick-up basketball one day, then hike 15 miles the next, then go try surfing for the hell of it another day, that wouldn’t be a smart move for that knee, but it’s not something I’d even think about if I had never had surgery.

Both legs can do the same activities, but the odds of the ACL leg feeling off afterwards is greater. This might only be one in fifty workouts, but again, it’s there. When my girlfriend and I go play tennis, when it comes to my left knee I don’t think about “I should probably stop now even though I’m feeling good, because this is more than we usually do.” I do consider that for my right knee though.

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Need help with your ACL recovery?

In the early phase? Go to The most important phase of ACL rehab

In the late phase? Then you want the remote client process

Having trouble with a specific range of motion?

Can’t straighten your knee? See the regaining knee extension guide.

Can’t bend your knee? Here’s what to do.

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