I’m now a couple weeks out from my reconstructive ACL and meniscus repair surgery. I wrote what I did the day of the surgery here. Next up is what days 2 through 11 looked like.
The bold indicates something that changed from day 1. Changes include weight bearing as tolerated up to 50%, the inclusion of proprioception exercise, and the discontinuation of ibuprofen.
Remember: Don’t get caught up in the exact days here. Everyone is going to vary a bit based on their experience and their surgeon’s opinion. A couple of things that shouldn’t vary: Attaining full knee extension. This should be accomplished IMMEDIATELY. Also, active knee flexion is not allowed until day 10. Passive is up for debate. FYI active is a movement you accomplish with the specific muscles where passive is when something else moves those muscles for you. Could be gravity, your arms moving your legs, another person, etc.
Other than that, the principles are what’s important. Pay attention to how things progress from day 1 to day 2, to day 10, to week 2, etc. For instance, how much weight bearing you’re allowed is going to vary. That’s fine. What’s important is that you don’t go from non-weight bearing day 1 to trying to walk day 2.
Some general comments on days 2 through 11: If there is any point during this whole process that is worse than days 2 through 10, I’d be shocked. Despite the fact I was barely in any pain, these days turned from bearable to miserable. Having to have someone help you drive, put your shoes on, grab objects for you, hold items for you, it all sucks. Sleeping with your leg locked straight, sucks. Not being able to bend your leg at all, sucks.
Next, I’ve been exhausted. I assume all the healing work my body is doing plays a role, but getting around is extremely tiring. Crutching around, only being able to use one leg most of the time, well, I’ve been sleeping like crazy.
I highly recommend anyone who knows they will be on crutches for an extended period of time buy a T-shirt or make a sign detailing why. This will prevent the inevitable 15 thousand people asking you, “What happened? Oh, how did you do that? Wow, when did you do that? Does it hurt? Yeah, I remember when I sprained my ankle.” While I appreciate the consideration, it wears on you. If you’re in California make sure to state whether you did or did not get hurt skiiing.
Lastly, this was intended to be days 2-10 but I wasn’t able to get in for my follow-up until day 12. Thus, this turned into days 2-11.
Oh, I had the surgery on a Friday and was back at work Tuesday. Not bad.
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Post-op Day 2-11
Compression
-Compression sock from hospital
-Manual massage quads, hamstrings, adductors
–Ace bandage
– >After a couple of days I could feel the compression sock losing some of its tightness. I believe day 4 I noticed a little extra swelling in my leg and I could feel the rush of blood into my leg each time I stood up. Almost like the skin was expanding. This actually hurt. A lot. I threw an ace bandage around the knee and that cleared that up.
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Crutches
-Up to 50% weight bearing as tolerated. Don’t try to put more than 50% of your weight on your injured leg. Don’t be afraid to use less than this as well.
–Move every hour or two
–-> This is another one of those areas where opinions vary widely. Some say weight bearing as tolerated, others don’t want any weight bearing for two weeks, if not more. If you only had your ACL reconstructed, weight bearing as tolerated seems to be a good way to go. With walking projected at about 10 days. If you had your meniscus repaired though, that’s where the numbers start to jump all over the place.
The size of your tear, where your tear is, how good your surgeon feels he was able to repair it, etc. will all dictate your weight bearing status.
Again though, I wouldn’t get too caught up in the specifics on this. There really isn’t anything to suggest an aggressive approach is worse for meniscus repairs than a conservative one i.e. weight bearing more than someone else does not negatively affect outcomes.
I even said to my surgeon “There really doesn’t seem to be a lot of consensus as to how long you shouldn’t weight bear after the surgery.” He said there really isn’t. Unless you have a seriously large tear, or a complex tear, or you are progressing slowly, I don’t see any reason you should still be on your crutches after two to three weeks. If you only have the ACL, 10-14 days is a good mark.
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Bracing
-Locked at 0 degrees.
–> Some will be allowed to unlock the brace to 90 degrees while sitting, allowing some knee flexion. For the most part though, the brace will be locked at 0 degrees. This is to make sure you don’t lose any knee extension. Something very common in ACL patients.
Again, if you had a meniscus repair you are going to be more on the side of having the brace locked at all times. This is how it’s been for me for the first 10 days, and I’m going insane. I did not think this was going to happen and fully expected to be able to bend my leg, at least somewhat. Based on the size of my tear though, my surgeon asked me to be more conservative.
The differences between having to have your leg always locked at 0 degrees and being able to bend it are huge. If you can’t bend your leg at all it’s going to be extremely hard to drive (I definitely can’t), picking anything up is very hard, sitting is hard, getting up and down is hard, you can’t go grocery shopping, basically everything in life blows ass. I’m on the verge of throwing my brace in the trash can and lighting it on fire.
I would highly suggest trying to find out before the surgery if your surgeon is going to let you bend your leg or not. He might say he won’t know until he goes in there, but make him give you some idea. Keep in mind that if your leg has to be straight for 10 days you are going to need someone helping you get around for 10 days. Possibly more.
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Range of motion exercises (15 reps of each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)
Note: Videos of the exercises can be found on the Post-op physical therapy day 1 post.
-Extension: To 0 degrees or 5-7 degrees of hyperextension. This should already be accomplished!
-Passive knee extension with quad squeezes
-Flexion: No active flexion. Passive between 0 and 90 degrees or leg locked straight. (See above.)
-Patellar mobilizations
-Sitting hamstring stretch
-Plantar flexion / dorsiflexion
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Strengthening (4 x10r each)
-Standing abduction
-Glute Bridges
-Straight leg raise
-Lying down calf strengthening with band
-Toe grabs
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Proprioception
-Weight shifts w/crutches:
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Meds
-Ibuprofen day 2. No ibuprofen after that. If used, ideally after exercise. (For reasons here and here.)
-Aspirin / Tylenol days 3-10. Ideally after exercises.
– -> Here’s how my med schedule looked:
Day 2 I took a total of 6 advil throughout the day. Two every ~six hours. Then at night I took one percocet. The pain from ACL surgery peaks at the 36 hour mark so I took the one Percocet when the pain peaked. I could have gotten away with more advil but took the percocet as a precaution.
Day 3 I took a total of 4 Tylenol. And that’s been it.
I’m not exactly sure why my pain experience has been different than most people. I mean, this doesn’t even come close on my most painful experiences list. Judging from the people I’ve talked to this is a surgery that hurts, a lot. Some act as if dying would have been better. This was also evidenced by my surgeon giving me a prescription for 80 percocet, all at a double dosage. That is a shit load of Percocet. I can’t imagine taking that many pills. And I used ice one time. (Oh my god he said whaaaaaat?).
Maybe one day I’ll try and find out why some have more pain than others postop, but I’m sure it’s a myriad of factors like the surgeon’s skill, your pain tolerance, how quickly you get moving, fitness levels, etc.
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Nutrition
-Calories = (Bodyweight x 15) x 1.10
–> For example:
I’m 190 pounds.
190 x 15 * 1.1 = 2850.
-Protein = Bodyweight x 1 = MINIMUM (190 x 1 = 190 grams of protein.)
-Supplements: Glucosamine and chondroitin, vitamin D, fish oil.
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For a comprehensive look at ACL rehab, check out The most important phase of ACL rehab
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Alex G
January 25, 2017
Hello,
Thanks for your very informative blog – you have pretty much answered all of my questions and queries (along with the addition of the comments). I haven’t found anything else as comprehensive out there – so thanks! Im on day 7 after a repair to my medial menisci (bucket handle tear) as wells ACL reconstruction (hamstring graft). Would you, as well as anyone else that is willing to, share how your knee is now after your full rehab and having lived with your knee for a number of years?
reddyb
January 27, 2017
Hey Alex,
Thanks for the nice words. Glad you’re finding things helpful.
ACL wise my recovery was very smooth. I also had a bucket handle meniscus repair, and that unfortunately failed about 18 months post-op, where the sutures tore apart. I wrote about this more in depth here: https://b-reddy.org/2015/09/21/your-knee-just-locked-on-you-what-do-you-do-the-fickleness-of-the-meniscus/
All in all I’ve done anything I’ve wanted to do since each surgery, though the meniscus retearing got me down mentally for a while. I really didn’t want to go back in for another surgery and was able to avoid it for years, but eventually the tear blocked joint movement and I had to have it done.
In the last year I’ve-
-Played tennis once a week for about six months
-Played in a dodgeball league which is a lot of changing direction movement
-Squatted / deadlifted multiple days per week
-Ran a couple times a week. Something like 1-4 miles per run (ran a 10k about three years post-ACL surgery)
-Played basketball
-8 mile hike
I still would not say my knee / mind is normal though. I think about it more than I did previously, and I will not do certain activities anymore. You couldn’t pay me to get on skis, and I have a forever fear of running on grass fields because a not well maintained grass field is how I originally hurt my knee. If my kids play sports, I will be scouring the field for holes before they got on it too.
Once in a while the knee lets me know its there. One random day last year I was walking around and could tell the knee was swollen. Nothing had happened the previous days. It just swelled. You couldn’t tell from looking at it, but I could feel it. It was bizarre. Next day I was fine. That’s actually when I hiked 8 miles, but you can see what I mean by it’s not like the injury / surgery never happened.
The same thing happens with the hamstring that was cut. I can go six months not thinking about it then one day it’s like “HEY! This is the exact spot you had a knife cut part of me. Just wanted to remind you!”
If I get to where I get some decent numbers going, I’m debating putting a post together showing what can be done post-surgery. Been playing with making things more intense the last year. Will see how much I’m willing to push it. I’ve repeatedly found once I’ve proven to myself I could return to X activity my desire to do it goes away. I’ve had enough injuries at this point and am at a stage in life where being on crutches is a much bigger deal than it used to be.
Varsha
February 10, 2017
Its been almost 2 months since the surgery and there is no problem in walking and extending my leg, but there is only 50 degrees of flexion…How do I attain full knee flexion?…And is it too late for attaining full flexion?…And till how when(duration) can we attain full flexion after the surgery?…BUT MY MAIN QUESTION IS HOW CAN I ATTAIN FULL FLEXION ASAP AFTER TWO MONTHS OF SURGERY???
reddyb
February 12, 2017
Discussed in this post and the comments: https://b-reddy.org/2013/10/23/the-biggest-mistakes-acl-patients-make/
As well as here: https://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
Diary of a progression can be found by scrolling down here: https://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/
Going to put together a manual on this topic too, but will take some time to complete.
Andy
April 15, 2017
hey there,
I’ve spent some time reading your story here to get some ideas as to what I cand expect in the next 6-8 months. I am 2 weeks post op from ACL reconstruction and meniscus repair. I’ve been unlucky enough to tear both in a ski accident earlier this year. The MRI did not show the full extent of the injuries and during th surgery the doctor decided to also suture my meniscus to try to save it, given that I am only 28 and want to remain active. So now I am stuck wearing a brace in extension for 3 weeks post op, then it will be unlocked to 60 degrees, with an objective to reach 90 after a month. Weight bearing is allowed now (30%, but i’ve been more conservative with this).
I was expecting all this to be more painful, but after the removed the drain tube the second day after the surgery I was off painkillers completely. I already started the recovery, but having a brace locked at 0 degrees is beyong frustrating and annoying.
Since the accident and before the surgery I’ve been working with a PT to strenghten my muscles and get ready for the recovery period. So far I think it helped… It’s kinda funny how I was laughing at others when I saw them being scared to jump in recovery or fearing certain exercises and now that I am post op I can totally relate to them. Will this fear ever go away? How did you push yourself to do certain things? I am sooo cautious these days to make sure the new graft stays in place and the meniscus repair is a success. I would do anything to avoid another tear, but I do want to go back to hiking at some point. I was used to long, quite intense hikes and hope they will be possible after all this. I am realistic though and will not make anything stupid without consulting the PT and the surgeon.
I’ll stop here and read some more stories now 🙂
reddyb
April 18, 2017
Hey Andy,
Your initial experience sounds a lot like mine. Pain wasn’t my big issue. It was more frustration with my circumstance and function than anything else. Having the leg locked straight can sure make one feel handicapped.
Hiking should definitely be possible after your recovery. Uneven ground can take some time to work up to, but this is the type of activity the majority of ACL patients should be able to get back to. It’s more dynamic activity like cutting sports that are the hardest.
If it helps, I just did an 11 mile hike last weekend :).
In terms of fear the best thing is a gently progressed rehab. Not making too big of jumps. The way I phrase this is “Physical preparation largely dictates mental preparation.” If something feels very scary, you’re probably trying too much, too soon, where things should be progressed at a smaller increment.
If you look at the ACL manual (https://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/) or my diary (scroll down https://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/) you’ll see examples of how incremental things can be made.
Running is one of the big areas people run into trouble here, because all of a sudden one day they, or their therapist, decides “let’s try running.” There is a way to build up to everything.
It’s more often than not *not* a courage game. Some think they just have to be mentally tougher, but the body is quite good at knowing what’s outside of its comfort zone. It’s usually cautious or scared for a solid reason.
CHRISTA NADEAU
April 23, 2017
This is a very informative blog. My 15 year old daughter had ACL reconstruction and Meniscus repair due to a direct hit to her knee playing soccer. She used her quad tendon for the graft. Her flexion is great at 135 degrees and extension is getting close to straight 3 weeks post op. My question is regarding pain during flexion and swelling. She has pain when doing flexion exercises while sitting down and bringing her knee in and her knee is still pretty swollen. Her PT says that some knee pain is normal, but she has a hard time verbalizing what she is feeling due to being 15 (I think), so it causes me to worry that there is an issue. What are your thoughts on this?
reddyb
April 25, 2017
Hey Christa,
Sorry to hear about your daughter’s injury.
At 3 weeks out, pain is certainly normal. However, if the pain is exacerbated through exercise, that exercise should be avoided. This is somewhat a subjective view, as many therapists believe in pushing through pain after this surgery. While the rest of us have the common sense of if it hurts, one probably shouldn’t be doing it :).
That said, there is a line between discomfort and pain. Feeling weird, feeling stiff, needing to loosen up, that’s part of the process. Feeling like the knee is progressively getting pissed off while doing an exercise should not be.
If the knee is swelling after exercise, something is wrong. Most often that’s how the exercise is being done. It’s either too much, or the person isn’t ready for it yet.
Exercising into pain is the best way to cause swelling after this surgery.
Caroline
June 7, 2017
Thanks for your informative blog! I found this while searching for information about the pain after knee surgery. I had a torn ACL and both meniscus repaired from falling down the stairs. Post op about 4 weeks. I was not put in a brace after surgery.
I agree that the first week was horrible but the last three weeks have been almost as bad with the constant pain. It’s about to drive me nuts! I can only relate the pain to a constant deep toothache “in the knee”. I work from home so taking the hydrocodon the doctor prescribed is limited during the day. I mostly use ice. I only sleep maybe three hours at at time at night.
The PT is working but I still cannot fully straighten my leg. I’ve had other surgery in the past but none took so long to recuperate. Knee surgery has to be the worst! I am healing nicely on the outside but don’t know how much longer I can handle this nagging pain! it really gets on my nerves.
b-reddy
June 9, 2017
Hey Caroline,
Sorry to hear your pain is being that persistent. The straightening the leg is a big priority right now. Can’t promise that will eliminate what you’re feeling, but it should help. If you need more direction in that regard -I’ve found most standard physical therapy is be lacking with this topic- you may be interested in this: https://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/