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.
–
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.
–
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.
–
For a comprehensive look at ACL rehab, check out The most important phase of ACL rehab
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abc def
July 1, 2012
Woah, Woah. Hang on. I didn’t know you were supposed to keep your leg straight. I’ve been sleeping with it slightly bent! Have I majorly screwed up?
reddyb
July 2, 2012
Slightly bent should be fine. The important thing is during the day you are able to achieve full extension and (some) hyperextension.
The more your leg is bent when you sleep the harder this becomes. Doesn’t mean you are screwed though.
Luke
August 25, 2012
I had ACL reconstruction using the Patella graft. I’m at day 5 and I still can’t do this damn leg raise. When I do raise my leg, I seems to be lifting from the hip and not the Quads, Then obviously get a huge amount of pain on the patella tendon. It’s driving me crazy not being able to do this.
reddyb
August 27, 2012
Hey Luke,
In a straight leg raise the hip IS doing most of the work. What you’re looking for from the quad is to maintain a contraction. It’s actually a low-level quad exercise in this scenario.
How’s your swelling and such doing? Might be a reason for the patellar pain.
Kenny
December 20, 2012
Hi, I’ve also had ACL reconstruction and meniscus repair. I am in my third week now. Should I be attempting to walk at all? That is, without crutches.
reddyb
December 21, 2012
Hey Kenny,
In the general sense, yes, at 3 weeks it’s about time to start walking.
You need to consult with your surgeon on this too though. If he’s not really confident in the repair he did, he may want you to wait longer.
Or you may be at the point where you vacillate between using the crutches and not. Or using one crutch, etc. But at 3 weeks you should almost (keyword) be definitely attempting some form of walking.
Best of luck.
-Brian
Fabien
September 12, 2014
I am wondering how you are going as I am having the same. ACL reco and meniscus repair / trim. Did they remove some of your meniscus ? I am 43 . How old are you ? and how are you going now.
reddyb
September 13, 2014
Hey Fabien,
Not sure who you’re asking on this, but I am doing well. I didn’t have my meniscus trimmed, and would strongly consider not having a partial menisectomy done. You can see a very thorough rationale for this here: http://b-reddy.org/2014/03/05/more-evidence-against-knee-surgery/
I’m almost 28 now, and had the procedure done at 25. While I’m doing well now, I can’t say I could strongly, or weakly, recommend this surgery. The reasons I’m doing well have very little, if anything, to do with the surgery. (I talk about this more in the above link.) To this day I heavily contemplate whether it was worth it, whether I would recommend (if I had) my child go through this surgery, whether I would do it again.
More research has come out on this surgery since I had it, and it finds the same things I discussed in my review (years ago) of it here:
http://b-reddy.org/2011/11/29/reconstructive-acl-surgery-is-it-beneficial/
and here: http://b-reddy.org/2011/12/05/reconstructive-acl-surgery-is-it-worth-it/
Long story short: After 30 years or whatever of this procedure, there is still no convincing evidence of its efficacy. When you put this into the context of how long of a recovery you’re looking at, how traumatic the surgery is, how hard the recovery is (just look at the comment section of this post), how even if your new ACL is great other things usually aren’t (such as having screws in your knee, having part of your tendons cut, a possible meniscal implant (they use certain implants / anchors in repairs)), and there just isn’t anybody who can make strong argument for this procedure. Maybe the elite athletes or the very (very) active, that’s it though.
Every case is different, every person has a different background. Overall, I feel on this just about the same I feel on partial menisectomies: Probably more than 90% who tear their ACL do not need reconstructive surgery. Everyone needs a phenomenal, highly dedicated exercise program though.
Pharoah
April 13, 2013
Hi no idea if your still answering but I had meniscal repair and acl surgey 5 weeks ago..and to be honest i havent really been obeying my doctor the first week post op i only used crutches complete non-weight bearing…but the second week i went on a college trip and i would walk completely without crutches …just because i wanted to do stuff for myself….had a follow up with the doctor in 3 week post op asked him if i should be weight bearing and he said no not until i gain muscle tone… but the last two weeks i havent used the crutches( and sometimes not even the brace) at home and occasionaly dont use my crutches for short distances at school. The only reason i havent is because i feel close to normal wlaking and no pain…am i wrong am i damaging my torn meniscus and increasing swelling..if so i will stay on crutches and non weight bear until my doctor tells me
reddyb
April 17, 2013
Pharoah also emailed me. Here was my response:
I still respond to all posts, so no worries on the dates.
You shouldn’t do any walking with a limping. You get what you train. If you train yourself to walk with a limp, you’re going to have to then deal with training yourself to walk without a limp.
Also, walking with a limp wreaks havoc on the lower back and other joints. While you may be avoiding pain at one site, you may be making yourself more susceptible to pain at another site.
Weight bearing and walking without crutches aren’t synonymous. You can walk with one crutch, let the leg do some work even with both crutches, etc.
You SHOULD be doing some weight bearing pretty soon. This will be based on your graft, if your menisci were repaired or excised, how the surgeon feels, etc.
No weight bearing at all is a very, very conservative treatment though.
If your leg is sore at the end of day, then it’s hurting.
It’s way, way too soon to be shooting in my opinion. You should be working on squatting and intensely focusing on just your legs. There is no way you’re going to be able to sufficiently do this while also shooting a ball.
You need to understand you’re looking at recovering from an injury with a LONG timetable. You play basketball right? Have you followed Derek Rose?
At 17 years old you need to be hyperaware you want to have a knee that can last you 70 more years, not one season of basketball.
At 17, I highly suggest changing this thought process to “I want to come back, and healthy, for 70 years. If that takes a few extra months, then fine.
You suffered an extremely severe injury to the knee. Having a tear on both sides of the meniscus is no joke, and if you had some of it excised, you now have a permanently less stable knee. You need to be very patient with this thought process, and from what I can tell, should seriously consider getting a physical therapist you trust to work immensely close with you.
Going based off how you feel is not a good idea. You need another pair of eyes to examine you and tell you how you’re looking. To tell you whether you’re moving well, whether your mechanics are clean, all to make sure you don’t simply go out there and tear the ACL, or the other knee, up again.
I don’t think you should be anywhere near a court. Zero weight bearing is too conservative in my mind.
You should be rehabbing, not working out. And rehabbing for probably at least 9 months. This is NOT a short process.
Another athlete for you: Adrian Peterson. Guy ran for 2000 yard this season and STILL said he didn’t feel normal.
HOUND the physical therapist’s office, or find another one. This is bullshit, you should be seen at the latest 2 weeks after surgery, and even that’s too long. This is a big pet peeve of mine with this surgery: The physicians and therapists take too long to help the person.
I typed this quickly, so I hope it’s helpful. If I sound adamant with anything it’s because I’m fully aware how not doing things properly after this surgery can screw someone up for decades.
When in doubt, be even more patient.
Tanya
December 11, 2014
I had surgery on my acl and meniscus Nov. 12th and this was the worst surgery I’ve ever had, I’d rather go through childbirth again lol. From the pain to the things you can’t do like drive is very frustrating, especially if your a person whose active. My pain experience with the surgery was terrible because I’m allergic to all pain meds including Tylenol and ibuprofen. I did get pain medicine but I don’t use it unless the pain is unbearable. On top of that I had to deal with my reaction to the anesthesia also so I’m vomiting and can’t eat because I’m so nauseated. It’s been almost a month and I’m still in pain and very miserable. I can say that I am moving around by myself, walking with no crutches and flexing my knee very well. Everyone’s experience is different but I do see a light at the end of the road.
I also am having trouble with my doctors office regarding post op appt and them answering questions. I didn’t get my stitches out until almost 3 wks after surgery and the stitches grew into the skin. So on top of my surgery pain now I also have pain where they digged to get the stitches out. It’s very frustrating to have a doctor’s office like that.
reddyb
December 11, 2014
Thanks for sharing Tanya, and welcome to the club nobody wants to be a part of :).
george
May 17, 2013
Hi how long after your acl surgery should you go to rehab? Its been 10 days and my doc gave me a referral to start rehabbing.
reddyb
May 17, 2013
You should be doing rehab work the day of the surgery. The sooner the better.
george
May 17, 2013
I hear of people go to physical therapy 1 month or 3-4 weeks after their surgery. I just wanted to know if 10 days is normal to start physical therapy.
reddyb
May 17, 2013
It’s normal, but not ideal.
Joe
August 4, 2013
I’m on week two after my acl and meniscus and wondering if its okay to sleep without the brace on, my leg bends a little
reddyb
August 5, 2013
Hey Joe,
I’d still keep the brace on at that point. It’s not so much you need the brace, but it can help prevent you from negatively moving your leg while asleep.
e.g. You roll over and bend your knee more than you’re supposed to. Unlikely you’re going to damage the surgery with this, but likely you will hate yourself for a bit.
Tangent: A tiny bit of knee bend is fine, but don’t forget to keep working towards full extension with your exercises. That tiny little knee bend is likely comfortable, but don’t let yourself be too comfortable. I see this too often with knee surgeries. Next thing you know it’s 6 months later and the person still doesn’t have full knee extension.
Sage
August 10, 2013
Hello, so as of now I received acl surgery 9 days ago with the patellar graft. My first 4-5 days were absolute hell. I have become concerned because my doctor doesn’t have me in PT until about 11/12 days after te surgery. I’ve called the doctor and the PT people and they all say its just part of his protocol. However, now that I’ve been starting to feel better I feel even more helpless. It seems as if I’ve lost all quad muscle. I can’t lift my leg for the life of me. I can actually put weight on the foot yet the issue is if I try to walk I literally don’t have the muscle to move my leg forward, the only way is to weirdly drag if across the floor. However I am somehow able to walk backward. Since my doctor has seemed kind of useless I’ve been trying to bend on my own. I can bend to around 60 degrees but I use my hands to guide a little since my quads are so week. My biggest concern is that I NEED to be walking in exactly two weeks. That is when I go back to school and it would be a nightmare if I’m not walking by then. Is they any comments or advice you could offer me? Am I screwed/are my expectations of walking unlikely?
reddyb
August 12, 2013
Hey Sage,
Unfortunately, your recovery is a common one. Most surgeons don’t start PT til roughly the two week mark. It’s absurd, but common.
The pain you’ve had and the quad atrophy you’re experiencing is very common too. My pain experience was not a common one. Most have excruciating pain for a while after surgery. As far as the quad: You’re realizing 1) How brutal this surgery is and 2) How quickly the body gets rid of something it isn’t using.
You should not be trying to walk while dragging the leg. You don’t want to acquire poor walking habits because they will be very, very hard to change later on down the road. If you need the crutches, you need them. Use them!
Walking backward is easier than going forward. It’s less stress on the ACL. One of the progressions back to running is start backward running before forward.
Your doctor is going to be pretty absent from this point forward. He will look at your leg, X-Ray things, and if all looks well, his job is done. The physical therapy is where your life needs to be now.
Do not start bending your leg too much too soon. This is something the surgeon and therapy will guide. The surgeon has some say here because he knows how well of a job he did in there. Bending the leg too much too soon can stretch the graft. Do not fuck with this.
You need to get that quad working, get full knee extension, and go from there. Knee flexion will come with time. The longer you don’t have knee extension the harder it will be to get it back.
Walking about a month post-op is very reasonable. Most are walking at this point. Everyone has different recoveries though.
My biggest advice to you is this: You do not need to be walking in two weeks. You NEED to worry about having your knee the rest of your life.
Get into PT. Be patient. No one looks back on their ACL process and goes, “Yeah, I really wish I would have tried to push things even more.” Many, many go, “Yeah, I wish I would have been more patient.”
Jacqie
August 31, 2013
Hi ! I’m sorry if you have answered this. I’m 2 weeks post ACL and Meniscus surgery and struggling to get my knee to bend at a 90• angle. I’m a 36 female and had a trampoline accident so not due to sports. Is this normal at this point to only be at 75-80 ? I have had 3 visits to physical therapy which I call ” visits to hell on earth ” 🙁 I’m discouraged because I am doing all the exerises and was also delivered a ACM last night to help . Any advice would be helpful !
reddyb
September 2, 2013
Hey Jacqie,
You’re definitely rushing things. Flexion will come with time. There’s no rush. Extension should be much, much more of a concern for you.
Hell, many people haven’t even attempted flexion til the two week mark as that’s how long some surgeons will lock you in a brace.
Next, there is a difference between active flexion and passive flexion. Passive you can push a bit, active you usually cannot. This depends on a host of factors: Did you have a meniscal repair or excision? A repair necessitates a slower process so you don’t screw up the repair. Your surgeon’s opinion weighs heavily here. What type of tear did you have? How good of a job does the surgeon feel he was able to do with the repair? These will all affect the timeline.
Next, what type of ACL reconstruction did you have? If you had a hamstring graft, your active flexion is going to depend on how quickly you regain strength. Everyone is different on this.
If you had a patellar graft, you usually can push flexion moreso than a hamstring graft.
Final points:
-If you have a physical therapist who is pushing you into certain range of motions, get the fuck out of that physical therapy office. Especially if they are actively grabbing your leg and bending it into positions which hurt. This shit enrages me. There is absolutely no reason to be put into pain or certain ranges of motion. Everyone has their own timeline, and many therapists make the rehab process about them rather than the patient. Really, there is no need for the therapist to touch you, at all. I absolutely refused to let anyone touch my leg but my surgeon.
-Extension ROM at this stage is way more important than flexion. You should not only have full extension, you should have some hyperextension too. Never mind the two week mark, you should have had this at about the 2 day mark.
-Lastly, at the end of the day: Slow down. There is no rush to this process. You need your leg the rest of your life. Don’t push things now at the expense of your leg 10 years from now.
Hope that helps.
Jacqie
September 2, 2013
Thank you for all of that information ! It really put my mind at ease because between my Ortho and Pt I was beginning to feel I’m way behind . I had a ACL patellar graph and a meniscus repair. I still feel very swollen and stiff around the incisions and I can put weight on it but still painful to walk on. I was under the impression that there was a urgency to be bending the knee at a 90 no later than 4 weeks post surgery for fear it will never bend properly. My pt compared it to sticking a piece of paper on the wall with glue. It can be manipulated for a short time but eventually it will stay where you leave it. In your opinion do you think the “lack” of progress I have made is due to swelling ? My Ortho when I last saw him 5 days ago basically said ” Just bend it”. It would be forcing it at this point :/
reddyb
September 2, 2013
There is an urgency to regain extension and hyperextension, but not flexion. You won’t get full flexion for a long time. Me, and others I know, probably took around 6 months to regain complete flexion. You just want nice, steady improvement in that regard.
Furthermore, aggressively going after flexion can 1) Stretch the ACL graft and 2) Damage the meniscal repair. If you don’t go beyond 90, this shouldn’t be a concern.
Extension though, needs to be constantly reminded of. Personally, I would go through extension 4-6 times per day. It took a while before I didn’t have to worry about it as much. From rough memory, probably a couple months before I didn’t have to monitor it multiple times every day. Extension is the ROM that if you don’t get soon after surgery, you run the risk you may never get it. Why the difference between needing to get extension and letting flexion come with time? I’m not sure. (My assumption is some type of calcification process with a lack of extension, but I’ve never really looked into this.) But it’s what happens. You rarely ever see a knee surgery where years later the person is missing flexion. You DO see surgeries where people walk around on a bent knee (lack of extension).
The fact of the matter is if you have swelling and fluid in your leg, you absolutely cannot expect to have proper flexion. Mechanically it can’t happen. The fluid will block the full ROM. So yes, your swelling could definitely be inhibiting you.
Why you’re having so much swelling? Hard to say. Some people swell more than others. If you’re pushing things too much that’ll cause swelling. Your surgeon might not have done as good of a job either. Focus on what you can control though: Not pushing too much.
The other aspect of pushing too much is you do not want to get used to being in pain. Being in pain can very much become a habit. You want to avoid being in pain as much as possible. For example, walking hurts? Use crutches / adjust how you walk / figure out why else it might be hurting. There is just no need to do anything which is painful. Nothing, zero, nada, zilch. Some discomfort? Sure. Pain? No.
Jacqie
September 2, 2013
All that makes perfect sense… I can get my leg completely straight and have been able to about a week post op. I will take your advice and not push it….it seems logical to me if I’m experiencing a intense amount of pain in PT that I’d be leaving more swollen than before and making things worse. Thanks again for your time!
Mandy
September 24, 2013
My son is 16 and just had ACL and Meniscus repair surgery on Sept 10. His injury was from football practice. He started back to school last Wednesday, and has his brace in a locked straight position still. He has lots of swelling when he is up moving around and comes home from school in the afternoon. The brace being locked makes him very uncomfortable, he just can’t get comfortable and makes sitting in a desk all day awful. He still cannot raise his leg or pick up his leg to get out of bed, into and out of the car, we have to help him. He started PT Monday and wasn’t able to bend his leg. The PT said his goal for the week is to be totally off the crutches by the weekend. He can walk on the leg with no pain, but says it feels weird, like unstable. He has been very discouraged and I think starting to get depressed. He feels he should be doing more by this point and really missing his independence. Does this sound normal? Has anyone else had these problems too? Thank You!!
reddyb
September 24, 2013
Hey Mandy,
Sorry to hear about your son’s injury.
If your son is having a lot of swelling after the school day my first concern would be what is he actually doing during the day. Being on crutches, in a leg brace, basically being a disabled person, absolutely sucks. When you’re 16, it can suck even more. If I were working with him I’d be on him like a hawk making sure he’s not disobeying whatever his protocol should be. This my long way of saying significant swelling at the end of the day isn’t a good thing. In the least, his leg should be wrapped to help keep that swelling out.
More here on wrapping technique: http://b-reddy.org/2012/07/12/how-to-wrap-knee-pain-a-knee-injury/
Getting rid of the swelling, and preventing it, is one of the best pain reducers, as well as ways to help improve range of motion. The knee simply can’t bend or extend properly when it has a ton of fluid in it.
Regarding walking: It will feel weird for a while. His body has a new body part in it. It takes time to acclimate.
There’s other things to consider here too. Here is what I wrote about walking in week 3 of my rehab:
“Walking as tolerated. Crutches can be eliminated based on your comfort and ability to walk WITHOUT limping / pain. Don’t push this. Be honest with yourself.
->By half way into week 3 I was able to walk without crutches. However, I kept using one crutch primarily to keep people away from me. This informs my environment, and the people in it, to stay the hell away from me. Don’t bump into me, don’t pat me on the back to say hi, don’t…touch…me. I trust myself without the crutches but I don’t trust those around me.”
Regarding timelines: There is only one thing to hammer at this point, which is ability to straighten (not bend) his leg. The bending will come with time. The extension though, once you lose it, it gets harder and harder to get back.
As far as nearly anything else, there’s no magic time as to when he should be doing certain things. In some ways, it is a simple as “If it hurts, don’t do it.”
Now, there are specific timelines as to what he should avoid. Such as when he should first be allowed to bend his knee past 90 degrees, when he can jog, etc. It’s not so much he needs to do these by things by a certain point. It’s much more he needs to avoid certain things until a certain point.
I cover this in my rehab process if you’re curious, but his surgeon and physical therapist are hopefully on point with this. For as bad as things are right now, he doesn’t want to screw up the graft or repair and have to go back into surgery. If you’re unsure of anything, grill the surgeon and physical therapist for specific information. If you’re unhappy with the therapist’s answer, get another one. They should have an extremely specific timeline as to what they’re looking for out of him. “Walking without crutches by the weekend” is not sufficient. For example, you should respond, “What if he’s in pain without the crutches?” They should have responses to this. (He should then still use the crutches.)
As I went over in my quote above, using the crutches have other advantages as well.
Finally, depression is a very common symptom of this surgery. I can tell you right now, your son may only be 16, but, this will almost assuredly be one of the harder things he ever has to do. (It’s probably already been the most miserable time of his short life.) Between my own experience, many I’ve worked with, and many I’ve talked to, depression is an overarching theme to this process.
Feeling disabled at any age is hard; feeling disabled when you’re young and all your friends are healthy is even harder.
He needs to have a concrete plan (therapist and surgeon help here), with mini goals along the way. As he hits each goal, his confidence can grow, and he’ll hopefully feel better about where he’s at.
What he cannot do, and what I finish nearly every ACL response with, is focus too much on the short-term at the expense of the long-term. Getting back to high school football is not his goal. Being able to play with his friends next weekend, walk around on his own right now, drive a car, none of that should be his main focus. The focus needs to be, “I want to have a healthy knee 50 years from now.” (I realize getting a teenager to think long-term is easier said than done.)
If he starts doing things like walking with a limp, getting used to pain and swelling, goes off running around, he is making life much, much harder for himself down the road. I get people all the time who had a knee surgery years ago and never handled it properly. It’s a hell of a lot harder to get someone to stop limping after 5 years than it is to prevent them from ever limping to begin with.
Again, long term focus is not 9 months from now, or his junior / senior year of high school. Long term for him is “I don’t want 5 more knee surgeries before I’m 30.”
Sorry for the long response. Hope it’s helpful.
-Brian
Mandy
October 2, 2013
Brian
Thanks so much for your response! I appreciate you taking the time to leave your comments and opinion. My son is now 3 weeks post op and seems to be feeling much better! He is not in pain at all unless he has been up on his leg for a long period of time, school/football games etc. He can walk with out crutches (still kinda wobbly and unsteady) but like you said…he still uses one at school just to keep people away from him and because his campus is so big he has a lot of one side of school to the other and upstairs/downstairs back and forth classes( he can use the elevator). His attitude seems to be better as well…he is starting to WANT to get out of the house, and attend football games and cheer his teammates on from the sidelines now. I think with all the blogs and posts we have read online and some other boys at school who had this done we were not expecting this to be such a “difficult” surgery and recovery. But I guess everyone is different, and it has just taken him longer. A lot of his is in his mind too, he is SO afraid of re injuring his knee…it just terrifies him! This is by far the worst thing he has ever been through and definitely doesn’t want to go through this again! So in some way I think it might inhibit him a little to push to work harder in therapy. I told him we just have to take it one day at a time and each day he will get stronger and stronger. We are looking forward to the road to recovery!
Thanks again!!!!
reddyb
October 2, 2013
That’s great to hear Mandy. Glad I could be of help, even in some small way. I hope things continue to improve.
A tangent:
I was talking with a client the other day, he’s had about 10 leg surgeries, with one being an ACL reconstruction. He recently had another.
He mentioned to me, “You know, each time I have something like this done, I swear I’m never doing it again. It’s such a horrible experience. But it’s like you forget how bad things were the last time. Where you justify to yourself, “Oh it won’t be too bad. Let’s do it.””
My response, “It’s like a really bad hangover. Where the person goes, “I swear I’m never drinking again.” But, next weekend, there they are.”
One thing I’ve learned is a much better barometer for what this type of surgery is like is not to ask the person who had the surgery, but to ask the people who were around that person. The moms, dads, significant others, they remember how bad things were. The individual seems prone to forgetting how miserable they were.
Yet another reason to not put too much stock in any one person’s recollection.
Aaron
September 30, 2013
HI I had ACL reconstruction and meniscus shortening 6 weeks ago. Everything is fine except for the flexion. I am currently at 90 degrees and surgeon wants me to be bending further at this point. My PT has been twisting and bending the knee by force twice already, which extremely hurts. I’ve read protocols on this and they all say 90 degree flexion is the norm. Surgeon now wants me to have a manuaul manipulation under anesthesia for the flexion. Would you recommend I get a 2nd opinion with another therapist? This therapist works at the same office as the surgeon so there might be some bias.
reddyb
October 1, 2013
I’d get another therapist and a second opinion.
In the comments above you can see my stance on this type of stuff, with some more specific rationale.
For what it’s worth, unless there is something extremely unusual about your case, I think manual manipulation under anesthesia, especially at 6 weeks post-op, is fucking lunacy.
Are you in the United States?
Jan
October 2, 2013
Hi I’m 5 wks post op from acl reconstruction harvesting frm hamstring graft. Had a minor slip when I tried to walk to my sofa without the brace. I could feel a little shift in the knee at that point of time. But no significant pain or swelling after that. The swell went bad when PT asked to do leg press n walk on treadmill. Been walking around to get to my school. The course will end in aug 2013. Am I pushing myself too hard?or i just rest at home. Afraid that I might be more depressed staying alone n bored to death at home.Feel pain if I walk too much…. Argh…
reddyb
October 2, 2013
I’m sorry Jan, but this is way too general of a question.
Really all I can say here is, and I’ve addressed this above, you should not be causing pain or swelling. That is almost a sure sign you are doing too much / not doing things properly.
Bernadette Bower
October 2, 2013
I see most people are concerned about extension…I am 6 days out from ACL reconstruction by allograph and meniscus repair. I have had full extension by day two and can raise my leg to chest level with no issue. I have been doing heal slides and and flexing my foot as well. I was terribly concerned about the bending of my knee. I can bend it not quite to 45 degrees. After reading all the posts, should I be concerned at all? I start rehab tomorrow, exatly one week out of my surgery.
reddyb
October 4, 2013
Keep in mind full extension is not the goal. You actually want to attain some hyperextension, which is the knee’s normal ROM.
In terms of flexion, there’s not much to be concerned with only a week out. Many haven’t attained any flexion until 10-14 days. If anything, you may be ahead of things. Which, keep in mind, is something you need to be careful about. Too much flexion too soon can be ill advised.