Reconstructive ACL and meniscus repair surgery: Physical therapy days 2-11

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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