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.
–
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
–
Strengthening (4 x10r each)
-Standing abduction
-Glute Bridges
-Straight leg raise
-Lying down calf strengthening with band
-Toe grabs
–
Proprioception
-Weight shifts w/crutches:
–
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.
–
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
–
john ashwin
February 11, 2016
Hi this john here,and i am 21 years old now,i had ACL tear in my left knee before 5 years at the age of 16,and this january 3 i had to operate for my ACL aswell as a meniscus tear(bucket handled tear)its now 6th week of my surgery and again i had a orthoscopic wash for over swelling of my knee,and its 2 week after the wash my knee is swelling gradually and its restricting my range of motion
i am not able to walk without crutches,and i have light pain when i do my physical exercises,do the fluid inside my knee settles down automatically or again should i meet my surgeon
reddyb
February 12, 2016
Hey John,
This is addressed multiple times here in the comments- would take a look: http://b-reddy.org/2013/10/23/the-biggest-mistakes-acl-patients-make/
Kenny
February 27, 2016
Hello I had ACL and meniscus surgery almost 2 months ago. I still can’t straighten out my leg and I still can’t walk. Am I behind or should I not worry?
reddyb
March 1, 2016
Hey Kenny,
That’s significantly behind, and something to worry about. This is discussed extensively in the below links:
http://b-reddy.org/2013/10/23/the-biggest-mistakes-acl-patients-make/
http://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
http://b-reddy.org/2015/09/03/why-you-dont-want-to-wait-to-regain-knee-extension-range-of-motion/
http://b-reddy.org/2015/12/18/why-is-it-so-hard-to-straighten-your-knee-after-acl-surgery/
Kainaat Momin
April 7, 2016
Hi, I had acl surgery about 5 weeks ago. I am going to PT but its very painful when they bend my knee. I can only bend it about 60 degrees and they said its not good and that I might have to go through the manipulation treatment if I don’t bend it up to 90 by the end of this month. I can walk without crutches but I kind of have a limp. Is my knee not being able to bend something I should be worried about at this point?
reddyb
April 8, 2016
Only being able to get to 60 degrees at five weeks is something to be concerned about, yes. That’s very limited. Most should be at 90 by, at most, two weeks. And that’s being fairly conservative.
Tracey
April 18, 2016
Hi there, I’m a 51 year old active woman and have been reading your blog extensively the last couple of days. I just had ACL (allograft), MCL and Meniscus (lateral and medial) repair 12 days ago (10 days after a ski accident). The surgeon initially thought he’d have to use a graft for the MCL, but was able to repair it once he got in there. I’m not gonna lie, this is easily been one of the most traumatic things I’ve ever been through and I so appreciate that you address that in your writings. I started PT 2 days after surgery and extension is going really well. Flexion however is definitely not. I haven’t been able to get past 60 degrees and getting anywhere near that is EXCRUCIATING, never mind beyond it. The pain I’m feeling is almost exclusively at the site of the MCL repair. PT and surgeon say I can’t damage anything but I just can’t push past it. My PT sessions invariably end in tears both at the office and at home and I haven’t made any progress at all. Is this just the way it is and has to be until I finally have some kind of breakthrough? My surgeon says he’ll do an MUA at 4 weeks if I haven’t achieved 90 degrees by then. My PT says she’s just going to push it aggressively in the next week or two. I’m frankly terrified now…. Thank you so much in advance for any insight or recommendations you might have.
reddyb
April 19, 2016
Hey Tracey,
Sorry to hear about the tough time you’re having.
Being limited to only 60 degrees is, I won’t lie, alarming. To where often something else is going on e.g. scar tissue issues from the surgery.
I’m not a fan of aggressive manipulation. To me it tends to make people guarded when you’re hoping they will, if anything, relax to help stretch an area. Plus, pushing through pain tends to increase swelling, which makes it harder to increase range of motion. I prefer long duration gentle holds instead. (I describe how I prefer to go about this in the ACL manual if interested.) I see no benefit in having someone leave a session crying. That’s too much.
Even with swelling in the knee though, getting to 90 degrees really shouldn’t be too tough provided nothing out of the ordinary is going on. And when people are limited flexion wise, you’ll often hear “Yeah, it just feels tight all around if I try to bend too much.” Opposed to “It hurts at this one specific location.”
Sorry that’s not more positive. I would be changing up how you go about your range of motion work, basically hounding the people around you for potential explanations, and getting ready for the possibility of going under again soon.
Judy Kehler
April 27, 2016
I have been trying to find information relative what I am experiencing, yours was bang on. Thank you for the reassurance that what I’m feeling is likely normal and the suggestions to alleviate the pain. Although I didn’t have ACL surgery believe the idea of keeping leg straight is important so decided to wear light brace during the day.
reddyb
April 29, 2016
Sure thing Judy. Glad it was helpful.
Sharon
July 10, 2016
Hi I had a ACL repair on 21st June, in brace straight no movement. 4 days later I had an infection and allergic reaction. Referred back to surgeon as swelling so bad and had second surgery 1st July the pin had come out (hamstring graft) and so he repaired it with a screw and completed a knee arthroscopy. I was told to adjust my brace to 60 1 week after surgery which I have done but I can hardly flex past 10, is this normal? In another 10 days I have been told to move brace to 90. Nervous that I have such limited flex that something has gone wrong again!? Thanks Sharon
reddyb
July 12, 2016
Hey Sharon,
Sorry to hear about your tough time so far. If you’ve had an infection and a follow up surgery already, then nothing has been “normal” at this point, and something has already gone wrong.
You should be talking to your doctor and physical therapist about why you’re so extremely limited flexion wise.
Sharon
July 14, 2016
Thank you for your comments and your blog, it has been really informative and realistic as there seems to be so little real information out there. I wish I had found your blog before I embarked on the operation!
I have seen the Physio today who has got my leg to bend to 40 degrees. She has said because of all the trauma of two surgeries and infection it’s going to take some time and to expect to be on crutches for another two weeks yet. I am feeling more optimistic now and trying to take a day at a time. I am working hard on all my Physio exercises and am determined to be walking by myself in the next 2 weeks but I think recovery is going to be a slog.
I hope this gives hope to anyone else who has to have revision ACL.
Thanks again
Sharon
reddyb
July 15, 2016
Thanks Sharon. I’m glad you’re finding things helpful.
That’s great your flexion already improved that much. As your therapist hit on, that’s a lot of trauma. Hopefully they’re doing things to get the swelling down, which will help improve your ROM. (Wrapping can help a ton: https://b-reddy.org/2012/07/12/how-to-wrap-knee-pain-a-knee-injury/ )
Brynn Holzwarth
August 3, 2016
Hi,
I had an acl reconstruction done just about 5 weeks ago. I appreciate all your articles you’ve written; it definitely makes me feel like less of a wimp after surgery- I can say it was the most painful thing I’ve ever been through. (Being 15 I suppose there’s not much to compare it to though.)
My physical therapist says I’m falling behind on flexion. Today I reached 100 degrees. Although it caused the most pain since surgery, should I keep pushing it that far to make it better? Is that too far behind? Where should I be at? Also, he told me to start taking my brace off and having my knee bent while I’m not walking around. I understand that extension is very important and that I could lose it by always having my knee bent. Is it time to start focusing on flexion?
reddyb
August 5, 2016
Hey Brynn,
Thanks for the nice words, though sorry to hear about your injury.
Flexion takes time. 100 degrees at five weeks is doing pretty well. (Keep in mind we’re talking passive flexion here, not active. Keep reading the ACL diary for more about this.) Pushing through pain is not the way to go. You want to instead go for long, low intensity holds. (I go over this in the ACL manual (https://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/ ), if interested.) There is no reason this has to be a very painful experience. Instead of intensity, you go for duration.
Having the knee bent during a good deal of the day isn’t something I would do. That tends to be tough on the knee, and as you alluded to, is going to make straightening the leg tough when you say, get up from a chair.
There is no rush on flexion. As long as it’s improving, you’ll get there. You could for example still have too much fluid in the knee to get full flexion. Furthermore, doing painful activities can increase the fluid in the knee, making flexion even harder to attain.
Samyak
August 18, 2016
Hi. Firstly thanks for putting up such great articles on ACL reconstruction and rehab. They have been really helpful. Following your advice, I have been focusing on extension and while I have regained extension I am still unable to hyperextend my knee. My uninjured knee has about 15 deg of hyperextension while my injured knee is stuck at 0. This makes standing for long durations difficult and I start experiencing pain in my uninjured leg. What should I do ?
reddyb
August 19, 2016
Hey Samyak,
Tough to know. For instance,
-How far post op are you
-What have you been doing to work on your extension
-Have you checked in with the surgeon
If you’re quite early in the process, like first week or so per what the post is about, then you’re likely (not meant to be offensive) not doing what’s necessary. There are situations where something from the surgery is impeding progress, but when it’s just the beginning, it’s typically a lack of proper exercise. May want to check this out, good deal of tips here: https://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
TERRY WITTE
September 21, 2016
Hey reddyb,
Thanks for your blog.
Although you’re way past post op, I can appreciate your patience responding to these people 3 years later.
I had an Allograft ACL, Meniscal repair one week ago and experience alot of what has been shared here. It IS a nuisance to be so dependent! I am an active 56 year old woman and injured my knee enroute to vacation…yes I did complete the vacation albeit very uncomfortable. Damn it I worked hard for that friggin’ vacation time!
Anyway, I’ve enjoyed your journalistic style~very expressive, thorough and funny.
Have a Great Life!
Terry
reddyb
September 23, 2016
Hey Terry,
Thank you for the nice words. I’m glad you’ve gotten something out of the writing. Tearing an ACL right before vacation, man that sucks! Hopefully after your recovery you can do the next one feeling solid :).
Brian
Marisol Caruso
September 29, 2016
Hi Reddyb,
I had knee reconstruction Feb 2016. I tore my ACL, MCL, meniscus and fractured my tibia. I had zero stability in my knee and whenever i bent it it would give out and i’d be in horrible pain all over again. I elected to have the surgery and the doctor repaired my ACL and MCL with ligament that he took from my quad. I’m curious to know how much longer will i be limping? My PT told me this was a year long type of recovery and although i don’t have all of my extension back-i’m a few degrees away. It still feels weird. I was told by my PT that my knees hyper extended beforehand so i would feel discomfort and limp because of that…when can i expect to not limp anymore? Or will i be limping for the rest of my life? I’m a 39yr old female. If you tell me this is typical for my type of injury then i can accept that it will take a full year before i feel back to normal, but i would’ve thought that 7 months post op that i would be back to normal by now.
reddyb
September 30, 2016
Hi Marisol,
Full extension should be regained within 24 hours of surgery (because most delay rehab too long, this doesn’t happen, but it can and should), and walking without a limp at maybe one month post-op…at the latest.
Full extension is the first priority. If one doesn’t have that, walking without a limp is likely not going to happen.
I discuss extension a lot in the following-
https://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
https://b-reddy.org/2015/12/18/why-is-it-so-hard-to-straighten-your-knee-after-acl-surgery/
https://b-reddy.org/2015/09/03/why-you-dont-want-to-wait-to-regain-knee-extension-range-of-motion/
Kelly
January 16, 2017
Wow!! I am so impressed and thankful for this site. I definitely was ill prepared for the duration of recovery. Absolutely didn’t think It would be this long before I could resume moderate exercise. I finally got full extension just recently. I am 16 weeks post ACL reconstruction with medial and lateral meniscus repair. I think I have about -2 degrees hyper-extension. It is still painful to go up and down stairs and I’m wondering if I have patella femoral syndrome…..I was wondering if you have any thoughts on what exercises I could do to strengthen my (VMO)? Or, if you have an idea as to why I have pain under my knee cap area. It is truly hindering my ability to progress and get better. I really want to get back to myself again and am getting discouraged. I just joined a 6 week martial arts program and am hoping this will help. I’m very careful with overdoing it (with my injured leg). Any comment or suggestion would be appreciated. BTW I am a petite active female (48).
reddyb
January 17, 2017
Hey Kelly,
Thank you for the nice words. Glad you’re getting something out of the site.
Plan on posting something about knee cap pain after this surgery. Until then though I’d recommend either the 6 Exercises to Loosen the IT Band manual, or Mitigating Patellar Tracking Issues:
https://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
https://b-reddy.org/2016/02/14/the-genesis-of-patellar-tracking-and-instability-issues-and-what-to-do-about-them/
The second is a more comprehensive version of the first.
Isis
January 21, 2017
Hello, are you still giving responses? I’ve done a number to my knee (torn acl, torn mcl, and torn/flipped lateral meniscus) and I’m not too sure how to go about post-surgery & physical therapy. Surprisingly, the extension of my knee/leg is okay to my standards, BUT the flexion/bending of my knee is AWFUL(my knee barely bends at 30 degrees).Anything you could help me with?
reddyb
January 22, 2017
Guide here: https://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/