It took me about 8 hours after waking up from the surgery until I felt good enough to really start moving around. Below is how my first day looked. Note this is the day of surgery. None of that waiting a week to do anything crap.
This is half-written for somebody looking for what to do after their surgery and half-written specifically for me. In other words, while below is specifically tailored for me, I think it’s a good starting point for most people too. The biggest factor in my surgery was an accompanying meniscus tear that was repaired. Whether the tear is cut off or repaired alters the rehab. As I’ve mentioned though, we’re talking pretty small differences in the overall rehab.
With that said, EVERYTHING here is subject to change based on the person.
Post-op Day 1
Compression
-Stocking compression sock provided by hospital ->Already on me when I woke up.
-Manual massage quads, hamstrings, adductors -> Just some simple rubbing of my leg by me.
Crutches
-No weight bearing allowed the first day. This is due to your pain medications and the nerve block not wearing off yet. Therefore, you don’t know how weight bearing actually feels yet. It might feel great the first day…and horrendous day 2.
-> I definitely could have put a lot of my weight on my leg the first day -the nerve block was kicking for about 15 hours- but not something you want to do. You’ll feel it day 2!
Bracing
-Locked at 0 degrees at all times. My leg was straight the entire day.
Ice
-If wanted for pain.
–>For reasons here, I didn’t bother with icing the first day. I didn’t need it pain wise, and it just stiffens me up. The last thing I want. Please read the link before you tell me it helps with swelling, range of motion, etc. And then read this one regarding icing specifically for reconstructive ACL surgery. Or this one,
–Should you ice your knee after reconstructive ACL surgery?
Hint: it doesn’t do anything but numb the pain. Why am I going to numb pain I don’t have?
Range of motion exercises (15 reps each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)
-Passive extension: To 0 degrees or 5-7 degrees of hyperextension. This should be accomplished Day 1!
–Quad sets
You can see some difficulty here:
And then much better activation here:
–Flexion: No flexion allowed. Remember the brace prevents all flexion.
–> This was surprising to me. The amount of flexion is something that varies widely amongst ACL rehab protocols. Typically, from what I’ve seen, passive flexion is allowed the first 10 days. However, if you have a concomitant meniscal tear this can be all over the map. Based on my meniscus tear and repair, my doctor recommended no flexion, at all, for the first 10 days. Something I’m complying with.
–Patellar mobilizations
–Sitting hamstring stretch
–Plantarflexion / dorsiflexion (Pull foot up towards shin, then push foot down away from shin. Back and forth.)
Strengthening (4 x10r each)
–Glute Bridges
–> Lying down with both legs straight, squeeze glutes and slightly elevate hips
–Straight leg raise
–Calf strengthening with band/towel
–Toe grabs
–> Like grabbing marbles with toes
Meds
Ibuprofen after surgery
–> I go with over the counter meds over the hard stuff as much as I can. I barely had any pain day 1 so I didn’t bother with the percocet. This allowed me to be able to move around without being dizzy and distorted from something like percocet. I also don’t have to worry about taking a header with my crutches due to balance issues.
Nutrition
(I’ll have a whole post about surgery and nutrition in the future.)
Calories = (Bodyweight x 15) x 1.20
-> For example:
I’m 190 pounds.
190 x 15 = 2850.
2850 x 1.20 = 3420.
This might not happen, and didn’t happen for me, day 1 due to the nausea after the anesthesia. It’s a good number to strive for though.
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
–
D.Patel
September 13, 2012
I had my acl surgery and miniscus repairs done in august..Im having a hard time strengthening my quads. I do quad sets but i end up tightening my ass instead..everytime i try not to, it just happens..any tips or advice?
reddyb
September 14, 2012
Well, this is certainly a first. Are you sure you’re doing them properly?
Billiebob
February 28, 2013
Just had allograft acl surgery with meniscus trim yesterday. Physical therapy appt. tomorrow but I was already bored of sitting around so your exercises really helped me. Thanks.
reddyb
February 28, 2013
Great to hear.
Chris Topher
July 30, 2013
2 weeks removed from surgery I accidentally put weight on my non weight bearing leg. Have I ruined the results of the meniscus repair?
reddyb
July 30, 2013
Unlikely. At 2 weeks you should probably should be placing some weight on the leg.
Never hurts to check with the surgeon though.
Justin
September 29, 2013
i am about to get acl and meniscus reconstructive surgery on October 10th. I am going the achilles allograft route. Problem is that my brother is getting married on November 4th. Being as I will obviously be a groomsman, Will it be possible for me to be able to stand at his wedding, much yet do some kind of walking?
reddyb
September 30, 2013
Justin,
There are a bunch of comments about walking in this post, as well as in the comment section: http://b-reddy.org/2012/01/06/reconstructive-acl-and-meniscus-repair-surgery-physical-therapy-days-2-11/
Also, this post talks specifically about ACL surgery and a wedding, albeit at a different timeline than what you’re looking at: http://b-reddy.org/2013/06/12/timing-for-an-acl-surgery/
Sean
December 17, 2014
These articles have been extremely helpful, so first off thank you. Secondly I was wondering if you had any shin pain that felt as if someone took a hammer and bashed it against the shin (hurts about half way down the shin bone not at the incision site and only when standing/moving). Had an acl reconstruction using hamstring graft and a medial menisectomy on December 11 and didnt develop shin pain until around the 14th.
At first I thought it as a blood clot but I’m 18, in okay shape, and move around every couple of hours so I ruled a clot out. I called the surgeons office and he said that its to be expected since, after all he did drill in my shin. I was wondering if you were able to give me more of a specific answer and any tips.
reddyb
December 18, 2014
Shin pain is atypical, at least as far as I know.
There is some potential for bone issues (mid shin issues), I suppose, if you had quite a bit of drilling done. Where, because so much bone has (potentially) been removed, other bone has to pick up the slack. I talk about this some in this post: http://b-reddy.org/2014/12/08/on-having-metal-in-your-body-surgical-implants-weather-pains-and-more/
Although, your sentence of shin pain is “to be expected since, after all he did drill in my shin” is perplexing. No “shin” drilling is done in this procedure. The tibial plateau is drilled through, but that’s quite different than what most mean by shin.
Honestly though, potential clotting would be my first concern. Next, considering you have issues when standing primarily, there may be something to be said for when you go upright a bunch of fluid pushes down the leg, causing some discomfort. Lastly, weird pains are part of this process. (This far down the leg and clotting really is a concern though.)
Perhaps someone else can chime in here, as, unless I”m not visualizing your description correctly, I don’t recall ever hearing something like this.
Sean
December 18, 2014
Turned out to be a minor infection.
reddyb
December 18, 2014
Good to know. Thanks.
Kristin
December 21, 2014
Hi, I got ACL reconstruction with hamstring graft on Dec 18th and they used a nerve block in my thigh. I think this helped cut down on the major pain since it hasn’t been to bad so far but I was told this would wear off in 24 hours and now past 72 hours and I still have a large part of my shin and some thigh numb. Have a lot of people gotten nerve blocks? Is it normal to last this long?
reddyb
December 21, 2014
Nerve blocks are quite common. (I mentioned I also had one in this post.)
Everyone comes out of surgery differently. Some people are writhing in pain within 8 hours or so, others are still groggy a few days later. There is a lot that needs to work its way through your system. Antibiotics, nerve block, anesthesia, pain killers. And this is all put in the body with no food.
One aspect that has potential to influence how quickly these things make their way through is how much one is moving after surgery. If one just lays around for a couple days, that’s not as effective as moving around.
Kristin
December 22, 2014
Thanks! I’ve been moving so hopefully I get full feeling back soon. Also wondering around when is expected to be able to have active full knee extension? I can easily get my knee to 0 degrees or even hyperextended when resting the ankle on a higher surface but when i try to actively lift my leg for straight leg lifts my quad is unable to get the leg straight so I do them with a slight knee bend. As I said I had my surgery on Dec 18th
reddyb
December 24, 2014
Hmm, if you went into surgery being able to do this, then you should be able to do this the day of, or at most, within a day or two after surgery.
If you weren’t able to perform this going into surgery -quite likely- then it’s tough to say. You may be looking more around a month.
The straight leg raise isn’t as big of a deal as it’s often made to be though. Having good volitional quadricep control is definitely important, and full passive extension ROM is crucial, but combining these aspects, such as being able to lift your leg with the knee fully extended, isn’t as important.
Doesn’t hurt to work on it, but there’s no need to be worrying about straight leg performance. (At least in comparison to passive extension ROM.) I like to worry about knee extension in other manners. Such as the videos below.
That is, how you get knee extension. When the how is looking good, you can then be more concerned with the ROM. The difference with a straight leg raise is the how is nearly forgotten, as you’re immediately placing the leg in full extension already. In many cases, you’re then going to be getting people performing the movement with a rounded lower back, as few people have that degree of hamstring flexibility already. (If hamstrings aren’t flexible enough the lower back will compensate.)
(May want to read this for more: http://b-reddy.org/2013/07/29/better-exercises-to-stretch-the-hamstrings/ )
Hope that makes sense.