It’s been almost two years since I had reconstructive ACL surgery. Between personal experience, those I’ve worked with, the emails and comments I’ve received, a few patterns have emerged as to what mistakes I see people making.
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Lack of mental preparation
Far and away the most common thing I get from people, post surgery, is “Oh my god! This is so bad! Is this normal? I’m so miserable. I can’t do anything. The pain is unbearable. I can’t bend my knee, my muscles are disappearing; I’m so depressed.”
I don’t expect everyone to do the amount of research I did for this. I spent over 3 months reading everything I could, talking to people and writing about things. However, if you do even a modicum of research on this topic, you should learn pretty damn quickly it’s normal to:
- Not just be down, but to be incredibly depressed after this surgery
- Not be able to do anything
- Need someone around you for a while after the surgery. I don’t mean a few hours, I mean like a couple weeks.
- Be in extraordinary pain
- Be on so many drugs you can’t see or think
- Be crying
Part of this is definitely the surgeons fault. I don’t know if it’s because the surgeons don’t want people to know how bad things are, or because they become jaded after doing so many surgeries, either way, they do a horrible job preparing people for what this surgery entails. One of the surgeons I saw sent me to his receptionist to schedule surgery without even discussing what the surgery was. I mean nothing was discussed. Not what’s an ACL, why I might need it, the length of rehab, invasiveness of surgery, time off work, NOTHING. Yes, I knew all these things already, but he didn’t know I knew them.
He didn’t even bring up the option of not having surgery. Or the fact I’d be denied health insurance in the future because of having it. If not for the law changes coming in 2014, for the rest of my life I would have severe health insurance issues because of this injury. The insurance companies take this incredibly seriously, so should you.
Part of me gets the lack of understanding; part of me doesn’t comprehend how people don’t understand a power drill will be put through their bones. Look at your leg, imagine a power drill being put through it. Is it really that hard to understand how you’re going to feel after this? “Waa, I can’t bend my leg, waa, this hurts.” No shit, a POWER DRILL was just put through it.
I’m not sure how else to get this across. My only other way is all the people I know who’ve had this done have another big theme to them. Their ACL experience is one of, if not the, worst experience of their lives. Since people love to look to athletes with this stuff, Derek Rose has said his ACL experience is the closest to death he’s ever been, and Wes Welker said he wouldn’t wish his experience even on his worst enemy. Keep in mind these are guys who are, for the most part, ACL success stories! They’re the outliers, and they still had awful times.
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Unrealistic expectations
This goes right with lack of mental preparation. If you even only briefly look around you’ll quickly find how many people are never the same again after this injury. Too many expect to have this surgery and be good as new. The fact of the matter is your leg will never be “normal” again. To reiterate, multiple holes will be drilled through your body, more than likely one of your tendons will be cut apart, it will then be either sewed back together or you’ll hope it grows back, the part of the tendon which was cut off will be screwed into your bones, one or two screws will likely be left in your body, and that tendon will hopefully turn into a ligament with time. Your leg will never feel normal again because it will never be normal again. It has been forever changed.
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That doesn’t mean you’re forever resigned to pain. You can not be in pain but have a leg that just feels weird at times. If you haven’t had surgery, this probably doesn’t resonate. For those who have though, they know exactly what I’m saying. Whether it’s their knee feels weird, it makes odd sounds, the screw moves around, whatever, there is almost always something odd remaining long after the surgery.
“But I’ll be different.”
In Thinking, Fast and Slow, Daniel Kahneman references a time in his younger days when he and some colleagues were writing a textbook. They were projecting how long the book would take and their chances of actually completing it. They pretty much all thought it would be completed, and in about two years.
Kahneman then asks the one colleague who has worked with others who’ve made a textbook, “How many of them actually finished?” The colleague was a bit embarrassed. “Maybe 40%” “And how long did it take those who finished to complete their work?” The colleague was now even more embarrassed. “I’d say the average was about 7 years.”
Kahneman refers to this as the inside and outside view. When you’re on the inside -you’re the person getting the surgery- you think the odds don’t matter for you, or that you’ll beat them. You don’t want to hear that 65% of ACL patients never return to their previous activity level. And even if you do hear it, you’re not listening, or you think you know something they all didn’t. Rather than consider the endless list of NFL players who never made it back after tearing their ACL, you instead focus on Adrian Peterson.
It’s not only a physical game; it’s a mental one too. This is what a lot of people miss when trying to come back from this. It’s not just the being able to come back physically, it’s the mental aspect. You very well could get your leg back to its former strength, have no pain, no setbacks, etc. But, you may end up thinking, “I don’t care. I don’t want to go through that again.” Honestly, that’s where I am. I was cleared at 9 months -exactly on time, had no setbacks, went out and played some sports, proved to myself I could do the entire process, then said “I’m done with this shit.” I don’t want to go through all that again. If I (or you) was a million dollar athlete I’m sure my mentality could change, but I’m not. I don’t want to do anything which could increase my chances of going through that whole process again. Physically, I’m able to go back to my previous activity level. Mentally, I’m not.
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Focusing too much on former patient’s experience
Asking those who’ve also had an ACL reconstruction can be productive, but you don’t want to rely on other people’s recounts as you’re only information.
1) Every case is different.
It’s unlikely you’re going to be able to run into someone who is having the exact same surgery as you. Here was my full surgery: Reconstructive ACL surgery with a hamstring autograft, medial meniscal repair, partial lateral menisectomy. Every word of that affects the rehab. Unless you’re talking to a person with the same procedure as you, you’re likely going to have different experiences.
2) Your sample size is too small
ACL surgery isn’t that common. So, you may only have one or two people you know who’ve also had this done. Even if you go online and read 20 different accounts, it’s still a small sample size.
That can greatly skew your perception of what this all entails. Using me as another example: I had basically no pain after my surgery. I have a couple ideas as to why, but regardless, pretty much no pain. This is an aberration. To illustrate how much pain is expected post-op my surgeon prescribed me 80 pills of percocet, all at double dosage (because I’m very tall). He told my dad, “Call me if he needs more.” That’s an insane amount of pills. How many did I take? One, which was the night of the surgery. I only took that because I was afraid a huge flow of pain was about to set in, and I didn’t want to wake up in the middle of the night when it happened.
If you’re someone using me as your reference point for pain after ACL reconstruction, you’re in for a rude awakening when you come out from your anesthesia and realize I was an outlier.
3) You don’t want to put all your faith in people’s memories
Since I brought up Daniel Kahneman, I’ll keep that theme. Kahneman has done some research on our perceptions of how painful an experience was. What’s been found is we remember pain by 1) How intense it was and 2) How it ended. Number 2 is what’s important here.
Tying this to ACL stuff: The worst part of ACL surgery is the beginning. As the process goes on, it normally gets better. You’re more likely to ask fellow ACL patients their experience not right after their surgery, but fairly far out from it. Said another way: You’re more likely to get someone’s recount a year, two, or three years after their surgery, rather than 2 weeks post-op.
Their answer is not only going to reflect things in the early stages, but also how they’ve felt recently. Plus, their recent memories are more available than their older ones. Since people tend to feel better a year, two, or three years after their surgery rather than at two weeks, they tend to mix how they currently feel with how they felt immediately post-up.
Say your friend Jon had ACL surgery. He was a mess immediately post-op, but now at 3 years post op he’s pretty good. He’s not amazing, but he can’t complain too much. You run into Jon, tell him about your current ACL issues, how you’re contemplating surgery, and what’s his advice. How did things go for him? Would he recommend it?
Because Jon feels pretty good now his first response is, “You know, it wasn’t that bad. Not the best time, but I’m pretty good now.” However, if you were next to Jon the day after he woke up and ask him how he was feeling, his response would be, “MAKE IT STOP!”
I have a client Dan who has had upwards of 10 leg surgeries, one of which was an ACL. Dan recently decided to have another leg operation. He came in about a week afterwards. “You know, every time I do this I swear I’m never getting another one. It’s like I forget how bad things are after these things. Then, once I get it done again, it all comes roaring back.”
Me: “It’s like a really bad hangover. You swear you’ll never drink again, but next thing you know it’s Saturday night.”
A much better way of learning what ACL surgery is like is not only to ask former patients, but ask those who were around them right afterwards. If Jon’s dad was his primary caretaker, ask dad what the experience was like. They’ll almost assuredly give you a more accurate description.
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Postponing physical therapy
Many years ago it was common practice after surgery to put the person on bed rest. With leg stuff you’d often be casted up for at least a month and pretty much couldn’t use the leg. Scientifically, those days are gone. We now know this is a terrible way of approaching the post-op period. The longer you don’t use the muscles the quicker and more they atrophy. You increase the person’s risk of blood clots. You also make the physical therapy phase harder as the person is starting from further behind.
Scientifically, those days are gone; realistically, too many still lay around for weeks before doing anything. If there is anything to be learned from athletes in this realm it is that physical therapy after reconstructive ACL surgery does not start a week or two weeks after the surgery, it starts the day of surgery.
There is no reason to wait. You can’t do much right after surgery, but that doesn’t mean you can’t do anything. You can mobilize the patella, wrap the leg, squeeze the quad to make sure it stays awake, as well as work on your range of motion.
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Obsessing over flexion instead of extension
If you read the comments of this post: Reconstructive ACL and meniscus repair surgery: Physical therapy days 2-11, which is about my experience, you’ll see over and over people fresh out of surgery going nuts about their lack of ability to bend their knee.
Again and again I respond, “Stop worrying about bending your knee, start worrying more about straightening it!”
I think why this happens is after surgery you may lose 10-20 degrees of extension, but 100-120 degrees of flexion. So, to the person, in their mind it’s like, “Holy fuck! I can’t bend my leg at all!” This is normal. The flexion will come with time, and there’s really no need to rush it. In fact, you need to be careful not to push it too much too soon as that can stretch the graft out. Mechanically, especially in the beginning, you will only be able to flex your knee so much anyways, due to the swelling. It’s going to take some time for all the fluid to get out of there.
Extension on the other hand, you need worry about immediately. First, there is no reason to not get all the extension back right away. By this I mean the day of surgery. You don’t have to worry about stretching the graft out with extension. Second, extension is much easier to lose in the long run. Personally, I needed to check my extension multiple times per day. And for about 6 weeks, everyday, I’d gain it back only to lose it again a couple hours later. Third, the longer you go without getting it and keeping it, the more likely you are to never get it back again. All the time I see people with a knee surgery history who years later still can’t fully straighten / hyperextend their knee.
The other thing here is returning to walking. It’s ok if you can’t bend your knee to 120 degrees, or hell even 90 degrees, that’s not going to affect walking. However, if you can’t fully straighten your knee, that’s a really bad knee to be walking on. You end up walking on a bent knee all the time, which beats the hell out of your joint. So, working on full extension helps get you back to healthier walking while obsessing over bending your knee does not. There is a progression here, and the ability to walk again is very high on the hierarchy. Certainly much higher than bending your leg.
Full, complete flexion will take months and months, and that’s ok. Stop worrying so much about it.
Which brings us full circle: If you only do even a bit of preparation, you should know not to bend your leg too soon, that you won’t be able to bend your leg, that you should be extending it, that you’re going to have a lot of pain and discomfort, etc. Just a couple questions to the surgeon will let you know this.
This often ends up being a $50,000 surgery, with power drills, screws, knives, hours of anesthesia, high level pain killers, a significant degree of short term disability, minimum 6-9 months of physical therapy, you get the idea.
For Christ’s sake do your homework.
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For more information on what to do coming out of ACL surgery, or if you’re someone who needs to take a step back and reboot the process, check out my manual The most important phase of ACL rehab. Click link for more info, or click below to purchase
For those looking to get things really dialed in, check out An underappreciated aspect of ACL rehab and prevention. Click link for more info, or click below to purchase
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-Update 9/3/15- Posted the following comment:
Hey Everyone,
I wanted to let you know I put together a manual specifically for regaining knee extension.
You can see more about it and get it here: http://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
I also wrote something detailing why regaining extension range of motion quickly is so important: http://b-reddy.org/2015/09/03/why-you-dont-want-to-wait-to-regain-knee-extension-range-of-motion/
I cover extension ROM fairly thoroughly in the ACL manual, but this is more extensive than before. Also, some have asked me, “I’m more than a month out, will your ACL manual still apply?” While the answer to that is usually yes, now I have the extension manual for those are only specifically looking at that.
Hope this helps!
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-Update 11/16/15
Another post on the importance of regaining knee extension range of motion, and why you don’t want to wait to do it: http://b-reddy.org/2015/11/16/how-weak-calves-can-cause-knee-issues/
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Post-script (Update 7/1/15)
After receiving many comments on this post, I left this comment:
Dear All,
Understand this coming from a place of wanting to see people do this process better. It is not meant to be judgment, or beratement.
I’m not sure what’s going on the last week or two, but some themes that keep coming up:
1) There seems to be an overall lack of acknowledgment about how long a process this is. Many of you have probably heard “6-9 months,” which is one reason I didn’t hit on this in the article. I assumed it’d be rare to to complain about progress at 2-3 months, as it ignores the fact you have, at least, *double* that amount of time to go. But I’m seeing this more than I thought.
Plus, in reality, this is an 18-24 month process. The 6-9 month mark is more, “Yeah, I’m running again, have full ROM, no issues with walking…but it’s not like I’m playing sports without worrying about it.” FULL recovery is upwards of two years, *IF EVER.*
2) There is either a lack of reading before commenting, or a degree of denial. Because either people aren’t reading the section on “Obsessing over flexion over extension,” or they want to ignore it. So many comments here are about lack of ability to bend the knee. At 2-3 months of all things!
Part of me thinks I need to write a sequel to this post. The other part of me thinks people need to read the following paragraph from the post until it really sinks in:
“Full, complete flexion will take months and months, and that’s ok. Stop worrying so much about it.”
I made two sentences its own paragraph specifically so it would stand out. “Months and months” is not one, two, or three months. It’s MONTH*S* and MONTH*S*.
I understand this is a traumatic time for many who come across this article. But I, nor anyone, can propel your physiology into a different state. It sucks an injury from perhaps out of nowhere, can jack your mind and life up so much, but it is reality.
And if you’ve chosen the path of surgery, you’ve chosen a very, very brutal, long, tedious, depressing, handicapped, lonely, path. One in which there are no guarantees you come out better for having it. You very well could come out worse.
Much like we all degenerate with age, and need to accept it at some point or live in delusion, there are realities to tearing your ACL we all need to accept. The first step to getting over any problem is full acknowledgment of the reality of the problem. I promise many of you, if you get to this point sooner, a sense of relief will come over you.
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Chelsea
October 23, 2013
So much good information here! Everything in here hits so close to home! I didn’t work on my extension right away…and now 8 years post op I’m still struggling with my extension. Except I’m odd and also don’t have full flexion either! About the mental part of this injury–I hit the jackpot by tearing my other ACL 1 month after getting cleared for the first one. Great post Brian!!
reddyb
October 23, 2013
Thanks for the nice words Chelsea. Hope you’ve been feeling good as of late.
Rick Merriam
October 28, 2013
There’s nothing shallow about this post! Thanks again for creating another well thought out post. You definitely hit on some great points here.
It’s so unfortunate that the surgeon doesn’t look at the big picture as far as recovery. And it’s even more unfortunate that the rehab in Physical Therapy is in many (most!) cases antiquated. The patient is left with more compensations than they had prior to the injury. And the scary thing is, they go unnoticed prior to being released from Physical Therapy.
I could go on and on about all the great things that you pointed out. But instead, I’ll just thank you for the great reminder that I have to read Daniel Kahneman’s book. I’m going to get right on that. Cheers!
reddyb
October 28, 2013
Thanks for the comment Rick.
While I enjoyed Kahneman’s book, it wasn’t the easiest reading for me. I’m also in the process of reading “Nudge,” which seems to be a more layman’s approach / introduction to Kahneman’s work, as it was written by one of his former graduate students. Might be something you’d either want to start with (this is what I would have done had I known this), or would also be interested in reading.
Rick Merriam
October 28, 2013
Yeah, it looked like a book that I would read in very small doses. I have picked up Nudge a few times, but never pulled the trigger. I wasn’t aware of the student connection.
It’s not on the same topic, however, when you get a chance check out Cal Newport’s, So Good They Can’t Ignore You. Thanks again for the phenomenal post! 😀
reddyb
October 28, 2013
I’ve read some of Cal’s stuff and enjoyed it. I’ll take a look at his book too. Thanks for the recommendation.
bj olden
December 26, 2013
After reading your post It gave me a chance to compare and reflect on my own ACL recovery. I’m currently at nine weeks. I just got cleared by my doctor to jog. I have never really felt pain, even when I tore it. After surgery my leg was numb for three days so I’m curious does all doctors perform this for the patient. Although I do feel sharp pains when doing leg extensions which I don’t know why. So what should I look forward to as I progress through therapy
reddyb
December 27, 2013
Hey BJ,
-You can see my entire ACL recovery process here: http://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/
-Being numb for 3 days is not something all patients have.
-If you feel pain during leg extensions, then you have pain. If you have pain during a particular exercise, you should be modifying or eliminating that exercise.
-Going with the theme of this post, “Mistakes ACL patients make”, I would strongly recommend talking to your doctors and therapists to thoroughly understand what the coming months hold for you.
BJ Beastmode Olden
March 21, 2014
Hey thanks for the advice. I’m at five months now. the last time I posted I had just started jogging. since then I have been lifting. I was cleared to run and perform agility workouts. Everything has been right on schedule. I plan to be cleared a month from now if I continue to workhard. I know my knee is not ready to play basketball yet. I’m not explosive off two legs. I’m really conscious of everytime i jump, land, and cut. That is the only problem I have.
reddyb
March 24, 2014
Hey BJ,
Good to hear about your progress. The last part, being comfortable with jumping / cutting / etc., is the toughest part. That’s what takes the longest. In terms of good everyday function, most are doing very well by the point you’re currently at. But nobody is full on back to sports at five months. That’s where those extra 4 months or so come into play. (Bringing most to a return at roughly 9 months.)
Keep being patient!
Carilla Matos
March 13, 2017
I found your site looking to see why I could not bend my knee. I had ACL reconstruction and both of my meniscus .One shaved away and the other repaired and I thought I was alone in this pain and struggle I’m going through. I’m going on four weeks and I can barely get to 90° Flex ation the extension isn’t a problem because they accidentally locked my brace down for the first 10 days and that’s not what the doctor wanted so straightening my leg is on point but it’s the bending that I’m having difficulty with. The mental frustration along with the pain not being able to bend my knee wondering is something wrong with me will this ever get better and not really getting any answers from the doctor .your site has really helped me and trust me I heard you the first time when you said months and months before you get your Flexibility.back. Not really understanding why I haven’t had any physical therapy at this point the doctor doesn’t seem too keen on really offering it he said I can get through this on my own … Does that even sound right?
reddyb
March 14, 2017
Hey Carilla,
Not having any therapy at the four week mark is not right. You should be working with someone. Going it alone is something pretty much nobody should do.
For more help with flexion, you can check out the ACL manual or the Knee Flexion manual-
https://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
https://b-reddy.org/2017/03/08/cant-bend-your-knee-heres-what-to-do/
With your repaired meniscus, I would lean towards the ACL manual, as that takes into account a slower progression. But this is where your surgeon and a therapist should be helping. Letting you know if they want you carefully regaining your flexion, due to not wanting to interfere with the surgery. (Takes some time for the repaired meniscus to heal. The stitches can come apart in the meantime.)
Charles
March 21, 2014
65%cant go back to the previous level. That is horrible. Just ten days post op. The surgeon asked me not to walk until six week after op, which is his fixed advice for meniscal repair. I am really confused, since the protocols I found on the Internet encourage WBAT. Beside, does the passive knee flexion hurt meniscus. BTW, I had ACL reconstruction with hamstring autograft and meniscal repair in lateral with 2cm tear, in China.
reddyb
March 21, 2014
Hey Charles,
I give a detailed outline for what I consider a good timeline with everything in a series of posts: http://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/page/2/
You’ll see notes on passive knee flexion in there as well. Going past 90 degrees too soon is where many get nervous. So, that’s the point you can usually work up to pretty quickly, but be careful about pushing past that.
Especially in the beginning, my example is about as fast as I see anyone going. Especially those with a hamstring graft.
Cori
May 26, 2016
I also tore ACL and lateral meniscus at the same time playing soccer. I was back to playing at about 8-9 months, but it wasn’t to the level I was before. I did PT very soon after, was doing bike and walking within a month I’d say. I now (10 years later) just re-injured my meniscus with a double tear (lateral and bucket-handle this time), and will be going into surgery. I may also need ACL reconstruction again if it looks degenerated (the MRI scan showed it looked ‘weird’ and we aren’t sure what that exactly means…)
reddyb
May 28, 2016
Sorry to hear about that Cori. How were you doing during those 10 years? Maybe not quite the level you were at before soccer wise, but how was everything else?
Adolpho
June 29, 2014
Thanks for the article. Its been three weeks since my surgery and my leg has been stuck at a horrible angle of about 20 degrees (whats more, its still quite swollen and part of it is reddish and warm to the touch. I will be going to an outpatient ER clinic and get tested for an infection) When I went to my post surgery consult, the surgeon wasnt concerned. I asked him about it again about 6 days ago and he said “It doesnt concern me”. One of the PT’s saw my leg on Friday and was basically horrified. Ive been a fucking mess the entire weekend. Reading your article inspired me and I did some extensions and gravity holds in bed. I got up and I have never walked better since my surgery. Thanks for helping people keep the faith in the wake of poor Physician communication/ follow up and other pitfalls.
reddyb
July 1, 2014
Hey Adolpho,
Sorry to hear about the rough road you’re having. Regaining full extension is a step in the right direction.
Keep me posted on what happens with your case. Interested to hear about the infection aspect.
Also, not sure if you saw this, but there are more detailed videos (such as range of motion exercises) and more in this manual: http://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
Adolpho
July 16, 2014
Hello again, thought I would drop in for an update. Its been about 5 weeks since my surgery now. After evaluating me a couple of weeks ago, my Doc is pretty sure I have arthrofibrosis. He said if I dont make significant progress in the next 4 weeks, he will need to surgically remove some of the scarring. He said ” Your range of motion is absolutely horrible, and if we dont work through this soon , you are going to be VERY unhappy with this knee”
I am pretty concerned now. My gait is still terrible, I have pain at all times, even when not doing PT. The knee is visibly swollen, so the amount of scarring must be very substantial (Doc tells me its no longer a swelling due to diffuse edema) I am stuck at about 10 degree extension and 50 degree flexion before PT (those numbers improve after PT to about 4 degree ext and 80 degree flexion but I lose it all after going to sleep).
I am being put in a brace that forcibly extends the knee, hopefully within a few days.
Do you have any advice for me? I already got a second opinion ,this other Doc agrees with my Docs assesment. But how much can these guys really know without doing another MRI?
At this point I just want to be able to walk normal and run some day.
reddyb
July 17, 2014
Hey Adolpho,
Sorry to hear about your situation.
Your doctor is right…those ROM numbers are not good.
If you’re able to improve your ROM during PT, then there is a strong likelihood you can further improve your numbers. My inclination is you may not be doing the work necessary on your own.
Have you not been in a brace up until this point? If not, that certainly hasn’t helped matters. I’m not sure what you’ve been doing sleep wise, but you should be sleeping with your knee at pretty much 0 degrees extension. It sounds like you have been sleeping with the leg fairly bent. If nothing else, we know it’s bent to at least 10 degrees, which is too much.
Regarding your gait: If you don’t have full knee extension, you shouldn’t be walking.
I’m sorry man, but barring you having something very unusual going on (I feel an infection would have been caught by now), I think what El Savage said is likely the answer: Things will get better if you put in the work. Things will only get worse otherwise.
With knee extension in particular, my experience has been anyone who does not have full knee extension has simply not been doing what’s necessary.
The other side of this is the possibility of doing too much. If you have a PT who is forcing you into things which are painful, pushing you too hard, then that can be a factor. However, in that case, there is still no reason to not have full knee extension. I just can’t think of a scenario where not having full knee extension is reasonable. It’s something which should be attained within hours after surgery. It’s that important, and to some degree, that simple to do.
(Again, unless something crazy is going on. Like a material from the surgery was left in your knee.)
There is a ton on this site on how to handle swelling, returning to walking, ROM, hopefully it can help you.
Adolpho
July 28, 2014
Hi, I wasnt able to reply to your latest comment, so I will reply here.
I have not been in a brace. The sales people at the brace company botched my order and delayed it probably at least 10 days. I am getting the brace on Tuesday.
I usually sleep in the generic post surgery brace, but that thing won’t keep my knee completely straight. It probably keeps it a little less than 10 degrees straight.
While I don’t have an infection, there must be a considerable amount of sclerosed tissue. I can’t get my knee past about 90 degrees on flexion. I feel a mechanical block in there, it isn’t just pain that is limiting my movement.
My insurance is not paying for anymore PT visits, unfortunately. I would go in and my PT would work on manually straightening my knee for about 15 minutes (this part was moderately to considerably painful), then we would go to weighted extensions. 15 lbs at 10 minutes. Then we went to standing muscle stim of the quads. By my last session, I had improved to about 0 degrees extension.
I think I am losing my extension via both scarring and fluid (most of the time after I ice, I have a better range of motion)
I am getting a knee arthrogram (basically at my insistence, doc didn’t seem to think it was worth it) sometime this week.
My doc wants to do a knee manipulation under anesthesia in the next 10 days, and he wants to immediately put me in alternating ext and flex splints (he also mentioned a continuous passive motion machine)
I REALLY do not want to go through any of this stuff.
I have read things can happen during a manipulation. I don’t want these stupid braces, nor do I want to pay for any of this stuff. This surgery has already cost me a lot of money in missed work alone.
I am seriously considering canceling all of that stuff (but not the arthrogram) tomorrow and just chilling out on the doctors and gadgets for a few months and seeing what happens (while sticking to home therapy)…
Adolpho
March 9, 2016
Hey man. Been a minute (nearly two years)
Long story short, shortly after the ACL reconstruct, my Doc went back in there and cleared away a large amount of scar tissue. He also thought I had an infection, (even though nothing came back on the culture). I was placed on antibiotics, but got off them after a short while. I didn’t believe I had an infection (they said I could have an “Indolent Infection”, an infection that is not detectable by culture)
By now every Doc agrees I had a complication of Arthrofibrosis.
My resting flexion is now at about 120 Degrees (not very good, but a hell of a lot better than the 90 degrees I was frozen at)
There is pain upon both flexion and extension (much more so with flexion beyond 120 degrees)
My resting extension is probably about 4 degrees. (I noticed it actually got slightly worse after the debridement) I can force the leg to close to 0 degrees.
The surgery has left me with arthritis (I’m only 39 years old) my knee gets swollen and painful if I run too much or too often.
I have seen several other docs. One of them has suggested an involved procedure of cutting natural tendons in order to free up the patella, a “Retinacular Release” which he says is the main cause of the bad flexion (Dr.Ronald Kvitne)
I saw two others that disagree with the release, saying it can cause patellar instability.
The Docs who have seen my last MRI all seem to think the Graft is optimally positioned.
I can at lease lift heavy weights now, I think in time I can definitely get the quads as strong as they were pre surgery. (I don’t know about the hamstring though. It’s much smaller and weaker than the other leg. It was a hamstring graft)
I can run, but my walking gate is now a little wonky.
Im going to give it another year before deciding to do anything radical. ( I do think my flexion has increased by a few degrees since the last surgery. Honestly, this happened on its own with PT or exercise. I stopped doing exercise for a few months after my knee swoll up and got painful after doing some running. They tell me this is because of the arthritis)
The last MRI displayed a Cyclops lesion scar. I hope to get it removed eventually and get any other scar tissue removed.
Even though my leg is possibly compromised to a considerable degree for life, I am just glad that the acute healing process is over.
reddyb
March 11, 2016
Hey Adolpho,
Thanks for checking back in, though sorry to hear about the continued complications.
There is a good amount here discussed about cyclops lesions. You may want to take a look.
When you stopped exercising and improved your range of motion, you likely let some of that swelling get out of the knee. I hope others see this, as I’ve hit on this a good amount: Pushing the knee more can make range of motion worse, due to the impact of swelling on flexion.
Your flexion sounds quite good. Keep hammering at getting that extension back! (Removing the cyclops lesion may be the best road for this.)
Best of luck.
hyth
July 13, 2014
this is my third day after the ACL surgery everything you mentioned is right i cant move i cant do anything im so depressed i feel like i wont be able to walk again.
reddyb
July 13, 2014
Hey Hyth,
You will definitely walk again. In fact, you should be walking pretty soon. The physical therapy is crucial at this stage. It gets better. It definitely sucks, and you will likely have some dark times, but if you have your act together therapy wise, it will get better.
I’m not sure what you’re doing PT wise right now, but this may be of service to you: http://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
El Savage
July 16, 2014
Adolpho I feel bad for you bro. It seems your going through a really difficult time and things are out of your control. Things definitely get better but you have to be willing to put in the work. The Anthrofibrosis thing might be a set back but don’t let it get you down, keep pushing foward. I’m not sure if you play a sport but use that as motivation to get back. Obviously everyone on here tore their ACL and so we all know how you feel. You said your at five weeks. At this point I think I had full motion and at eight weeks I was jogging so I think that is the bar for progress. So, it might be a longer road to recovery but as long as you reach the end result, that is all that matters
Irene
July 22, 2014
Adolpho..I too had the same problem with arthofibrosis at about 8 weeks. My numbers were terrible. The doc wanted me to get the extensionator and the flexionator. My PT told me that they were very painful to use. I did a lot of research and basically did the same prolonged stretches w/o the machines. My biggest motivation was the doc telling me if I didn’t get better ROM that he would have to go back in and remove the scar tissue. There was no way I was having surgery again! One of the stretches that I did for the flexion was laying on my stomach and bringing my heel towards my butt and pushing it with my good leg to get a good stretch. I would hold it for about 60 seconds. I was doing these in PT but not for as long. I also would lie on my back and basically do a heel slide but push my leg as far as possible with the good leg and hold it there for about a minute.For the extension I layed on my back and put a rolled towel under my ankle. I then put 5lb ankle weights right above my knee and stayed like that for 15 minutes once a day. Pretty much this is what those machines do for you anyway. When I went back to see him he was very pleased with my progress and could tell that I worked my ass off. I still have a problem with extension equal to my other knee, but I am past 0 and currently at 1(my other knee hyperextends to 4) but I am still plugging along 5 months post op. Good luck to you and keep working at it!
Adolpho
July 28, 2014
At the 8 week mark, what was your extension and flexion numbers in the morning, and then after PT?
( Im 7 weeks post surgery, I wake up at about 10 ext and 70 flex. Those have improved to 0 degree ext and about 85 degree after physical therapy.)
I am curious to see if you would lose your gains after one day the way I have been….
Irene
July 28, 2014
Yes my ROM always got worse after a while, so I always felt like I was losing my gains. The first time I saw the Dr I didn’t stretch before going, but made sure to stretch the next time! If I remember correctly, my extension was at -2 and my flexion was 102. That PT appointment was on a Thursday and all weekend long I did the extended stretches a couple times a day. By Monday at PT I was at 120 and 0. It really worked. I sit all day at my job and I made sure that I stopped sitting with my leg extended(which was more comfortable) and sat with it bent most of the day. Last time I was measured my flexion was in the 130’s(cant remember exact #) but my extension is stuck at 1. I see a huge difference when I make sure that I do my stretches for the extension..so just keep working at it.
reddyb
July 28, 2014
It’s common to lose range of motion gains in a couple of hours, never mind an entire day.
Mary
July 30, 2014
Thank you, thank you, thank you! This info means the world to me! I’ve been a mess since surgery because I had to wait 7 weeks for surgery. I am a girl who is extremely active (2 hours at the gym everyday). I am a nannying so I chase after kids and play every sport. On July 25th 2014, I had ACL reconstructive and medial meniscus surgery. The doctor basically told my mom that my knee was mush. My accident happened on June 6th, 2014. I doubled bounced on a trampoline. I saw 3 drs and only 1 said he would take me into surgery ASAP.
My pain was unbearable and I was screaming, crying, and regretting how it happened. I also had to recover in a hot apt with no AC and it was just awful.
It’s a painful, expensive surgery/recovery. I also do not enjoy being waited on and having to rely on other people. I drove to Starbucks (drive thru) on Monday morning because I needed my normal routine. I was on Tylenol for pain at this point because the drugs were too much for me.
But thank you. I just miss the gym and it’s summer! It sucks in the summer! I miss the great 5K’s, the beach, and drinking margaritas by the pool!
I really enjoyed this info and I’m glad it’s normal for me to get mad and cry. I’m independent and saying I have an awesome boyfriend to help me is not true because I was dumped a week before surgery! I just want my workouts back! And maybe go back to work!
reddyb
July 30, 2014
I had a break up right before my surgery as well. Definitely not the best timing!
Be patient. You can get all those things back if you do this right. For the most part, there is little harm in going too slow. There is potential great harm if you go too fast.
Best of luck with things.
Angie
February 3, 2015
Mary, my life changed on a trampoline as well!!
I was double bounced on 6/15/13 had surgery a couple of weeks later.
It was definitely the worst thing I’ve ever gome thru. Lost the summer and a lot of muscle.
I unfortunately fell last summer and ripped my other ACL, so I will be doing this again in the year to come 🙁
reddyb
February 3, 2015
Unfortunately, Trampolines are hellish on the knees and ankles. So is skiing. Even more so for women.
hyth
August 23, 2014
I’m 6 weeks after AClr ( BTB ) the doctor didnt make me start PT till 3 weeks after operation which i dont know why … i can straight my knee now to 0 degree but i can only bend it to 105.
i think im much behind because the pt told me i should be having a full ROM by now but im stuck at 105
i cant walk without crutches at least one still
through your experience ? do you think that i wll be able to walk without crutches and do sports again ?
the doctor wants to do MUA but i told him to let me try harder with the PT first.
reddyb
August 25, 2014
Hey Hyth,
As I mentioned last time, yes, you can walk again. But you need to have your therapy together. Last time you wrote to me you were three days post-op. If you’re saying you didn’t start any therapy until three weeks post-op, then yes, you’re behind.
-I go over worrying about knee flexion in this post.
-You should have hyperextension in your knee. Not just full extension. That is, you should be able to straighten past zero degrees.
-I don’t know if you’ll be able to do sports again. I can’t predict that far into the future, and I know very little about you. I wouldn’t be worrying about sports at this stage if you’re still having trouble walking. The fact you’re not walking yet is a huge red flag.
Brian
September 23, 2014
Hey, came across your post as I have been obsessed with reading about others experiences to make sure I am on the right track. You are spot on with surgeons doing a very poor job managing expectations. My surgeon was talking like this was going to be a piece of cake ie “you’ll be walking in no time, back to work in a week”. Nonsense. The first week after surgery was the worst week of my life…by far. He also didn’t tell me to do any extension exercises so I was behind right away in PT. Thankfully I have a great PT person and I have kicked the rehab into high gear. I’m 10 weeks out now and my extension is fantastic, the flexion I can get to about 130 on my own, but this takes time. I am doing elliptical, stationary bike and just started agility drills. One thing you said above I don’t necessarily agree with (at least looking at from that viewpoint). “65% of ACL patients do not return to the previous activity level”. This may be true but it’s the wrong way to look at it. First you have to accept the fact that you are injured. If you do nothing, you have zero chance of returning to your previous activity level. Once I started looking at it this way, my expectations changed. I fully accepted that I would never be the same again, but if I put in the hard work in rehab, I will get back to playing sports again. I’m not there yet, but I think a really important thing is to educate yourself on your own realistic expectations. Thanks again for a great and insightful post.
reddyb
September 23, 2014
Hey Brian,
Thanks for the nice words. The beginning part of your story is unfortunately all too common, but that’s great to hear things have quickly turned around for you.
I see what you’re saying regarding that percentage. I think if looking at it that way helps you, that’s a solid way to think of it.
Another way to look at that though is, and this is much more the problem from the patient perspective, is based on the percentages, one should quickly gain an understanding of 1) What’s really happened to them (how serious of an injury this is) 2) How hard the process is and 3) How much work is needed. I have no doubt if people’s therapy was more together, those numbers could be better. The surgeons can be better on this front, the therapists can be better, but too many patients have no idea what they are getting themselves into.
Best of luck with things! Hope your process keeps going well.
Brian
September 24, 2014
I appreciate the response and as hard as it was for me to read your post and reflect on my experience so far, more people need to read this. I think it’s important for people to be their own health care advocate. Don’t accept sub standard physical therapy. I happen to be lucky living in NYC with many options and top of the field therapists, but you can still get a dud. Also, when I was first injured, I kept asking the questions, will I be the same again, will I be able to play tennis at the same level again. Somebody told me I was asking the wrong questions and completely change my frame of reference. They said I am injured – I will never be the same again. The question you need to ask yourself is are you willing to put in the work post surgery to get yourself to the top level you can be after an injury such as this. As soon as I started thinking in these terms, rather than “Can I be the same again” it changed my entire mental state. If you’re not going to do the PT seriously, don’t get the surgery, there’s no point. I do want to say again that I really appreciate post such as yours because as I have been learning through this experience, this injury is a total mind f…k and you need to be mentally prepared for it (which I was not in the beginning). After I saw my surgeon 1 week post op – I chastised him for not mentally preparing me for this and the seriousness of what was done to me. He then proceeded to bend my knee and I almost passed out from the pain. I still have bad days where I need to have a mental pep talk with myself. The more I read about others experiences, the more I realize this is common and that helps mentally. Thanks again and keep up the good work!
reddyb
September 24, 2014
Great comment. Thank you for sharing.
Al
July 24, 2015
Hi Brian, you mentioned in your later follow up comment to Brian about options in NYC. Just curious, which PT clinic did you go to in the city?
Brian
July 25, 2015
Hey Al – went to Cynergy Physical Therapy. Mellisa was the PT – she also helped me recover from a shoulder surgery (yeah I know I’m a mess). But she is fantastic.
JP Erasmus
October 31, 2014
Hi Guys, Thanks for an excellent post on ACL recon. I thought I would share an issue I am having 8 months post ACL recon, hamstring graft and partial lateral meniscectomy. Full flexion and extension has been achieved. No real pain but annoying discomfort quite common after a day of serious movement/ walking around. I use a pedometer and have found that if I do anything more than 9000 steps a day, I start having the discomfort to the anterior lateral meniscus area and hamstring… I am doing regular stationary bike exercises to maintain ROM and strengthen hamstrings and Vastus Medialus. Any thoughts regarding ongoing discomfort? Doc has given me the all clear and my PT and Biokinetics rehab was very swift and (not to sound pompous) quite painless.
reddyb
November 4, 2014
Hey JP,
It’s common to have some odd sensations, especially right near the sites of incisions / where the work was done.
At 8 months post-op, you still have a ways to go as to when most people feel the best they’re going to feel (~18 months). Could be something that just needs more time. Or, for now, 9000 steps could be where your leg strength and endurance is at. It’s not quite ready for more yet. Similar to someone who can squat a 100 pounds, but 110 is too much. It takes time to get to 110 -or wherever that line is.
Keep us posted.
Nath29
November 12, 2014
Good stuff. I was too worried of not able to bend my knee the way i want it. im 3 weeks post op, I can walk without crutches and doing rom exercises 3x/day even if i see no improvement on bending. I’ll be meeting my PT tomorrow on my first session.