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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Claire
April 20, 2016
Hi I am 3 wks post Acl reconstruction, hamstring graft tomorrow. This is the most informative and honest article I have found. I didn’t do much research before having the op because I didn’t want to frighten myself. So waking up in pain was a shock (yes I know a power tool! Really should have seen pain coming) and then being given a leaflet on how long the recovery shock me but the I thought, oh well I’m in it now. Do what the physio says and get on, head down and I am doing ok but occasionally I jump ahead and think how many months until I can do zumba and yoga? I’m not a big sporty person but I do like my zumba.
Now I do want to know how much I should be walking? Not been out on my own (with my crutches yet).down to 1 crutch in doors as per physios advice. My other worry is if I will be brave enough to ski again. Is my new or other acl more vulnerable now?
reddyb
April 22, 2016
Hey Claire,
That mindset of “Oh well, I’m in it now” can be a good one to have. Where some acceptance of what’s happened can help propel one to get on with the recovery, and not dwell on the injury.
You may want to check out the ACL manual, or my ACL diary. Both discuss timelines a good amount.
http://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
(scroll down and you’ll start seeing dates) https://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/
In short, yoga likely wouldn’t be too long. Zumba I’d be much more cautious with due to a lot of the twisting. For comparison most cutting back and forth won’t take place for people for 6+ months. I’ve seen many different people do Zumba many different ways, so it’ll really depend on that. From what I’ve seen, Zumba may not be as intense as trying to cut on a basketball court, but a lot of the movements are similar.
I have a post coming up about skiing. It’s one sport people, even high level athletes, can routinely come back *better*. Provided they put the work in!
The activities you’re looking to get back to are activities you should be able to get back to no problem, provided you’re patient and get the therapy in order.
Bryan
April 20, 2016
Reading this article has given me a great sense of relief. I tore my ACL,MCL, and partially my PCL in early November. It was devastating because sports are my life. I had surgery February 29th and am about 7 weeks out. My MCL and PCL healed on their own so I only had the ACL reconstruction surgery.
I started to get nervous because I was behind on my R.O.M. My extension has gotten much better pretty close to 0 if not at 0 degrees, however my flexion is what has been stressing me out. Unfortunately on my own I have not seen much progress and without stretching I can only bend it about 60 degrees. I understand now after speaking with my physical therapist and reading a lot of information that extension is more important and as it says in the article “Full, complete flexion will take months and months, and that’s ok. Stop worrying so much about it.”
It has been hard for me to not worry about it because I am still significantly behind and my surgeon suggested an arthroscopic to remove scar tissue to help catch up to hopefully bending my knee to 90 degrees because I am not quite there yet. Unfortunately I can only get their with a lot of stretching and a large amount of pain. It is quite unbearable at physical therapy and has been very hard to deal with. I am trying to do what I can to keep a positive mind set and tell myself that it is a long process. I keep finding myself comparing to other people online or friends that have had the same surgery and seeing that their flexion was better than mine is at this point and it gets me discouraged.
I am hoping that this minimal arthroscopic surgery can help get me back on track with my R.O.M.
reddyb
April 22, 2016
Hey Bryan,
Sorry to hear about the troubles you’re having. When flexion is that limited, that’s different, and can easily be a sign of a complication, as the surgeon is alluding to. Especially when there is such a degree of pain when trying to improve it.
While full, complete flexion will take a while, getting to 90 degrees should not. And ideally it’s barely painful to get to that. For many, as soon as they’re allowed to bend their knee, they’ll get there within minutes. If not, something is going on. Whether that’s *significant* swelling, or something scar tissue oriented.
I’m curious what were your immediate post-op instructions like? For instance, were you locked in a brace for a few weeks? When did you start PT, when did you start bending the knee, etc?
Bryan
April 22, 2016
I was given a standard protocol but I was not given any instructions on what I should have been doing for the first week or two. That was part of what was so frustrating for me because I have never suffered an injury like this so I simply did not know what I was supposed to be doing for those first weeks. I did not bend my knee much at all and I was not given any brace following the surgery which I thought was a bit strange because I thought most people were supposed to wear one after the surgery. I started PT at about 3 weeks post op and I was told that I was behind on my protocol because I was at about 5-10 degrees for extension and only 30-40 degrees for flexion.
Flexion is definitely the issue and I am worried because it has not gotten much better over the last month or so. I hope the surgeon can manipulate my knee so I can do physical therapy and see the progress that I should be getting.
reddyb
April 26, 2016
Sorry to hear that. Unfortunately that delay may be the cause of what’s going on right now.
If interested, you can check out the ACL manual and see how I go about restoring people’s range of motion. I prefer to make it as painless as possible through things such as long duration holds, opposed to attempting to brute force the range of motion.
courtney
April 20, 2016
I am 3 weeks post op and i have to say i will NEVER go through this again!!!!!! It messing you up mentally more than physically
Annaliese
April 23, 2016
Thanks for this post! Sadly, I was one of those patients that did not do much research pre-op. and went into surgery thinking “Oh this will be great, 9 months and I’ll be back in sports!” Obviously that was wrong, and I’m ashamed of being so innocent about it haha. I’m only 2 weeks post op. and let me say I am jealous you basically had zero pain. This post was really eye opening for a noob like me, and I am very grateful 🙂
reddyb
April 26, 2016
Hey Annaliese,
At least you now know you’re not alone :).
Thank you for the nice words. I hope your recovery goes well. At only two weeks out, 9 months and back into sports is certainly still on the table. It just might not be as smooth sailing as you originally thought, but still feasible!
Jose
April 25, 2016
Hey thanks this really helped allot. So I’m basically at 10 days after having my acl reconstructed by the end of the week my doctor said that I’m going to be off the crutches so recently I’ve been walking of course not putting my whole weight on it but still do you think this is a bad idea and also I’m at 70 on the flexion do you think that’s fairly quick or normal
reddyb
April 26, 2016
Hey Jose,
Read around some more. https://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/
Charles
April 26, 2016
I found reading this information very comforting I had my surgery in January it’s about be 4 months next week my ROM is 118-125 if I push hard enough I have a lot of swelling a lot a lot. I can extend my leg with easy though I think I might be of by a degree but none the less it’s fully straight with no problem but I am worried about my range of motion any comments or suggestions on what would help?
reddyb
April 28, 2016
Hey Charles,
I would search the page for swelling. For example, if on a non-mobile device, Ctrl+F in your browser. Command+F on a mac. (Saw you have an iCloud account. In Safari on an iPhone you just type in swelling in the url bar and scroll down to “On this page” http://osxdaily.com/2013/10/03/search-text-web-page-safari-ios/ ) This has been discussed a lot.
Anna
April 27, 2016
Thank you so much for writing this. It was so, so therapeutic to read. Tore my ACL and meniscus skiing in February. I’m now 4 weeks post op with a hamstring graft. As a mother of two small very active children this entire recovery process has been quite a challenge. It’s so nice to hear someone call a spade a spade in terms of how suck-tastic the weeks following the surgery are. In keeping with the tradition of commenters posting their numbers: Extension 0, Flexion somewhere beyond 90 but not quite 120. 😉
reddyb
April 29, 2016
Going through this with two small kids will make some of us (like me) realize our experience could have easily been harder!
Keep up those good numbers :).
Shahbaz
May 2, 2016
hey guys i tore my acl b4 5 month but i want 7 month more for surgery,
it is possible i can delay 1 year for surgery?
reddyb
May 3, 2016
Hey Shabaz,
Read around. Avoiding surgery has been discussed a lot.
Kelsey Bogan
May 6, 2016
Hi
Thought I’d share my story as this page and the comments have really helped me through this process. Maybe mine will help others
27 y/o female. School librarian. Non athlete. Casual runner, mud runner, work out-er. 5ft3. 170lbs.
Not exactly the usual suspect for a torn ACL, right? I tore my right ACL February 2016 when I was doing jumping jacks at school. Yep, jumping jacks! Heard and felt the painful POP and then had subsequent knee instability. never imagined it was a torn ACL. went to the hospital to be safe (since it was a work related injury). They said “probably a sub located patella but follow up with an orthopedic doctor.” Followed up with an ortho who sent me for an MRI and sure enough the ACL was torn. I was shocked. Not being an athlete, or particularly athletic, I was shocked and in denial. The ortho explained that my options include surgery or no surgery, that basically surgery isn’t required. We talked for a bit about my activity level. I’ve been overweight my whole life but in the past 3 years I’ve worked hard and lost 50 pounds through healthy eating and excersize. I do a lot of running, mud runs, squats, box jumps, etc. I decided that at 27 I was not ready to commit to a more sedentary lifestyle and risk my weight so decided to get the surgery. The ortho and then the surgeon did not speak with me at length about these options and largely glossed over and completely underestimated how challenging and horrible this experience would be. I was hugely unprepared. ( didn’t find this blog until after surgery lol oh well).
So now I’m 4.5 weeks post op. Right ACL recon with patella graft. Was assigned to wear a brace and sleep in it locked out for 3 weeks then unlocked for the 4th week. The first week was horrific. Tons of bruising, tons of swelling and it was almost impossible to sleep or even get comfortable. Sleeping in the brace was a nightmare. Couldn’t sleep more than 3-4 hours at a time when I was lucky. Getting out of bed was difficult and painful. Some days I couldn’t even move my leg forward to walk. I think my muscle atrophy was very sudden and very very extreme. I needed a lot of help for the first 10 days post op. I had my first follow up and the surgeon decided the swelling was too much so he used a needle to remove two vials worth of fluid from the knee. He squeezed the leg like a toothpaste tube to get the fluid out. It was horrific. But the next day I felt HUGELY better. So the swelling was causing me a lot of trouble
Didn’t get to start PT until 2 weeks post op thanks to some shenanigans from my comp insurance so I’m a bit behind where I think I could be right now. I love my PT though, and after two weeks of PT I’m seeing a lot of improve
Don’t although it’s very very slow from what I’d been led to believe it would be. For instance, prior to surgery I was told I should be able to drive 3 weeks post op (no way in hell, my quad strength and control is still nill even at 4.5 weeks) and I’d be back to work after 2-4 weeks. Well my job is 8-9 hours a day of constant on your feet movement, plus red helming 400 books a day, plus traveling between 3 schools. At 4.5 weeks post op I truly cannot fat home why my surgeon ever suggested I’d be able to do that after 2-4 weeks because I currently can barely handle 20 minutes on my feet and can’t yet walk reliably without my brace. I don’t know if the surgeon lied or was just wrong but there’s no way I could drive (safely) or work yet. My guess is maybe after 8-10 weeks. Maybe.
Also it’s a very slow, painful, and frustrating process. It’s indeed a lonely road and depression (and cabin fever) has been a real challenge. Watching my weight creep up while I’m so unable to move about has been hard. Wondering and fearing how long it will be until I’m back on track has been difficult. This post and everyone’s comments have helped let me know I’m not alone in this.
If you are considering surgery I’d caution you to research, research, research first. Make sure you know enough to know the right questions to ask the doctors. I didn’t and I regret that. Make sure if you get the surgery you work on keeping your head in a healthy space throughout recovery. The recovery and rehab are way harder than the surgery lol. Not that they warn you of that.
Ps my e tents ion is really good most days. I think being locked out in a brace for the first 3 weeks really helped me achieve and keep extension. Important, especially since my regular extension is hyper-hyper extension at about 11dwgrees I think. Today I got to 110 degrees flex ion for the first time and that feels great. Of course that’s at the end of nearly 2 hours of PT. I don’t just wake up being able to get to 110. I wish.
Sorry for the long post but thought my story (non athlete, overweight female) might be useful to someone else on here. Also wanted to thank you for providing a great post and especially for allowing your comment section to act almost as a message board and community forum of support for us ACL victims. Thanks so much!
reddyb
May 10, 2016
Great comment and very well written!
And tearing the ACL while doing jumping jacks is the first time I’ve heard that one myself!
Good for you for 1) Getting your weight down 2) Being conscious of it during this process. Getting the weight down makes things a lot easier post-op than if it weren’t, and not letting the weight go up the best you can will only make life easier as things progress. In the beginning it can really help things like the arms and the other leg as they’re having to pick up the slack, and then as things progress I think we all appreciate how being lighter is easier on the knees in general.
By doing this, in some ways you prepared your body more than others 🙂
Kelsey Bogan
May 11, 2016
Thanks so much. Hoping you can help with something. I just had follow up w surgeon. It’s the 5th week since ACL patella graft surgery. I’ve only had 9 PT sessions so far (as my employer caused almost a week delay on my starting PT). My therapist is telling me I’m doing great. Extension is fine and flex has been improving. Friday I measured at 110 flex while therapist was stretching me out. Today I saw surgeon first thing in the morning (when my knee is usually at its stiffest) and he bends it a bit and says ” looks like you’re only at about 90, if you aren’t at 120 by Monday I’m going to do a MUA (manipulation under anasthesia) on Tuesday because I’m going out of town for 10 days after that and we do t want to let this go too long. Now I’m shocked and confused. My therapist is surprised the surgeon would consider an MUA for me and so soon because therapist thinks I’m right on track and not needing of MUA at this point. Surgeon hasn’t even looked at my PT info and is pushing for MUA if I can’t get to 120 by myself by Monday. Today at PT I was able to do full rotation on the recumbent bike for the fist time and my therapist got me to 120 by bending g it for me but of course it’s excruciatingly painful. I’m lost as to what is the best option for my knee. I have two professionals telling me opposite advice about the MUA and although my preference is not to do another surgical procedure, I don’t know how I am supposed to know what the right decision is. Have you heard of an MUA being done 6 weeks out from an ACLr on someone whose extension is good and who can now get past 90 degrees on her own? I am at a loss about this decision. I just want to do whatever is best for my knee in the long run
Best regards
Kelsey
reddyb
May 13, 2016
If you’re truly only getting to 90, then that’s pretty limited. But it sounds like once you warm up and stretch out, you’re getting farther. That might be something the surgeon doesn’t know or didn’t see.
Do not assume the surgeon and therapist are communicating in any way. They often aren’t, and often don’t even see one another’s records. You’d think they would, but that just makes too much sense.
I’ve relayed this story before but it’s worth repeating: My physical therapist was across the hallway from my surgeon. First day of PT they ask me “So what surgery did you have?” My jaw hit the floor. Next follow up with the surgeon? “So how is physical therapy going?”
“Uh, not good doc. I’ve had three therapists in three visits because each day was each therapist’s last day.” <- This really happened. "Temp physical therapists" actually exists.
"Oh, geez, sorry about that. I didn't know that was going on." Yet they refer all their patients to this office!
Since you don't want another surgery, it's perfectly reasonable to say "I'd like to give the therapy some more time. The therapist feels good with things, I do have more motion it just takes a little time, plus I'm steadily improving. For instance, I wasn't able to ride the bike but just recently I was able to for the first time." If you do end up needing the MUA, then a couple week delay isn't going to be a big deal in the grand scheme of things. But avoiding another surgery can be.
Finally, as it's been said here repeatedly, I recommend avoiding pain when working on range of motion as much as possible. Where instead long duration holds are used. Long duration can mean one to ten minutes worth, if not longer. (Not 30 seconds.) This way the knee is gently, though aggressively, pushed into range of motion. Just pushing the shit out of the knee to where one wants isn't ideal. The whole point of stretching an area is to relax the area.
Putting people in pain makes everything worse. Specifically with flexion, as regularly going into pain tends to swell the knee, which makes flexion harder. (Another thing to consider: Did your surgeon assess your knee on a day you happened to be more swelled or stiff?)
Sarah burten
May 9, 2016
My name is Sarah Burten, I’m 15 with 3 surgeries under my belt in the past year and a half. Two were ACL surgeries, the doctors and physical trainers said I was going to be able to do everything and anything I wanted. I was cleared at 8 months then I spent the next two months training, strengthing, making sure I was at the top of my game when I went back on the softball field. Ten months out of my first ACL surgery physically and mentally I was perfectly fine I went back on the softball field like nothing had ever happen. I retore it my 5th practice. It’s been 4 months since surgery, but nothing prepaired me for this mentally. I was was boiling inside for months because I knew I tried so hard to go back to play the sport I love the sport I was going to go to college for but ended up right back where I started. I couldn’t make jokes about my injury like I used to too, smiling was hard for months. I wasn’t there. I had my first anxiety attack at 15, I couldn’t breathe, I couldn’t walk anywhere to go get air. I passed out in the halls of my high school. ACL surgery is nothing to me it’s what it took away from me. I’m not typing this for pitty or anything in return for that matter, I want people to realize how lucky they are to do what they love. I hope this helps them.
reddyb
May 10, 2016
Thank you for sharing Sarah and sorry to hear about having to deal with so much surgery so early in life. Having a sport taken from you like that can really hurt.
While it might not give a whole lot of practical help, you may want to take a look at this as it may give an explanation for having such trouble with your ACLs so young: http://b-reddy.org/2015/09/14/meniscus-wedge-angles-a-genetic-component-to-knee-injuries-why-some-knees-are-only-built-for-some-sports/
If sports are big for you, one random piece of advice which might help is to use this time to get into the other side of sports. Often those who experienced injuries end up being the best at helping others with them. Where having your own injury can be a solid career jumping point for later in life. While this sucks now, at 25 or 30 you may find you have a knowledge and experience few other, say, physical therapists or athletic trainers have.
Hope you’re healed up soon.
Robert
May 26, 2016
Hello I tore my acl on 11-2-2015, I had surgery on 12-8-2015. While surgeon was in there he found out it was a major tear in the acl,I bruised the mcl,I tore a significant amount of cartilage and broke some bone right on the knobs of the knee. I was told after surgery my knee will never be the same and at 32 I will have osteoarthritis for the rest of my life. I have done pt and done exercises that they told me to do. I just got approved thru workers comp for a second set of pt. At the end of first set I was at 121 bend and about 2. And released back to work on light duty at beginning of 2-2016. Well work refused to follow exact guidelines and pain and rom got worse. I’m now at 6 months post op. And now im at 125 and 4, I went back to doc again to tell him of issues which he has ignored since after surgery. I’m still on average experience pain on 1 to 10 about a 3 to 4, which I can handle. But when I use my leg alot or walk on it a bunch it goes up to a 7 or 8. I still toss and turn every night cause of my knee. Also I get pain right below and above knee and it pops and clicks alot. Now the pain in my IT Band is worse which has risen to about a 9. The doctor has no idea why it could be hurting and refuses to find out why. I got put back on seated work only but around my knee is swollen and takes on a purplish tint to it. Doc ignores it.I do have numbness in some areas around my knee and below knee.I do walk with a limp because that knee will buckle from time to time or pain will get worse with more pressure applied to it. Is anybody else had or having issues and got any advice. Thank you
reddyb
May 28, 2016
Hey Robert,
Sorry to hear what’s going on.
-Regaining full extension is crucial. There could certainly be something going on surgically preventing full ROM, though my experience has been it’s more often a lack of proper exercise. I have a manual on this here if interested: https://b-reddy.org/2015/09/03/help-i-cant-straighten-my-knee/
-If your doctor just came right out and said “You’ll have arthritis for the rest of your life,” they’re an ass. You may very well have some arthritis, that does not mean you have to be in pain. A beat up knee on a X-Ray or MRI can still be a very functional, feeling good, leg.
-The IT band does seem to get stiff in many after this surgery. I have a post coming about this, but in the meantime you may want to check out the IT band manual and play around with the exercises: https://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
Your therapist should be helping out with this too.
-Numbness can be a sign of nerve damage. This is a risk for this surgery (and most surgeries), but can also indicate the surgeon didn’t do as good of a job as they should have.
-You can also take a look at the remote client process and see if that’s something you’d like to entertain: https://b-reddy.org/2013/06/20/the-remote-client-process/
Robert
May 28, 2016
Thank you,my pt has ended. The therapist told me that the surgeon is great but when it comes to workers comp surgeries he doesn’t care.since therapist said they can’t do more for me,he will force the doctors hand to fix the issue or for him to push me to another doctor that will. So hopefully I can get it fixed and go back to do the fun activities I used to do with my 7 yr old son. He actually said that to my family when he got done out of surgery and they got it on recording. Which all this does play heck on mental status. I try to stay positive and get full use of my leg back and pray and hope for nothing less than 75%. As I stated I do all they tell me to do and the doctor still and has ignored the reason why I got pain or even address the issue.I will try the links you put on here to get it to help. Thanks for your reply and suggestions
thrasher
May 28, 2016
You must have had a horrible surgeon or have a very low threshold for pain. It really isn’t 1/100 as bad as you describe it. You should be ashamed of yourself for trying to scare people out of making the right decision. If you tear an acl, surgery is by far the best option.
reddyb
May 31, 2016
Every part of your comment has been addressed numerous times. Please read 1) the post AS IT SAYS I HAD LITTLE PAIN 2) the comments, rather than making yourself look like a jackass.
Robert
June 1, 2016
I’m not trying to scare people from surgery,as for my pain threshold I have sliced open my testacles before and handled the pain.