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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jkupetz
December 5, 2014
Great post. I’m about to hit four weeks post-op on a right ACL allograft and meniscus debriding. I’m having really good outcomes with my PT (started day seven, wish I’d have started earlier but, to be honest, my leg was like seven times normal size for a few days)–already most of my extension is back and I’m getting a lot of flexion, too. So on the physical side, things are going really well–the chronic pain from my meniscus is gone, and I’m just dealing with some hip flexor stuff for the most part. My knee hurts like hell for the first ten squats, but loosens up after that, and all the other ROM stuff is going well–only popping an occasional hydrocodone after PT sessions that add lots of new exercises or crank up weight and reps. What I’m really getting hammered with is the depression–I’m a lit professor and I would have KILLED for an excuse to sit or lie around with books all day everyday before I had surgery, but now I’m so bored, feel trapped in my house, impatient with progress even though it’s good, and sick of the routine (and I can’t wait to get out of the brace at night–I never really thought, “I won’t be comfortable in bed for months after this”). Prior to surgery I’d been hitting the gym 5+ times per week for cardio and weight training for a long time, and I’m climbing the walls. Only eight more months of recovery to go! Any recommendations on getting my head right?
reddyb
December 8, 2014
I touch on this some more in other comments as well as my ACL manual, but my biggest advice for drudging through this journey is doing things well, diligently, patiently, sets you up to have a healthy leg the rest of your life. This is not a process you can redo. And you can absolutely screw this up to where there is a very strong chance of having issues the rest of your life. Whenever you feel like say, pushing things faster, try keeping this perspective in mind.
This isn’t meant to be an insult to you, as I know many don’t know all the particulars about this process, but for others who read this comment, I want to reiterate some points, because I see some of the things you’re mentioning too often:
-Starting day 7 is late no matter the circumstances. Your leg very well may have been so swollen due to this late start. One of the reasons therapy should start the day of surgery is to help avoid such extreme swelling.
-You really, really want to have more than full extension at this point. For each day you don’t have full extension -meaning some hyperextension- you are that many days behind.
-I’m not sure what you mean by “occasional,” but you don’t want to be taking narcotics for pain relief after PT sessions. At most, an advil here or there, but if your pain is that severe, something is wrong. There should be no days with “lots of new exercises” or “cranking up the weight.” These are recipes for pain.
Brian
December 9, 2014
Hey – so I posted before, but my rehab has hit a roadblock. I am been having pretty bad pain down the front of my knee. I saw my doctor and he said it was patello-femoral pain and my PT thinks it is patella tendonitis. My surgeon said this is common and it will go away – but it’s been almost 2 months and I can’t leg press with even light weight without pain. Forget about squats, I can’t even do them with a medicine ball on my back. It is really wearing on me because I can’t rehab the way I want to. My PT has changed my program a bit to work more on hip strength and hamstring strength – but it’s still an issue. Have you seen this before – any advice you can give me to help make this go away? I am now 5 months out and my extension is almost identical to my other leg (maybe 1 degree of hyperextension left) and my flexion is as good as can be expected 5 months out. I had an allograft reconstruction. It is driving me crazy because right now I don’t see any light at the end of the tunnel and is really getting me depressed.
Thanks,
reddyb
December 10, 2014
This article on hamstring curls is poignant, particularly the comments on how the hip flexors -rectus femoris; TFL- can become stiff after this surgery: http://b-reddy.org/2012/05/21/thoughts-on-hamstring-curls/
In other words, at this stage, howyou achieve active movement, such as knee flexion, is crucial. It’s all too common to try and force certain movements in an attempt to rehabilitate. This often happens at the expense of good movement though. (Again, see the hamstring article.)
This is also a program very much geared at helping patellofemoral pain: http://b-reddy.org/2013/08/20/6-exercises-to-loosen-the-it-band/
Hope that helps.
P.S. if squatting, leg pressing, or whatever gives you trouble, get rid of it for now. There are other ways to work your quads. (Backward walking on a treadmill being a nice way to get a good quadricep pump.)
Brian
January 22, 2015
What are your thoughts on Platelet Rich Plasma Therapy to help get rid of patellofemoral pain after ACL surgery? I have tried everything else – stretches, strenghtening hips, glutes, hamstrings, quads, VMO, loosening up muscles, stretching IT Band, massage, ultrasound, laser therapy. The pain refuses to go away and is the only thing holding me back from recovering. I am about 6 and a half months post surgery and the patella pain started around week 6 of recovery and has persisted. I am sort of desperate at this point and don’t know what to do. I have full extension and about 97% flexion.
reddyb
January 22, 2015
-I think PRP is a waste of time and money.
-Something to keep in mind is just because you’ve tried all those things doesn’t mean you were doing them all properly.
-Considering you’ve had your issue for 5 months, that’s a lot of programs / approaches to be trying in only 5 months. My last response to you was only ~5 weeks ago. Sometimes not a whole lot can happen in only 5 weeks. e.g. The IT band manual I linked you last time takes 5 weeks just to get to the full volumes.
-As well, nothing you mentioned in those approaches deals with changing how your patellofemoral joint is moving, which is probably what’s causing you issues. Not lack of strength.
-Nothing in those approaches deals with how you go throughout your day either. Such as how you sit, stand, drive, etc.
-Laser therapy, ultrasound are time sinks as well.
-I’d bet a lot your IT band / TFL is still stiff. If it’s not, then you may have actually been trying to do too much activity. This is rare, but does happen.
Brian
February 6, 2015
Sorry for the many posts – but it’s hard to get good unbiased info on the net and I really appreciate your responses. I had another MRI on my knee and apparently I have an intrasubstance degeneration and tear of the posterior horn of the medial meniscus (which I think translates into a meniscus tear?). Have you heard of somebody tearing their meniscus so quickly after ACL surgery? This probably happened within 2 months of the surgery as that’s when I started to feel my somewhat abnormal pain. I’m a little peeved at my surgeon as I went to see him atleast 4 times complaining of pain in the inside of my knee (along with the patellofemoral pain). He just told me it will go away and didn’t even really check into it. My PT knew something was up and she kept prodding me to get another MRI. This seems to be the source of atleast some of the pain I was having. Do you have any advice on what to do? I really want to avoid another surgery at all costs. The pain has actually been getting better and only really happens when squatting, going up stairs, kneeling or pushing off the knee to jump. I can live with this I think, but I am not sure if I am risking further damage to my knee if I don’t get it fixed. I don’t trust my surgeon at this point as he is going to be biased towards surgery as that’s what keeps him employed. I can’t even begin to tell you how depressed this is making me – 7 months of hard rehab and now I am back to square one.
reddyb
February 9, 2015
-That would be a meniscal tear, yep.
-I haven’t heard of this, but it wouldn’t surprise me.
-I’d be quite surprised if a posterior horn meniscal tear was causing you patellofemoral pain. But medial knee pain is a classic sign.
-Thorough post regarding meniscal surgery: http://b-reddy.org/2014/03/05/more-evidence-against-knee-surgery/
Amy
July 27, 2015
Brian – I’m having very similar issues to those you described. Would love to hear if you had additional meniscal surgery or not, if you tried PRP, and how you are doing. I am 5+ months post ACL and meniscus surgery, started developing pain around the same time that you did (and with the same exercises), and the Dr. speculates that the meniscus did not take to the repair. Only difference is that I still am ~10 degrees off on bending. Feeling very frustrated.
Brian
August 1, 2015
Hey Amy,
Sorry to hear you are having knee pain as well. It turns out my meniscus was slightly torn pre surgery, but my surgeon didn’t think it was bad enough to operate on in addition to the ACL. Brian was right though, that isn’t the source of my patello femoral pain. I’m doing better, am back to playing sports at about 95% ( I’m a year out). I didn’t waste my time with PRP, it’s a scam. I still have pain behind my kneecap, when bending down and squatting. I can’t squat in the gym, however I can leg press without pain (about 315 for both legs, 170 for just the injured leg). I’m sort of resigned to the fact that I’m going to deal with some minor pain the rest of my life, but it is not affecting my ability to live my life and play the sports I want to play. I wish you the best of luck.
Brian
Beatrice
December 10, 2014
Great post and also great to hear othervpeople’s experience. I’m a 45 yo female with an active life – lots of walking and trecking in the summer, gym in the winter, occasional tennis, and lots of dancing at parties 🙂 I had allograft 4 1/2 weeks ago in Toronto, ON. Thigs are going amazingly well – I have full passive ROM, and I asked my PT 5 times if full means really full compared to the other leg. Doing 20 min on the treadmill at 3.5 -3.7 mph or (not and) 30 min on the bike resistance 3. Half squats on Bosu, lunges, 12 in step-ups. Started PT at home the day of surgery with quad sets, heel slides, SLR, hamstring streches. Had the surgery on a Friday and started PT at a sports med clinic on Monday. Went every day in the first 2 weeks then 2/week. There’s been a lot of sweat an tears, literally, especially with ROM exercises and it’s hard to believe the progress I am making every day. Was off crutches day 4 and off splint day 10. Early PT played a huge role, I believe, and also the fact that I did prehab for 1 year after the accident before the surgery. Also working with a PT specialized in sports injuries. I am feeling my quad coming back but I know I still have a long road ahead. I had spoken with people who had had ACL recon and knew what to expect, also read almost everything available online. I totally agree that you have to be mentally prepared to go through a long, painfull rehab, doing the same things over and over again, which is the definition of insanity, according to Einstein 🙂 What I can tell is, there is light at the end of the tunnel as long as thinghs are done well and timely. Good luck everyone!
reddyb
December 11, 2014
Ladies and gentleman, please take note, this is how you do it! Best of luck Beatrice. Hope things continue to go well. Thank you for chiming in.
Beatrice
December 11, 2014
Thanks, Brian. I was fortunate to have the surgery done by one of the best sports orthopaedic surgeons in Toronto, he’s worked with elite athletes. I received the rehab protocol at discharge, this is his standard protocol. I gave it to my PT, he’s following it but also working at my body’s pace. I had full extension right away but had some troubles with the flexion. He encouraged me to continue, used various techniques to loosen the joint (it hurt like hell, but I knew it was effective) and even though I didn’t hit the dr’s 2-week milestone, at 4 weeks I was ahead. I’ve learned to give my body the time it needs to heal. I’m doing something every day – if the joint is sore, I do SLRs and isometric exercises on the couch while watching tv. I don’t let the pain control me and have found ways to work around it. Another note – nothing else was damaged in my knee, just the ACL. This protocol worked for me. If people have had other things touched and repaired, the approach is probably different.
Michael
December 14, 2014
I had surgery to repair the torn lateral meniscus in my left knee 33 days ago. I am now walking without crutches or brace, but I still cant straighten my knee fully while standing and I’m a little concerned. I know this isn’t an ACL question, but I noticed you’re helpful responses. Any advice?
reddyb
December 15, 2014
I have specific exercises and video demonstrations on regaining extension in this manual: http://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
If you go Ctrl+F and type in “extension,” it’s discussed a lot in the comments here.
If you go to this page, http://b-reddy.org/2011/12/27/reconstructive-acl-surgery-postop-physical-therapy-day-1/ you can see more on extension with a picture and more. Along with scrolling through the ACL rehab process, specifically earlier in the process, here http://b-reddy.org/category/anterior-cruciate-ligament-acl/rehab/page/4/
(I wouldn’t be walking on a knee with less than full extension.)
raid ahmed
December 20, 2014
hi, i did an acl surgery in mid January, i did physiotherapy, my extension is good, I’m back playing football but softly, i don’t engage nasty tackles, i still have that fear that it can happen again, i really need to overcome the fear, but i have one problem on bending my knee, i can bend more than 90 degrees, but when i try to force it i feel pain and my muscles get stiff like they don’t want it to go further than that, how long will it take to fully bend my knee, and what should I do? Please assist if possible, thanks
reddyb
December 21, 2014
In terms of being able to actively bend your knee past 90 degrees without any issues, if you had a hamstring graft, it could take closer to 18 -24 months, or, it may never happen. The hamstring doesn’t always fully regenerate / gain all its strength back.
If you’re talking passive range of motion, if you’re having trouble bending your knee past 90 degrees, then that’s usually a good sign of fluid being in the knee.
Navin
January 13, 2015
Hi Reddy, very good and realistic article ! I am 27 and have been playing football over last 15 years and tore the ACL about a couple of months ago…Do people like me have an edge in the recovery ?
reddyb
January 15, 2015
Being in shape absolutely helps recovery. The better one goes into surgery, the better most come out.
Steve
January 19, 2015
Had ACL repaired via hamstring and to it ad a grade 3 MCL tear, OS said h had to debride/ remove 50% of my meniscus. Also had a nasty femoral cartilage tear that OS debrided as best he could. Left OR in a brace locked out at 8 degrees and have been in that thing for 2 weeks post op. Saw OR today, he removed the brace and says I’m free to move my leg – thing is, I can’t! Seems to feel “locked” at the original 8 to 10 degree point. Cannot extend or retract leg. REALLY freaking me out. Doc has not prescribed any PT yet but instead, at this point, says to work on it as I feel OK with. Anyone else dealing with this type of issue?? Any insight would greatly be appreciated.
Kim
January 31, 2015
I had ACL reconstruction (hamstring) 10 days ago. By day 8 I was able to hyperextend and had 110 degree ROM. Crutches are only used outside and for stairs. I have been fortunate, worked with my physio a lot pre surgery to get in the best possible shape for surgery.
I was well prepared for this, 3 years ago I had similar surgery on my left knee. Good luck to everyone on this journey 😄
reddyb
January 31, 2015
Thank you for chiming in Kim.
I don’t want to hammer the point too much; I don’t want to make those who haven’t taken a similar route feel bad. But hopefully those who are still early enough into this journey are catching the theme and patterns here between those who have a “good” (relatively speaking) experience versus those who struggle.
Lyndsey
July 1, 2015
Fantastic site, so appreciative and glad that I found it. Wish I had read it sooner. I had my first PT session this afternoon at the two week mark (ALC and medial meniscus repair). I now realize that I had not been pushing myself enough since surgery. I was doing quads sets, leg raises, etc and was told at my post op appointment one week ago that everything looked good. I am a little concerned, though, by the reaction of my physical therapist. I am at a -3 and my left leg is -10. Should I be overly concerned? Am I still early enough in my journey to turn it around?
reddyb
July 2, 2015
I wouldn’t be overly concerned. 7 degrees is something you should be able to get in a day, if worked on enough / properly. Might take something like a 15 minute hold (as tolerable) to get there (this should be done multiple times per day as needed (the exact amount of time is up in the air; 15 minutes was an example)), but should be able to be done.
As an aside, if by your post-op you mean your surgeon told you things looked good, my experience has been the surgeons don’t really even check full extension. That is, some hyperextension. I’m sure some do, but it doesn’t seem regular. The surgeons seem to check 1) The ACL 2) Flexion ROM, and that’s about it. To some degree, if those are solid, their job is done.
Anyways, if you have some hyperextension, you’re doing solid. The people who can only get to zero, or can’t even get there, that’s where the problems are more at.
Hope that’s helpful.
Brandon
February 2, 2015
Hi, I was wondering if someone can tell me if clicking when extending the knee fully is a bad thing? I’ve had acl/miniscus surgery,and itll be good to know how im getting these clicks, because my physiotherapist says it is bad thing if it continues, and so far it has been week of clicking. Itll be good to know how serious, and what causes it to happen. Thanks
reddyb
February 3, 2015
I think you’ll find this helpful: http://b-reddy.org/2014/07/14/whats-up-with-the-noise-my-knee-makes/
Matt
February 19, 2015
Surfing around and found this blog. It was very helpful. I am 5 weeks out from an ACL hamstring graph and was walking with out crutches. Over did it a bit on Tuesday with walking and now for 2 days my back of my knee aches and when I extend my knee in the seated position, at the last few degrees before forcing it level, I get pain inn the back of my knee and now its more difficult to bear weight on my heel. It comes and goes and seems to respond to ice and Advil. It also is sore at the last few degrees of flexion, but everything in between is fine. The leg just feels more unstable than a few days ago. I live overseas and the therapist has been on vacation for 6 days and its in another language so its sometimes not clear what he says. 3 questions 1) should I be concerned about the setback 2) any ideas what I did. 3) I can push through the pain, how hard should I push
reddyb
February 19, 2015
Hey Matt,
If you search around the site’s ACL material you’ll find plenty of comments discussing these types of things.
1) Any pain is a concern.
2) It’s common to feel all types of weird sensations during this process. They are usually simply part of the deal, but if you’re particularly concerned, it never hurts to have the surgeon double check things.
3) You should not push through any pain.
Matt
February 23, 2015
Thanks, went back to pyhsio today. In 5 days I have lost most of my quad strength and when I try to push the backs of my knee to the floor to work the quads my quads can’t hold the knee and there is pain. Also I feel pain in the back of my legs on the right side. I feel like I am back 2 week 2. therapist says he has no idea why and that the pain in my knee is the joint getting stuck due to the knee being weak. I still have extension but have lost flexion due to pain in back of knee. Could this be muscle related or should I see the surgeon ASAP. This really sucks.
reddyb
February 24, 2015
End range extension ROM is something you want to be working passively, not actively. There is no need to be actively pushing the back of the knee to the floor.
A “weak” knee will not prevent full, passive ROM. In nearly all cases, not working on extension ROM often enough and properly is what causes a lack of extension ROM. For flexion, there is no need to be rushing it or to be concerned by a loss of ROM here and there. This is part of the process. (This is all addressed in the comments and the post.)
My guess as to what’s going on is you’re pushing things too much, and in the wrong ways. Because of this, you’ve caused some swelling, which has caused your flexion ROM to decrease.
Arghya
February 24, 2015
Can’t agree more to what is said here. For me, I delayed the surgery by a month and vigorously exercised before the operation. The post-op first month was full of self doubt as I occasionally wondered whether I will be able to walk normally again or will I be able to play cricket or table tennis. However, at the same I consoled myself saying that I should try my best. So, the physiotherapy is continuing for the last 3.5 months and I can now do lunges and half squats and my walking is more or less normal, though I limp occasionally. And this is so true that the leg fels funny, I mean earlier I could feel where my toes will be while walking, but now a days I get to realize it a little less and sometimes clumsily hit the road, like a drunk person trying to walk. But with more walk and physiotherapy, I hope to get much better and to the point where I can play table tennis again. It will probably take a year, but I can wait till then. After all, having a functional leg is better than not being able to play TT.
reddyb
February 24, 2015
I still notice myself dragging my toes on the ground here and there, almost as if I forget to pick my leg up sometimes. At this point for me, 3+ years post-op, I’m not sure if this me being more aware of my operated leg, where it happens on the non-operated side but I don’t notice it, or it does happen more on my operated leg.
I’ve never bothered to pay *that* much attention to it, like attempt to count how many times it happens per week, per leg (it’s tough to count the good side because, well, I’m not sure if I just don’t notice it!), but I do notice the operated leg. Being hyper aware of the leg is another aspect to all this. Where it can be tough to turn this off, even years later.
These are some of those awkward things only people who’ve had a surgery like this will understand.
Matt
February 25, 2015
Thanks for the advice. Here is the last question from me
Full disclosure: Surgeon says I have bursitis. Basically I have a sack of water on top of my knee. He says he’s never seen something like this after ACL surgery and if it does not drain he will take it out, but also says the graph is strong
I am having trouble getting full extension as well. guess its more accurate to say, It takes a while. At first when I extend leg it hurts bad around the bottom of the knee cap after a few minutes the knee gets more extension and then after about 5 minutes it goes flat like the other one. This is new for me and appeared after I overdid walking and started doing some heel props on a chair at work to improve my extension. Surgeon says it was good but of a few degrees. This was all about 2 weeks ago, I have no swelling, just some bruising on the bottom of knee cap and a a real sore spot to touch on the bottom inside of my knee just to the inside of the patella tendon.
It was not like this when the surgeon examined me, now when physio asks me to straighten let it take a few minutes for it to “stretch out” and it hurts around the bottom of knee like I said. I live and work in a small town France and I am limited with quality of rehab. The physio has never given me any home exercises to do and just tells me that I have weak quads and hurt my muscles and so i need to re strengthen my quads. Okay, I am fine with that, my concern is the knee pain while working on extension. Any ideas, is this scar tissue, inflammation from over doing it…
Matt
reddyb
February 25, 2015
If you’ve been pushing through pain to generate extension, then that’s pushing it too much. Some discomfort is expected, but there is a line here.
You may want to look into my ACL manual. It gives tons of exercises to do at home, how to work on extension and flexion, and all that. http://b-reddy.org/2014/04/02/the-most-important-phase-of-acl-rehab-copy/
Tangent: Removing a bursa due to some bursitis sounds pretty extreme at this stage.
Taina
August 20, 2016
Thank you so much for taking the time on posting this information. I been reading for about an hour And im right at home …im post op almost 4 months ACl reconstruction and medial meniscus removal i also fractured the femoral chondile. At 44. I didn’t know what i was about to face. Got surgery after 3 weeks and started Therapy after rhe 4 th day..what has helped me its that because i had to do everything myself without any transportation i got on my Bicycle a month after surgery.in my case my strugle became my best friend. Still working at it and sometime my knee locks. Again thanks so much. All this reading encourages me to go at it. Because i know im on the right track and because im not alone in tnis journey.
reddyb
August 23, 2016
Thank you for the nice words Taina. Good to hear you’re finding things helpful.
Curious to know if your doctor has given any thoughts on the knee still locking on you?
Dawn
March 16, 2015
Day 6 after ACL reconstructive surgery. I have had a very rough day emotionally. I literally googled “ACL reconstruction surgeon and depression” and your article popped right up. I read it and started laughing and crying out loud. It saved my sanity today! Thanks! PS- started PT on day two. So far so good but had NO IDEA how slow of a process this would be.
reddyb
March 17, 2015
Hey Dawn,
Glad to hear the article gave you some relief :). It always helps knowing others have had / are having similar experiences.
Best of luck with things. Hope you find more help here if you need it.
Suraj Patel
August 9, 2015
Hi there I have my acl reconstruction and meniscal tear op this Tuesday I wasn’t to concerned as my bestmate under go his last summer but did it privately where as I waited 7,on the for them to finally send me for the Mri scan I am after reading this concerned now as you state not everyone’s the same, I think I’m just looking for re assurance here and any last minute advice pre op and I have to play football again I will die if I don’t honestly.
And I must say thank you for this article really helps you to not feel like your going through it all alone especially as my surgeon didn’t even introduce himself to me but he does all the Leicester Tigers rugby players torn acl so I suppose I can’t blame him for being an arrogant idiot but still.
reddyb
August 11, 2015
Hey Suraj,
Sorry as I didn’t get to this before your operation. I wouldn’t be concerned with football immediately post-up. That’s a ways off when it comes to recovery. I’d recommend taking things one step at a time, and seeing how far you can take that. There is an element of crawl before you walk, walk before you run, to all this. Trying to run too soon only messes this process up.