ACL Surgery Recovery
I fully tore my ACL, and partially tore my LCL and MCL due to a ski accident. I’m a fairly active female in my mid 20s. Before the injury I was regularly cycling, occasionally running and occasionally doing yoga, frequently skiing, and frequently going on backpacking trips or day hikes with substantial elevation change.
After I tore my ACL and was told that I needed surgery, I scoured the internet trying to find out what the surgery was going to be like, what the recovery would be like, and just every bit of detail that I could gather. I decided to keep a log of the high level recovery process. As a disclaimer, this is my individual recovery process and yours might be very different. I had an achilles tendon allograft, which means that my recovery may be very different than someone who uses their own tendon. I also waited 8 weeks between my injury and surgery due to a mix of extenuating circumstances and also to allow my acute injury to heal. During this time, I had physical therapy once a week and was going to the gym regularly doing both strength and cardio (stationary cycling) to strengthen my knee in preparation for surgery.
March 21, 2017
I went in to the surgery center at 11am. Because I was going to be under general anesthesia they didn’t allow me to eat past 10pm the night before or drink past 4 hours prior to the surgery (so,past 8am). My surgery was scheduled to begin at 12:30 and it was an expected 90 minute procedure.
I woke up several hours later with a bandaged up knee and was really thirsty. I was also really unstable and dizzy/sleepy.
Dmitriy drove me home and I hobbled into the house. They inserted a cooling pad into my bandages that connects to an ice chest with tubing. This is to continually keep my knee cold and reduce swelling. In practice it means I’m really uncomfortably attached to a cooler and it’s more difficult to get out of bed since I have to detach things if I want to move. But, supposedly it should help with recovery.
The remainder of the day I was extremely out of it and an infuriating mix of nauseous and hungry. I was able to eat a little bit before my body gave up on food.
Sleep was rough. I kept waking up in the middle of the night in pain since the pain medication only lasts about 4 hours. I have to also consistently take the anti nausea medication since the pain drugs make me extremely nauseous.
My knee is in a lot more pain today than yesterday. I feel like it’s stiffer and heavier than it was the day before. I can put a tiny bit of weight on it, but it’s painful to do so.
No real progress to note — I was still very sore and very stiff, and I was woken up at night by the pain if I didn’t take my pain meds.
I had my follow up appointment with my doctor who told me to continue elevating/icing my knee and to schedule my next physical therapy appointment as soon as possible.
I had my first post-operation appointment with my physical therapist. He very concernedly told me my calf was absurdly and unsafely swollen and instructed me to immediately get some running compression socks and to elevate my leg about twice as high as I had been. I upped my leg to rest on 4 pillows instead of 2 and put on compression socks. After following his instructions for the rest of the day, my calf returned to normal-ish size.
A friend who lived nearby was hosting an afternoon BBQ, so I hobbled over to his house which was just around the corner. I had strapped an ice pack to my knee which stayed cold for the time I was there. In the evening some friends came over and we had dinner and such. By the end of the day it was very clear that I should not have been as ambitious as I was that day and my knee was paying for it. Lessons learned.
I knew I was still sore but I decided to go entirely off of the pain medication and the anti-nausea medication. I had realized that the anti-nausea medication (a generic of zofran) was causing me to have a continual headache, and the pain medication was causing me to have nausea, and I was tempted to keep taking the pain medication because of the headache… So, I stopped the cycle and went entirely off the pain meds and the nausea medicine. My leg hurt, but not enough to wake me up at night anymore. All of Sunday was a wash though, since I had a killer migraine that I think was triggered by the zofran, which after some reading I discovered messes with your serotonin system.
I continued my routine of elevating and icing my knee, though I didn’t keep my knee iced all day as I had and instead used the machine in 30–45 minute increments with my leg returning to normal temperature in between. I also realized that I could start walking without crutches without being in pain (though still in a locked brace). I probably wasn’t supposed to do that yet, though, since my leg was a bit sore afterwards. I started exploring what of my physical therapy routine I could do, and found that straight leg raises were ok, ankle flexing was alright, and quad pumps felt very stiff.
Physical therapy went well. I realized that I actually hadn’t been told to do straight leg raises but rather to keep my leg straight in the brace. Oops. Well, I could do them anyway.
I got permission from my PT to get showers without plastic wrapping my knee, and also got permission to walk around the house without using crutches (but keeping the brace locked straight). This, as you might imagine was a huge quality of life improvement. I was also instructed to keep my leg elevated as much as possible since I still have a lot of swelling, and to ice it directly against the skin for short periods of time (~20 min).
I had PT in the morning and one of the other patients had the same exact surgery that I had (also with a cadaver achilles tendon) and she was 9 weeks post-op. Her knee looked fully functional, and she was walking around without any kind of brace. I’m sure she still has some amount of instability and still needs to be careful doing sports, but it was really reassuring to see someone who had gone down the same path as me and was doing really well.
At PT, he started me on the bicycle for the first time and I was able to slowly and carefully do backwards and forwards pedaling, which was a huge milestone for me. My knee was really tight, however, and so I had to be extremely cautious about using the bike and to not push my knee further than it was willing to go.
I also had my post-op appointment with my surgeon later that day, and he took out the sutures.
I started working this week, but I was still working from home. My PT had requested that I work from home in order to keep my leg elevated during the day. It’s quite difficult to work on a laptop while keeping your knee elevated above the level of your heart, so I wasn’t working fully normal hours and instead was taking time in-between to elevate and ice my knee. Working from home also allowed me to do my PT in the middle of the day, so I was doing my exercises 2–3x a day, and I also started using the stationary bike 2–3x a day for 5–30 minutes at a time depending on my pain level. I found that in the evenings my knee was much more stiff and it was harder for me to do a full rotation, but if I was careful I could rock the pedals slowly back and forth until my knee allowed me to go around fully.
My passive range of motion was also measured at 112 degrees, but it was a struggle to get it there and it was quite painful.
I got permission to start walking around outside with only one crutch, but I was told that I should keep my knee brace locked straight when walking, and that was probably going to last until 4–6 weeks post op. I wouldn’t be allowed to unlock it while walking until my quads are sufficiently firing. I guess many more quad sets are in my future. Quad sets, by the way, are still fairly painful for me. My knee is pretty stiff and while I can sometimes get it fully straight, it strongly depends on the swelling level of my knee.
My passive range of motion had improved to 120 degrees, and this time it was much less painful when my PT measured it.
I got permission to stop using any crutches, and to unlock my brace when walking around.
I met with my surgeon for the 4 week follow up and he told me that I was doing really well and no longer needed to use the brace at all. Active range of motion was up to 156 degrees so basically full range of motion.
I had started walking around much more outside — sometimes doing up to 11 miles in a day. I also started doing some outdoor hikes (~6 miles, up to 1800 feet elevation gain/loss). My knee was sore, especially in the joint, but I could finish the hikes without too much pain. I find that my knee feels better if I stick to wearing my compression socks. I’m also still supposed to be icing it daily, but that doesn’t necessarily mean I’m good about doing it. Also, technically my surgeon cleared me to bike outside, but proceeded to tell me horror stories of patients who started too soon. So, I decided to be patient and not throw away the past 2 months of recovery, and to wait until 12 weeks as suggested.
I started biking outside again. Some pain in my knee, but it definitely feels good to be able to bike again.
3 months (14 weeks)
I ran my first mile on a treadmill (12 min mile, so super slow). I could feel my gait was unequal and I tried really hard to focus on evening it out, but I also had pain upon each step for impact. :(
I also did yoga for the first time, and had difficulty with my muscles being super tight, in addition to child’s pose is really painful to bend my knee so much while also applying weight to it. But, gotta start somewhere.