6 Keys to the Early Phases of Rehabilitation Following ACL Reconstruction Surgery

Rehabilitation following ACL reconstruction surgery has evolved significantly over the last 25 years.  We have progressed from casting the knee to allowing immediate motion and weight bearing in just a short amount of time.  As our understanding of rehabilitation concepts continue to evolve, our focus has shifted towards functional exercise and rehabilitation progressions, which is integral to maximize results following ACL reconstruction surgery.

We are now seeing professional athletes absolutely dominate their postoperative rehabilitation.  Adrian Peterson is now going to be the poster-boy for return to sports after ACL surgery after tearing up the league and winning NFL MVP just months after having ACL reconstruction surgery.  While, AP is definitely the exception, not the rule, the postoperative rehabilitation is a huge factor in determining how well people recover from surgery.

While everyone wants to talk about advanced exercises and return to sport, it is probably infinitely more important to assure that the early phases of rehabilitation go well to avoid complications and allow more advanced drills down the road.  If the early phases of ACL rehab go poorly, you will surely be behind for the duration of your rehab.

On that note, I wanted to discuss the 6 keys to the early phases of rehabilitation following ACL reconstruction surgery.  Master these basics and the advanced phases get easy.

 

Diminish Pain and Inflammation

early rehabilitation following acl reconstruction surgeryThe first key to ACL Rehabilitation is simple, diminish the pain and inflammation associated with the surgery.  While this is a no-brainer, it is worth reviewing why this is so important.  Really, the following list of keys to ACL rehabilitation are all going to be difficult to achieve without addressing the pain and swelling.  Here are just handful of important things to consider:

  • Pain and swelling has been shown in numerous studies to essentially shut down your muscles around your knee, specifically your quadriceps.  Even a small amount of fluid in the joint has been shown to decrease your ability to contract your quad.
  • Without a quad, it is hard to function, and you tend to walk around with a bent and stiff knee.
  • Pain and swelling will limit your range of motion progression.

So, as simple as this concept may be, diminishing pain and inflammation should be an area of focus initially after surgery.  Compression wraps, ice, intermittent compression machines, elevation, ankle pumps, electrical stimulation, and not pushing through too much activity can all help.

My biggest advice to patients after surgery is that you can’t ice too much.

 

Restore Full Knee Extension Motion

Loss of knee extensionRestoring full knee extension range of motion could be the #1 key to rehabilitation following ACL reconstruction surgery, however I chose to list it second here because addressing pain and swelling has implications for everything discussed in this article.  Really, though, my focus is almost always directed towards restoring full knee extension as soon as possible.  One of the more common complications following ACL surgery is loss of motion, with loss of extension being more troublesome than flexion.

When pain and swelling is present, it is just more comfortable to hold your knee in a slightly bent position.  Keep it this way too long and you run the risk of developing scar tissue, or arthrofibrosis.  Restoring knee extension immediately after surgery is so important, because once it gets tight, it’s often hard to get your motion back.  I’d much rather focus on this initially and slowly restore motion than get too tight and then have to aggressively attempt to improve motion.  That is never preferred.

Loss of full knee extension does not allow the knee to function properly, even if just a small loss of motion.  Plus, studies have shown loss of motion to be one of the most important factors associated with the development of arthritis after ACL surgery.

Luckily, with proper rehabilitation, loss of motion can be avoided.

In addition to my range of motion, soft tissue mobilization, and manual therapy techniques, I always instruct patients to perform a lot of range of motion and stretching exercises at home, essentially once an hour.  I like to show them hamstring stretches and calf towel stretches.  I don’t perform these stretches to really enhance hamstring and calf flexibility.  I perform them and instruct the patient to also work on knee extension at the same time.  So the focus is essentially knee extension.

Knee Extension Stretch ACL Reconstruction

Towel Knee Extension Stretch ACL Surgery

If loss of motion starts to become a problem, I don’t hesitate to start to introduce low-load long-duration stretching.  My goal is full knee extension by 1 week after surgery.  Biomechanical studies have shown that the stress of the ACL graft when stretching into extension is below the forces seen during common functional activities, so there is no need to avoid this motion.

This is such an important concept, that you may want to review my past article dedicated to restoring knee extension range of motion.

 

Gradually Progress Knee Flexion Motion

Knee Flexion Range of Motion ACL RehabilitationAlthough loss of knee flexion doesn’t tend to be as common as knee extension, it does happen and you don’t want to neglect working on flexion.  There is often a see saw between flexion and extension.  The more you work on one, the more you tend to get stiff in the other direction.  This is reduced by working on frequent bouts of gentle but progressive range of motion.

I also like to empower the patient to also work on restoring knee flexion, both by stretching as well as through functional motions like mini-squats and eventually lunges.  When the patient can control their range of motion progression, their perceived threat is reduced and motion often comes back easier.

Knee flexion is restored more gradually, with about 90 degrees achieved at 1 week and full knee flexion gradually advanced and achieved by week 4-6.

 

Maintain Patellar Mobility

Patellar Mobilization ACL RehabSometimes one of the reasons that range of motion is reduced is because patellar mobility is lost.  Full patella mobility is required for knee flexion and extension.  As the knee is painful, swollen, and difficult to move, scar tissue can form and limit patella mobility.  This is especially true if a patellar tendon graft is used for the ACL reconstruction surgery.  If patellar mobility is neglected, the chances of loosing range of motion goes up significantly.

Soft tissue mobilization around the knee and patellar mobilization is performed immediately after surgery.  I also like to instruct patients on how to do this themselves and add it to their homework.

 

Restore Volitional Quad Control

NMES quad ACLAs previously mentioned, there is a reflexive inhibition of muscle control around the knee after surgery due to the pain, inflammation, and swelling.  In addition to address these factors, there are techniques that can be performed to help restore volitional control of the quadriceps muscle.

Lynn Snyder-Mackler, at the University of Delaware, has produced dozens of articles on the use of neuromuscular electrical stimulation (NMES) on the quad follow ACL surgery.  Essentially, NMES helps restore quad strength and function faster that just exercises without NMES.

Naturally NMES becomes an important component of the early phases of ACL rehabilitation.  I will superimpose most early quad exercises that we perform with NMES.  This includes quad sets, straight leg raises, and knee extension exercises.

An added benefit of all these quadriceps contractions is that this also helps restore knee extension range of motion.

 

Restore Independent Ambulation

Retrowalking ACL Rehabilitation

Now that we have addressed the pain and swelling, started to restore motion and patellar mobility, and can now turn on the quads, we put it all together to work on being able to walk without limitations or a limp.  If any of the previously mentioned areas of focus have not been addressed, independent ambulation is often going to be difficult, or at least impaired.

I usually have people weight bearing as tolerated around week 1, unless other structures were damaged or need to be protected.  We may continue to use the crutches for up to two weeks, however, I still want them to be able to walk and just use the crutches as assistance, rather than, well, a crutch…

I have found weight bearing exercises like weight shifts that focus on transferring your weight and locking out your knee can be helpful initially.  I also tend to use cone walking drills to help groove the pattern of shifting weight and transitioning to single leg stance.  I have also found backward walking while stepping over a cone to be helpful to rock the body back over the foot and assist with achieving knee extension.

 

More Information

Those are my 6 keys to the early phases of rehabilitation following ACL reconstruction surgery.  I try to focus on each one of those keys during each session I have with a patient.  These 6 keys are so important, that I would rather increase my visits early in the rehab process to assure that these are all addressed, then try to conserve visits (per our insurance limitations).

SEE ALSO: Download a free copy of my ACL Rehabilitation Protocol

Really, this is just the tip of the iceberg.  If you haven’t seen it yet, my coauthor Kevin Wilk has contributed 4 different webinars of  4 hours of content detailing exactly how he rehabs people following ACL reconstruction.  Kevin is no doubt one of the best there is at ACL rehab.  He and I have probably rehabbed over 1000 ACL reconstructions in our careers, including many professional athletes.  If you want to learn from the best, take a look at Kevin Wilk’s ACL Rehabilitation webinar series at RehabWebinars.com.

Wilk ACL Rehabilitation

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73 Responses to “6 Keys to the Early Phases of Rehabilitation Following ACL Reconstruction Surgery”

  1. Trevor Winnegge PT,DPT,MS,OCS,CSCS Reply March 18, 2013 at 7:50 am

    Mike,
    This is a great post and a must read for anyone treating ACLs-especially new grads. Patella mobility is often neglected, and I can’t agree more that this is critical especially in patella grafts. A lot of therapists are afraid to do this too soon but it is CRITICAL! I find, in terms of the patients pain, that there is a direct correlation to their ROM. In other words, once they achieve full, or near full, ROM their pain level is minimal and essentially a non factor. So in my book, I think regaining ROM is the number one early factor. I always tell patients “Ten years from now I can always make you stronger, but if you dont get your motion back in the next 6 weeks, You are going down a road that I may not help you come back from”. So many patients/athletes want to jump into the strengthening so I think it is critical to de-emphasize the strengthening and over-emphasize the ROM early on! Re-directing their focus helps to allow them to understand how important ROM is and how it will speed their recovery. I am amazed, talking to PT’s all over, how many still refuse to use NMES for quad strengthening/activation for not only ACL but for scopes and TKR as well. I am glad you included this in your piece. In our clinic, patients with an ACL reconstruction always get an EMPI Continuum home unit for NMES at home within the first week of PT. I have no financial ties to EMPI-I am just an absolute believer in NMES in the early post of period!!!

    • Trevor, can I ask how you are charging for the Empi Continuum device? I am in the process of updating the ACL program where I work and we have been discussing ways that we can get this unit to patients for home use. Are insurances covering a rental of this or are patients paying for it out of pocket?

      • Eric,
        We order them through EMPI and most insurances cover it. We have a supply on hand in our clinic and issue to our patients, showing them how to use it and set them up with it. Paperwork gets faxed into EMPI and they haggle with the insurance company. Most often it is covered under durable medical equipment benefit for a short term rental (3 months). Some insurances buy it. Others dont cover it at all. contact your empi rep…alot of times they give you some patient poaners for patients who need it but cant get insurance to cover it or cant afford to rent it. If you use them enough, the reps will be more than willing to help you. Hope this helps!

  2. Hey Mike,

    Are you achieving 100% knee extension by the end of week 1? Or more like 90%, but still lacking some of that terminal knee extension? In my brief experience as a new grad I have found I can get the knee pretty straight after a week or 2, but that last little bit of knee extension only comes back with some work over the following weeks and is normally regained 100% around week 4-6. What are your thoughts on this. Am I missing something/are patients not being compliant enough with extension stretches I prescribe? Thanks in advance!

    • Generally, in my opinion, the further out past week 2 you go without full knee extension, the more problems you are going to have…from pain, edema, poor quad activation, poor gait, etc. get it in the first two weeks! Educating your patient on day one of PT as to what to expect and how important ROM is is key. If you scare them enough, they will do it! and get great results!

    • We get full(symmetrical not just 0) knee extension by week 1. Its part of our protocol milestones. The reason you are seeing patients lose that little bit of terminal knee extension in between visits is usually because lack of volitional quad control and subsequent gait deviations. They need to continually use that terminal knee extension during gait in order to maintain it. You can keep re-gaining that bit of extension each time they visit with stretching but until they use that ROM functionally they will not own it.

  3. Mike,

    What are your thoughts on regaining full knee extension with someone who has significant genu recurvatum? Are you trying to get the extension to match the other knee? Also, what are your thoughts on SAQ/LAQ for quad recruitment? I have read so many articles stating it should be avoided because of too much “stress on the ACL”. I have also read other articles stating the stress is insignificant and may be beneficial to strengthen the tendon. I also agree with Trevor that NMES is frowned upon by many PT’s, but provides great results. Thanks for the post!

  4. I was reading an article last night that talked about using open-chain exercises because research is showing there is not as much stress on the ACL as once assumed.

    • Martin van Hoppe Reply March 24, 2013 at 7:43 am

      Hi Mike,
      Be careful using a traditional quads bench though. X-ray films (!) show very large tranlationary forces due to the artificial point of rotation placed upon the knee by the bench. 35 flexion to full extension seems to be safe though.

  5. Interesting stuff, I got ACL surgery November 22, 2011 and i dont have full range is it still possible to get full range?

  6. I had my ACL reconstruction on 26th April 2013, for first 3 weeks rehab was going very well. Full extension after 1-2 days full ROM in 1st week. My PT & surgeon both very pleased. But now at week 4 a lot of swelling is back around the knee and very sharp pain from muscle at back of knee. Making it tough to fully straighten as done before. Making me walk with a limp again and causing pain in calf. Any thoughts?

  7. Had my ACL reconstruction on 26th April 2013, for first 3 weeks rehab was going very well. Full extension after 1-2 days full ROM in 1st week. My PT & surgeon both very pleased. But now at week 4 a lot of swelling is back around the knee and very sharp pain from muscle at back of knee. Making it tough to fully straighten as done before. Making me walk with a limp again and causing pain in calf. Any thoughts?

    • Hi Mike,
      Just had ACL reconstruction using an Allograft on Sept.4 th. I also tore my MCL and Medial meniscus. At 48 hours in , I still have a bulky dressing and ace bandage on which is limiting my ROM. As well, my attempts at icing have been futile since the cold does not reach the site. I see my surgeon in 2 weeks and have not received instruction re exercises in the interim. After reading the articles, I already feel like I have fallen behind. Bulky bandage comes off later today. What to do?? I have crutches and I am allowed to toe touch weight bear. I feel very stiff but have only taken pain killers twice since I got home. Will my initial rehab be modified because of the involvement of the other ligament and cartilage? I am 54 and quite anxious to get back to my competitive soccer and volleyball. Also, I was to groggy when the surgeon spoke to me post op , so I don’t know the extent of the procedure. I think the meniscus was trimmed??

  8. Hi all, hi mike,

    I have the same problem as NAS, for the first 3 weeks everything was well, now I am in the 4 th week after ACL reconstruction using hamstring graft, severe intense pain behind my knee, with non stop pain, and I am limbing again, my doctor said it is normal, but I don’t think so,

    Any advise?

  9. Hi Mike,

    I had ACL reconstructive surgery three weeks ago today. I’ve still got some swelling and I’ve not got full bend on my knee yet. I was told to use crutches for six weeks and I’ve can’t get an appointment with a Western physiotherapist (I live in South Korea) until next week (week four since the operation).

    My first question, is it normal to have some swelling on the knee after three after the operation date?

    My second question, is there anything I can be doing in the interim before I start physio?

    Finally, will having physio four weeks after the operation be a massive problem for me making a full rehabilitation?

    Many thanks, all help is appreciated.

    Gareth.

  10. Hello, Mike~
    I am an almost 44 year old female. I had ACL reconstruction on July 17th (5 weeks ago). My physician used a cadaver graft. I have full range of motion, as well as a full knee extension. I gave up crutches at 2 1/2 weeks. So, all seems to have gone well. My question is…how long will it be before I can walk, without limitations? I feel that I can’t even walk from one end of our mall to the other. I am supposed to go on vacation the week of October 6th. I am worried that I won’t be “normal” by then. Any thoughts?? Any specific exercises that you suggest for home? Thank you so much.

  11. My son has had a full ACL Reconstruction five days ago as well as a miscus tear fixed in the same knee. He does not cope well with anesthetic and is still unwell. He is still in quite a lot of pain every time he gets up it is painful and even when he moves in his bed. Is this normal to be in so much pain? He is doing some excercises like moving his toes and trying to move his ankle still very swollen and is unable to move his knee is this normal?

  12. My husband had ACL reconstruction (hamstring graft) combined with some of his meniscus removed 3 weeks ago. He is still in some pain and also has quite a lot of swelling around his kneecap area (despite frequent icing) which is preventing him from obtaining full extension. How soon should the swelling be reduced and will him not having full extension at this stage have consequences for the future?

    • Swelling needs to get out ASAP. If he is trying to control swelling with ice, compression, elevation, etc and it is not improving he may be too active. But it is hard to feel good and achieve your other goals with swelling present.

  13. ACL’s are done much differently than when I had my done 30 years ago. I have the 8″ incesion down the front of the knee. I was in a plaster cast from the upper thigh to my toes for 3 weeks. No rehab at that point. The next 8 weeks I was in a split cast with hinges at the knee. That was first time I was able to start moving the knee joint and start to gain mobility. Stretching was somewhat painful but necessary. I had to promise my surgeon prior to surgery that I would commit to rehab. A torn ACL is not life threatening. After the hinged cast was off, I went to phyical therapy. He measured the motion of the knee and my leg strength; he was inpressed. He released me within two weeks as I was way ahead of where I should have been. While at physical therapy, I did notice a girl who also went thru a ACL repair. Her range of motion was very limited; I felt bad for her. Either she babied the knee or had an inferior surgeon. After 9 months I was 90% ‘normal’. I did tape up the knee and wear a brace when playing sports; just didn’t want to re-injur the knee. A couple of years later I did away with taping and the brace. I continued to play baseball and eventually had a successful boxing career. While my knee is good, I still will not put it in a position where it is vunerable. One surgey is enough. Bottom line is you got to commit to rehab.

  14. Hi mike, how long after ACL surgery should i be able to swim?

  15. Hi Mike,

    I had my right knee synovectomy arthroscopy surgery on 10th july, 2013. I still have swelling above knee cap area and it varies with exercises and it cause little pain when touched.

    I am doing PT exercises except squats taught by my Physiotherapist. I am also doing cycling on stationary cycle for around 3 minutes at present.

    Is it normal to have swelling after 2 and half month of synovectomy?

    What should i include/avoid in my activity to get rid of swelling?

    Thanks and Regards

  16. Hi Mike,

    I stumbled across your site about 3 weeks ago. Had ACL surgery on Wed Nov 6th, 5 days ago, have followed your 6 rules to a tee, already have full extension, about 95 flexion, using crutches more out of fear, but I actually can weight bea, albeit tentatively, am icing it constantly, especially through the night the first 3 nights. My first physio appointment is next Wed, but Ive been doing all your recommended exercises at home. THANK YOU for all the info. I am committed to a full recovery and to get back to playing tennis, squash and skiing…….and I am 57.

  17. Hi Mike,

    I had my Acl reconstruction surgery using hamstring graft on Oct 17 th 2013(4 weeks back).
    I have full extension (0 degree). When will I be able to get full flexion ( leg touching the butt)? Also how to get minus degree extensions?

    My flexion is a lil over palm size more to touch the butt.

    The swelling has gone down considerably but there is still slight swelling around knee and on thigh around knee. Is it normal and will gradually reduce or should I concentrate on reducing it more? I am taking 1 Advil every night for anti- inflammation.

    I hstarted walking without crutches after 2.5 weeks and occasionally don’t wear brace around house.

    Also I go out for walking. Is it safe to walk for long time say an hour at a stretch?

  18. Forgot to mention that I ice my left knee regularly ( all through night as well).

  19. Hi mike,

    I just had acl surgery 2 weeks back.I have been getting around on 1 crutch for the past few days.I have full extension and pretty good flexion.Today after pushing the heel slides a bit too much, I feel little unstable while walking and hurts the back of the knee a bit.I am just paranoid about having done damage to the graft.Any ideas?

  20. I have a player who is 17yrs old on my fastpitch softball team who had ACL reconstructive surgery on the 26th of December. Her doctor tells her they aren’t really doing physical therapy after acl surgeries anymore?? I went through the same surgery 16 years ago and physical therapy seemed to be the most important part….what does she do?

  21. Hi,
    My son had ACL surgery 09-21-12,and they released my son (Seth) back to reg. activity 5/2013. He plays Baseball, football, and basketball. We are not sure what exercises he needs to be doing to build the muscle around his knees. I have been told he is to never do squats with weights or lunges. Is there any way you could let us know what we need to be doing?? Please we need help on this. It has been a year and 3 months since surgery.

    PLEASE HELP!!! He is a major athlete and is has scouts watching him.

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  23. I’m a victim of runner’s knee, worst injury ever!! I like your tips & advice for recovery. In my experience the epsom salt bath worked sometimes, but sometimes it triggered pain too. Mine was really wacky, kept me off running for 4 months. I can’t stand runner’s knee. I hate that every time I run it’s always in the back of my mind that it can flare up again. I’m sorry to hear it lasted so long. It’s the worst! http://www.mykneestretches.com/

  24. Just wondering what your favorite exercises and/or activities were while performing NMES post ACLR or TKA?

  25. Hi Mike,
    Thanks for the useful information.
    I did my acl reconstruction surgery about 3 months ago (19th of Nov 2013). My ROM before the surgery was about 120 degrees flexion and with hyperextension. I told my surgeon about it and he said Ok to perform the surgery with limited ROM. Now, after 10 weeks of intensive rehab i can achieve about couple of degree of hyperextension and around 130 degrees with assistance. However, these flexion degrees tend to go away after the PT. The worse time is when i wake up. My flexion in the morning around 100-110 but as i start moving around, it starts to improve. Is there any chance i could improve my flexion ROM or i will live with this for the rest of my life?

  26. hi, i just briefly browsed through this article and im worried now. i had acl reconstruction on 31st dec 2013. its over 45 days now but i am still experiencing pain in my knee. from yesterday my ankles have also started swelling up. i dont know technical terms but i cannot fully bend my knee backwards as in heel to butt. i also cannot squat fully. and the part below my knee..the shin…it is swollen with some kind of hard swelling and very less sensation. i can only feel pain there if i press very hard. i am in a place with no access to doctors or physiotherapy. i am also overweight. i walk with a slight limp but otherwise have no difficulties. am i in trouble? do i need to consult a doctor immediately? or is this all normal. is there anyway to self rehabilitate without the help of a physiotherapist?

  27. Mike, my son is 9 wks post acl repair. Was doing extremely well. Last week Pt notice his one quad muscle interior was not building up the exterior is fine. She recommend some exercise. The one ex that I was worried about was a lunge with the knee out to the side, rather than the knee straight over the foot. Yesterday he went to step out of a bus and he said the knee popped out. And today just walking down stairs with out a brace on he said it feels just like it did before surgery, he see his dr on thurs. I am very worried he has over done something and the surgery is no longer holding, Do u have any suggestions? Cindy

  28. Hey Mike, I have just done my ACL surgery on 28/2/2014, and I am 3 days post-op.

    My knee is doing extremely well, with little swelling and pain. I can achieve about 90-100 flexion and almost full extension now without pain. Is it normal? Or is something wrong because the progress appears too fast compared to others?

    Thank you!

  29. Hi Mike,

    I undergone ACL reconstruction surgery on 5th Nov 2012. After 6-8 months of continuous cycling, I got good muscles around my knee.However once I stopped doing that I have lost all the muscles and my operated leg has also become very thin.

    Further more I have developed varicose veins in my left leg and they are more prominent in the below knee part of operated leg.I have visited couple of doctors but they have different views over it, some says that I should not do any exercise which puts strain on lower body as it will increase varicose veins problems and some doctors are advising me to undergo another surgery for varicose veins.

    I am totally confused now about what I should do now, whether I should start doing exercise to strengthen my operated leg muscles or should undergo varicose veins surgery first.

    Please suggest something.

    Thanks in Advance!!
    Vijay

    • What is more important to you? strength and function of your leg? or how the veins look?

      • Hi Mike,

        First of all, I would like to thank you for taking some of your valuable time out and going through my query. A big thanks for that. :)

        Regarding your question, I am not too sure about what should be more important for me, as I have very little knowledge of varicose veins, the only knowledge that I have about varicose veins is the one that I have acquired through Google or from the doctors whom I have consulted till date, and I have got mixed replies, some doctors say that varicose veins are not that dangerous and I can continue exercises except those which puts strain on lower body, while some doctors are suggesting me to undergo surgery for varicose veins.

        And frankly speaking I am sorry to say that ,I have stopped believing in doctors here in India, because in our country most of the doctors are money oriented and doesn’t give proper advice, all they want is money.

        So I am quite confused and frustrated about what should I do.

        Are varicose veins really harmful or are they only cosmetic flaws??

        Please suggest something, I desperately want to be fit and healthy again.

        Thanks in Advance!!!

        Vijay

  30. Hi Mike,

    Great article, wish I had seen this 6 months ago when I had my ACL op. I’ve spent a lot of money on physio and I still don’t have 100% flexion.

    Due to this I have been told I shouldn’t road run yet but to do 15 mins running on the treadmill. It sounds like I am miles behind where I should be – any suggestions?

    Thanks

  31. Hello. Before I ask my question, here’s my history. I had an unusual scenario. At age 38, I tore my meniscus (which was a bucket handle tear) and tore my ACL at the same time, while skiing almost a year ago (mid April ’13). There was a 4 week delay between my accident and my last surgery. To start, it took me a week to be seen, after not being able to walk b/c my knee was locked and b/c (although unknown at the time) I had no ACL. Apparently, my MRI didn’t show my ACL was severed and I guess my doctor didn’t have a good ACL available, and after seeing inside my knee, he realized that he could ‘repair’ my meniscus, which I guess is rare (less than 5% chance) b/c the tear was on the bloodline – and even more rare that someone my age and weight (ie I’m on the heavier side) and almost 40, would have a healthy enough knee, that he would risk a repair. So, we schedule my 2nd surgery – 2 weeks later, b/c my husband/caretaker would be out of town the week before. I woke up from the 2nd surgery in the worst pain I ever thought possible. My outpatient surgery (16 hour release) turned into a 3 day stay hospital stay and another 4 days of agonizing exhausting pain at home. Oxycontin didn’t touch the pain. Day 7 I stopped taking all pain pills (accept ibuprofen), went through a severe 24 hour drug withdrawal, with terrible anxiety, for the following 3 days — note I’ve never been addicted to anything and rarely even drink. Day 10 saw my physical therapist, twice a week for 3 months and continued for 3 more months, once a week. B/c of the meniscus repair, I was kept in a brace, which allowed for slow extension increases every week. At home and at physical therapy, I had to force my leg to bend and it was a VERY painful process the first 2-3 weeks! Once I got to 90 degrees it got easier and I’m now at 120 or so. I workout 3-5 days a week, with the goal of 5 – doing strength training and water aerobics. However, I’m concerned that although I don’t feel any knee pain while walking unless it’s a lot, my knee does get stiff and hurts to bend and straighten it. I also still feel uncertain using stairs, confidently. I hold onto the rail like I’m 80. I know every patient and scenario (especially mine) is different, but what is the likelihood, this pain and stiffness will continue? And was the delay between my accident and surgeries have any bearing on anything, my pain, my recovery, and/or my continued stiffness?

  32. I had knee surgery Dec 20 to remove – believe it or not- cement left in by a previous doctor in surgery in October. I had been in horrible pain and my knee was swelling all the time. Now I am in PT. It hurts a lot for like 2 days after PT- is this right? Also, now I apparently have bad arthritis in that knee and it hurts all the time- esp when walking. Can surgery (multiple knee surgeries, foreign bodies in knee) cause or exacerbate arthritis?

  33. Thank you for a great article. I’m 3 days out of ACL surgery & near to 100% full extension. My flexion is ok but I’m get that back little by little everyday until my physio. I cannot stress enough how right mike is about icing. I’ve done it for every hour on most of my lower leg at the same time as putting my foot on a towel & letting the knee slightly hang as was told this is a good way to get back extension. It hurts but only from surgery nothing excruciating. I also agree with mike about pre surgery regime. I’m a “action actress” & I dance, do martial arts & gym it! I was doing gym 3 times a week plus physio at Isokentic twice a week & they were saying nothing is more important than strengthening up the leg & almost making it feel like u don’t need surgery. Boy were they right. I’m walking ok crutches quite well considering I’ve had surgery. You have to put the time in & after get the swelling down. As I’m icing I’m also pumping my ankle to get the blood pumping.
    It’s easy to get down after the op but just keep being positive & ice is your friend! Thanks mike!

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  35. Hi Mike,
    I see that the empi continuum is $1000.00. Is there a less expensive unit you recommend? For example the EMPI 300 PV for $90.00?

    http://www.ebay.com/itm/Empi-Electrotherapy-Physical-Therapy-Complete-System-Kit-Home-300PV-NMES-/331177001550?pt=LH_DefaultDomain_0&hash=item4d1bb0024e

    Thank you

  36. Hello! I would love to follow a more aggressive rehab protocol such as this, and I wonder if it’s possible given the nature of my reconstruction – ACL & PLC using hamstring grafts from both legs and meniscus repair… a rather bad tear from what I understand. I’ve been told NO weight bearing for 2-4 weeks, no Physio until the staples are out, zimmer splint for 2 weeks and then I need to get a custom one that bends at the knee.

    Is this common protocol, because it feels very conservative to me? I should also mention I have hyperextension syndrome if that makes any difference.

    Thanks in advance!

  37. Thanks in favor of sharing such a nice thought, piece of writing is nice, thats why i have
    read it entirely

  38. I have torn both ACLs, I’m currently about 2 weeks out of the second one. With the first and second one the orthopedic center I had received both surgerys from they have put me in an Immobilizer brace, each times they have not bent my knee to the fullest in the early stages at all.. With the first one it took me about 2 months to reach full range of motion (give or take a few weeks) and I was back freeskiing within 4 months post-op. That being said I don’t agree with the article, what are the benefits to this approach?

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  40. Hi, everyone, 6 months ago I had surgery on my left knee, acl full thickness tear and meniscal tear. They took a graft from my hamstring…pretty much had to learn to walk all over again, 8 months later I’ve Toally lost the teardrop mussel in my leg. It still hasn’t come back..now I’m at the stage of doing a intense gym program to try and retrieve that mussel.

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