ACL Reconstruction Surgery Recovery - First Month

Written: 6/1/2013 By: Ryan Hogue

Warning: If you're squeamish, some of the post-op images are graphic!

The first week after ACL knee surgery is the most painful. You'll want to exercise caution when moving around, and stay on top of your rehab exercises.

Day 1 (Day of Surgery)

Pre-op notes:

The night before surgery, don't eat or drink after midnight (minimize water consumption)
My surgeon allowed wearing shorts during the operation (if the length wasn't too long)
They shave your leg around the knee beforehand

Post-op notes:

When you wake up, your leg will have gauze on the incision wounds, an ace bandage wrapping the gauze, and a tall knee brace keeping your knee in place.
They wheelchair you out of the building
You will need to sprawl out across the backseat of a car, to keep your leg straight (front seats would likely cause your knee to bend, which will be uncomfortable)
I was able to walk without assistance from the car to my house, but it's a good idea to keep a cane or crutches with you.
You're encouraged to spend the day relaxing, while taking blood thinners (Advil), and keeping your leg straight, elevated(above your heart ideally), and iced.

Pain levels & Sleep:

Pain - 3

After ACL reconstruction surgery pain levels were about a 3. They gave me oral pain pills about 20 minutes before the operation, and injected numbing drugs that kept my knee pain free for the entire day, including while walking on it.

Sleeping after ACL reconstruction surgery can be tough at first. We brought my mattress down to the main floor of our house, so I never had to deal with more than 1 step at a time while getting around. I tried to sleep on my back at first with my leg elevated, but ended up sleeping on my side (opposite my injured knee) which was much more comfortable. I didn't take pain meds before bed, but I would recommend it if you think you'll have trouble sleeping like I did. Also keep in mind, you'll probably be sleeping in your knee brace (if you take it off, remember to put it back on if you have to pee in the middle of the night).

Video of me walking after ACL reconstruction surgery (~8 hours post-op):

Day 2

Pain - 8

About 22 hours after I had ACL surgery, the knee pain had started to creep back in (I still hadn't take any pain meds other than blood thinners to fight inflammation). I waited on taking knee pain medication for as long as possible to see how bad it would get, and after about 3 hours of increasing knee pain, it was probably an 8 on a 10 point scale of pain. At this point, I started taking the pain meds.

Exercise

After the pain meds kicked in, I began the basic ACL repair exercises regimen, 10 sets of each:

10 second hold: push your knee down into the floor
Flex your foot forward and back to stimulate blood flow in through the leg
10 second hold: straight leg lift
10 second hold: push your heel down into the floor

I repeated these once an hour, as instructed, and tried to walk around and stretch. With pain meds, it was manageable. The point of the exercises is to prevent scar tissue building up as the new ACL heals that would limit the knee's range of motion. For a better, more full list of my ACL reconstruction rehab exercises, check out the Rehab Exercises page.

Day 3

Pain - 4

The knee pain after ACL surgery started getting better today, after getting worse on day 2. I continued to take the knee pain medication to help with the ACL exercises and moving around. On day 2 I felt the pain inside my knee, but today it had subsided from inside the knee and was limited to where the ACL reconstruction incisions were.

I took the ace bandage off today to see relieve some of the pressure from my knee and see what the gauze underneath looked like.

Day 4

Pain - 3

The knee pain continued to subside, and now that it had been 4 days since ACL surgery, I took only one pain pill in the morning.

The surgeon who performed my ACL surgery told me I could shower today. His instructions were to take the brace and bandage off, and to wrap the gauze that covers the incisions with plastic to prevent them from getting wet. We used masking tape to hold a plastic bag to my knee, and it worked like a charm. Finally showering after ACL surgery was great.

While wearing the leg brace, I was able to go out after ACL surgery to my friend's BBQ and stand on my own for around 2.5 hours.

Day 5

Pain - 2

I didn't need any knee pain medication today, as the pain following ACL surgery has continued to subside since day 2.

We changed the gauze that covered the incisions, as it was beginning to slide off as swelling went down (and it was a bit bloody). We also continue to adjust the knee brace for comfort each day.

Day 6

Pain - 5

As the swelling in my knee went down, the gauze became looser and eventually fell off my leg. I showered again today and then put new gauze around the acl surgery incision wounds.

While the original gauze was off, I felt around the exterior of my knee and noticed half of it was numb. As the full range of feeling returns, I can feel more and more pressure in my leg when I walk on it. After not taking any pain meds yesterday, I took one earlier in the day to cope with the new pain of moving around (I was home alone and had to walk more than usual).

Day 7

Pain - 8

I scheduled an appointment with the surgeon who performed my ACL reconstruction surgery to make sure that the sharp pain I felt each time I stood up wasn't the result of an infection. After not needing any pain meds two days ago, I now feel immense amount of pressure and pain in my leg while standing (or having my leg in a vertical position).

The appointment was short, as doc checked my leg, replaced the old bloody bandages, and sent me on my way. He also added Aspirin to my daily regiment (making it 6-9 200mg Ibuprofen, 1 325mg Aspirin, and Vicodin as needed)

Week 2 (Day 8)

Pain - 5

Today the pain that occurs when my leg is vertical is starting to subside (rather than continue to get worse)!

Week 2 (Day 9)

I had a 5 minute appointment with the Dr. today and took the stitches out of the two large incisions. The stitches were underneath the skin, so all he had to do was pull one end with tweezers to remove them. I was instructed to wear the knee brace for another 2 weeks, totaling about 3.5 weeks since surgery.

For the first time, I was able to go to the gym after knee surgery, and do an upper body workout while wearing my brace. I made sure not to put any pressure on my weak leg while exercising, and everything was fine.

Week 2 (Day 10)

The next step in my torn ACL recovery began today with the first session of physical therapy. The therapist educated me on the knee rehab exercises and how to concentrate on doing them properly, and assigned me some new exercises that focused on strengthening the muscles around the knee as well as helping me bend my knee and get its range of motion back. They also took initial measurements of my knee's flexibility and range of motion.

The therapist also recommended that I wear the knee brace while walking, all of the time, and reiterated the importance of wearing it while performing leg lifts (I had stopped wearing it thinking my leg was strong enough, which wasn't the case).

In total, I have 12 physical therapy sessions scheduled over 6 weeks.

Week 3 (Day 15)

Pain - 0

Today marks 2 weeks since I had ACL surgery. You can tell from the picture that my knee swelling has gone down significantly, and the bruising is subsiding. The doctor told me that the strips over the incisions should fall off on their own, so once that happens I'll post a picture of the scars.

I was told I only needed one physical therapy session a week today as well (down from two), as I had kept up with the exercises at home and was able to bend my knee past 90 degrees which is the two week benchmark.

Week 4 (Day 23)

Swelling in my knee has gone down significantly, but for the second time in the past week I've got bruising in my ankle and inner-heel. All other bruising is gone and I'm able to bend my knee to 110 degrees (measured in my most recent physical therapy session). The knee brace slides down my leg when I walk because it's so loose as my leg returns to normal size. I've also been scaled back to one physical therapy session a week.