ACL Reconstruction Surgery Recovery

Written: 6/1/2013 By: Ryan Hogue

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

I suffered my torn ACL one week before RG3, quarterback of the Washington Redskins injured his on December 9, 2012 vs the Baltimore Ravens. Ultimately RG3 completely tore his ACL and LCL later that season in the first round playoff game vs the Seattle Seahawks on January 6, 2013. RG3 opted to have ACL reconstruction surgery immediately on the day following the Redskins loss, but I waited 5 months so that I could finish the semester of school. This is my knee rehabilitation story, in blog format.

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.

Week 6 (Day 38)

I was able to go to the beach today, I wrapped my knee for support while on the unstable sand, but was able to (while being very careful) go into the ocean without hurting my leg. Side note: I was so focused on my leg that I lost my sunglasses to the first wave that hit me, not thinking about the fact that trying to make sure waves didn't break on my knee meant I had to get low enough for them to break on my head... *shrug*.

Week 8 (Day 50)

It's been a while since I've written an update, mainly because it's been the same story: swelling has gradually continued to go down in the knee, and I've been able to walk with a less-noticeable limp. Flexibility has been gradually coming back, at my last physical therapy session I was able to bend 110 degrees while on my stomach, and able to fully straighten out my knee after 3 attempts/stretches.

Week 9 (Day 57)

I'm writing this on July 4th (U-S-A! U-S-A!), and my knee has been doing great lately. I went on an all-day bar crawl recently that involved a ton of walking and ended up really straining the non-knee muscles in my bad leg as they were overcompensating for its lack of strength. Although it's almost been two months since surgery, I learned the hard way that my leg is nowhere near full strength still, and staying on my legs for ~10 hours straight is far from a good idea (the calf pain was that bad).

Week 10 (Day 68)

OK so I'm not completely immune to weekend-long alcohol binges at the beach. I was gone for 2.5 days, pretty much in an active state where I was utilizing my legs 90% of the time (not counting sleep). On top of this, I slept with my ACL surgery knee bent two nights in a row (and the car ride was ~5 hours with it bent). Needless to say, my knee got swollen and hurt like hell, so I've been icing it and elevating it as much as possible, and sleeping with it my bad leg straightened, both of which seem to be helping. I didn't want to take a picture because I'm too angry at myself for the setback, but I have an appointment with the surgeon this week as well as my last knee physical therapy session, so I will follow up with what they had to say.

TL;DR: Even two months out, be careful!

Week 10 (Day 69)

As promised, after following up with both the surgeon and physical therapists (both of which I was scheduled to see this week coincidentally), they told me that the knee swelling is the body's way of letting you know that you overworked it. It does feel like it's gone down faster than it had post-op, so I might have overreacted, in part due to the fact that alcohol was involved and I was unsure if I caused traumatic knee damage or not.

Side note: This was my final physical therapy session, and they sent me home with an knee rehabilitation exercise program to continue on my own at the gym, which I've posted here. It's mostly light-weight, high repetition exercises, with stretching mixed in.

Week 11 (Day 76)

I'm not sure if you can tell from the picture but the swelling has gone down a lot from a week and a half ago. Most of the remaining knee swelling is below my knee cap, to the outside (in the picture above, it's the top-left I'm referring to).

I've been keeping up with the ACL reconstruction rehab exercises, and the gym at my university has all of the same things I used at physical therapy which is great. My knee still gets sore if it's in the same position for too long, such as a long car ride, and I can feel it while walking if I've been sitting down too long like when I'm at work. I purchased a Knee Brace that works really well while I'm at the gym or walking long distances (I walk to campus), by adding noticeable support. I would highly recommend buying an athletic knee brace, as it also adds peace of mind.

Week 15 (Day 105)

It's been 15 weeks since my ACL reconstruction surgery. I'm now half way through the typical recovery process of 6 months, and my leg is still vulnerable to swelling and soreness if I go on a long car ride, or go out on weekends and am too active. I still feel like I'm fighting the swelling regularly, and am not sure if working out causes it to get worse, but either way with the brace I still get good leg workouts and stretches in while I'm at the gym. My inner-hamstring is also almost always sore, which could be a result of walking.

4 Months

It's been 4 months since my ACL reconstruction surgery. I felt significant improvement in my knee at about week 16, where bending it for too long didn't seem to bother it as much, and stressing it by using it a lot didn't seem to have the same negative effect. I did notice that any lateral movement (even minor) often causes a non-painful crack, but the Dr. didn't seemed worried and said once the swelling had subsided, life would be back to normal and the knee problem would be an afterthought.

5 Months

Five months after my ACL reconstruction, I realize why they say this is a year-long recovery process. I still do supersets of leg strengthening exercises in the gym regularly, and the swelling is continuing to go down over time. I still can't straighten out my leg very easily, because of the remaining swelling, but I do stretch a lot and am quite flexible. When I do try to straighten it out, I can feel a shift/movement underneath my knee cap, again probably because of swelling. The discomfort while walking is more and more minor as time continues to pass.

6 Months

I'm working my legs out at least 4 days a week and stretching daily, and the leg is still quite swolen. The biggest progress since the last update is that I don't have to worry about my leg being bent while sitting or sleeping as much anymore, as it's able to straighten out (with no limp) faster now. Until all swelling is subsided I don't think I'll be able to lock the surgically repaired knee in parallel with my healthy knee.

I scheduled an appointment with the surgeon to talk to him about why i can feel two clicks in my knee when I straighten it out (it's more noticable at night while I'm in bed and there are no distractions). The appointment is around the 7 month mark, I'll follow up then.

7 Months

At my 7 month post ACL surgery check up with the doctor he assured me that it was normal to feel the clicking in the knee when straightening out, owing it swollen tissue under the kneecap. As swelling reduced, the two clicks that I was experiencing after the 6 month mark gradually became one click. My inner hamstring still gets sore when I'm in the gym, probably as a result of stretching and lifting weights. The main takeaway for me was that according to my surgeon I'm still on track, and his advice was to disregard what is commonly found on websites like Web MD or on ESPN where professional athletes return to competitive sports in under a year. I'm continuing to rehab regularly, and can't wait to feel normal again.

8 Months

It's been 8 months since my ACL reconstruction surgery. I got back into cardio at the end of my workouts, jogging at 6.0 with no discomfort (I tried 7.0 but it put too much pressure on the knee, which could've had more to do with the treadmill and shoes I was wearing). I also do the Stairmaster every other day, but it's a bit annoying because I can feel my knee clicking every time my surgically repaired knee straightens out and then bends to take the next step. Again, the doctor said this was fine and said it should reside when the swelling does. I was also able to do a fitness class full of lateral movement and squats, which was tough at the end of an hour, but it felt great to get back into athletic form.

9 Months

At 9 months post op, the swelling is still taking its time to subside. There's an audible pop noise each time my leg is straightened out (other people confirmed they can hear it). I still jog and was able to do a Yoga class, but the knee still feels a bit unstable, which I''m sure is to be expected.

10 Months

It's been 10 months since I had my ACL reconstruction. It's still noticeably swollen and while it does get easier to do full quad stretches (which is a sign that swelling is continuing to go down), I still don't feel comfortable doing things like squats or playing sports. I can run on the treadmill at a 6.0 but feel discomfort at 7+. I continue to stretch regularly in hopes that this will all go back to normal as soon as possible (rather than accepting this as the new normal). My knee is still sore and almost pops into place each morning when I wake up and if I sit with it bent for too long I still feel discomfort as it adjusts to being straightened out again.

11 Months

Not much has changed since month 10. I'm still waiting for the knee swelling to reduce, as it prevents me from having full range of motion while stretching. It's still uncomfortable while sitting with the leg in one position for too long, it resulting in walking with temporary limp isn't uncommon if I sit for too long.

12 Months

Shortly after my 11 month post I was experiencing a lot of locking and popping in the knee - so bad that I scheduled another MRI. I eventually realized that stretching (painfully) my leg's hamstrings and quads a lot more helped ease the tension in the joint. I did a few long stretch & holds which over time allowed more range of motion, and in the long run helped out a lot. I've also been taking 3 Fish Oil Pills which I heard (from the Joe Rogan podcast) helps with joint pain.

UPDATE: The surgeon showed me a lump of scar tissue outside of where the patella graft was taken, and claimed that it might be the cause of the discomfort. I passed on the option of having a scope done to break up the scar tissue as he said the body should break it down on its own over time.

14 Months

I've been going on at least one run of about 2 or 3 miles a week and done Yoga once a week for the past 2 months which has noticeably helped my ROM and overall flexibility (especially with quad stretching and pulling my heel in to my butt). I'm also making more of an effort to get back into weight training for my legs.

I also picked up a Groupon for acupuncture which had my leg feeling great the morning after each session (the most noticeable improvement was in the morning after where I woke up with virtually no knee stiffness which is very rare). Let me know what works for you in the comments section!

16 Months

I do a 15 minute Yoga program every morning that gets my entire body loose, and I try to pay special attention to getting my legs as stretched out as possible. Specifically, if I am laying on my back and I bend my surgically repaired knee-leg and then straighten it out into the air, it was make an audible pop the first ~2 times, but eventually it stretches itself out enough and stops doing it. I can also feel movement in the knee when it happens.

I don't wear the knee brace anymore though when I run or do athletic activity, and I ran a 5k and felt good. I still get sore when it's bent or straightened out for long periods of time, and it will be noticeably more prone to being sore if I'm dehydrated. All in all I'd say I'm still progressing.

18 Months

I've continued to stretch aggressively, through discomfort in my knee, and it's had good results. I have been sitting back (with my legs bent) on my heels, through pain, and it's helped restore even more ROM, but there is still swelling that is making it painful. Since my last update I've definitely noticed more looseness and less pain, and the audible popping has gone away when doing the same yoga moves.

If I could go back in time to earlier in the rehab process, I would myself to stretch more aggressively through the pain and discomfort (obviously not to the point where you might reinjure yourself though).

24 Months

At the 2-year post operation point, I had a day where I was experiencing pretty severe pain just walking around in my reconstructed knee. I know this sounds like a nightmare, but it was just a one-time thing, but it was enough to have me schedule a doctor appointment. I had been weight training my legs once a week for about 4 months at this point, and (accidentally?) taken about 3 weeks off. When the doctor saw me he tested the knee out as it's been tested before and said that the patella tendon is probably not tracking properly, but the ligament is fine. He also guessed that I also had a bit of meniscus damage initially which was correct (he was a new doctor but seemed very good). I was given exercises to do that would help the patella tendon track normally, and told specifically to focus on leg extensions.

I'm a strong believer in the power of the human mind and what kind of a difference having a positive outlook and confidence in yourself can have on any outcome in life. Something about the confidence instilled in me by the doctor really changed something in me and since the visit not only has my knee been doing noticeably better in multiple regards, but the other issue I spoke with him about that had been lingering for years has also subsided. It may have nothing do to at all with my outlook, but it gave me the confidence to start playing basketball again, jumping and propelling myself off my “bad knee" only again and again, and returning to lifting legs consistently. I still have a minor internal click when my leg extends, but in time I'm hoping that will go away.

I don't know that I'll continue the story that I've been sharing on this site much longer (if at all), so if this is my last post, my closing thoughts are really surrounding if a patella graft was the best approach. A friend of mine tore his ACL around 8 months after me and had his ACL reconstructed from his hamstring and his recovery seemed to go immensely better than my own, so please do as much research as you can into both options and decide which one will be best for you - I hope my story helps you in your decision!

4 Year Follow up!

It's been 4 years since my ACL reconstruction at this point. I've had multiple friends go through the same process, that used hamstring grafts and they all recovered much faster, with less pain. I would highly recommend NOT USING A PATELLAR TENDON GRAFT - I had an MRI with Dr. Annunziata (the surgeon that was on-field at FedEx field for many Washington Redskins games) and he revealed to me that I had a ball of scar tissue undernear by patellar tendon graft - that could've been avoided.

I also learned that a cadaver graft shouldn't be overlooked, as NFL superstar Aaron Rodgers claimed it made him even faster after going through the rigorous rehabilitation process.

I do yoga twice a day on average and have great flexibility - I don't feel like my knee holds me back at all, but there is still soreness after strenuous athletic activity - I'm considering having an operation to remove the scar tissue, in hopes that it will help prevent future arthritis and reduce pain in the short-term. It can be easy to let this become to new norm, which it has for me after 4 years, but I don't like feeling like I'm a lesser version of myself due to restriction caused by my ~~knee surgery~~ paterllar tendon incision.