I recently had ACL surgery, and thought I would share how my recovery progressed, and some tips I learned along the way:
Now, for those that don’t know what takes place during ACL (Anterior Cruciate Ligament) reconstruction, the surgery is mostly done arthroscopically. (The ACL is a ligament that starts in the thigh bone, threads through the knee, and connects to the shin. It is part of a system of ligaments and muscles that keeps the knee stable.) The first thing done is the surgeon creates an incision below the knee and goes through that incision to harvest a piece of the hamstring tendon. (Assuming the patient is using their own hamstring to create a new ACL. Otherwise, that step would just be cruel!) Then, holes are drilled in the tibia and femur, the new ACL is strung through the knee and screwed into place into each of the bones mentioned, and you now have a stable knee again. One interesting ‘technology’ that was done during my surgery was called ‘platelet rich therapy’. Right before I went in to surgery, a nurse removed a vial of blood from my hand. This blood was then put in a centrifuge, where the plasma was removed. During surgery, this plasma was injected into the surgery site with the hopes of speeding up the healing process.
Anyway, since I had already undergone ACL surgery nine years prior on my other leg, I somewhat knew what to expect. (Which is why I dreaded the surgery and really had to think about if I wanted it done or not.) Please keep in mind I am not a doctor and I am not advising any particular type of treatment. I am just sharing my own experience.
My First Week Post ACL Surgery:
I rock when it comes to anesthesia, which is a good thing because they plied me with tons of extra drugs after surgery because the anesthetist kind of forget to do a nerve block in the back of my leg. I woke up in excrutiating pain, so the answer apparently was to just try drugging me up more. A different anesthetist did finally show up and gave me the block in the hamstring area. At that point, my whole leg went numb. A numb leg is a very strange thing. I kept challenging myself to try and move my toes, which I could not do no matter how hard I tried. I realized I much preferred a numb leg over an in-pain leg. It just made it super hard to get around on the crutches when one leg just kind of hung there. I heartily give femoral nerve blocks a thumbs up!
After surgery, I was sent home with enough prescription pain pills that could probably earn me a small fortune in street value. We filled the prescription on the way home at my least favorite pharmacy, Walgreen’s. (Tip: NEVER get your prescription filled near a hospital. You will wait two times longer than what the pharmacist promises, and they will not apologize for the delay either.)
At home, I ate a good dinner (anesthesia kind of makes me hungry) and dug into the Percocet, as I was told to do. Well, as I remembered, Percocet really doesn’t do much for me, so I only took it the first 24 hours or so after I got home. I found I was also running to the bathroom literally every 50 minutes or so, 24 hours a day. That is a royal pain when you have to put an ankle-to-upper thigh brace on every time you get up, and your leg is numb to boot. One thing I found is that I didn’t have to use the bathroom as much once I stopped the Percocet. Could be coincidence, or maybe the nerve block wore off, who knows, but I was glad to be done with the Percocet. After the first day, I just took Advil every 4-6 hours or so, and that managed the pain just fine.
On the second day home, my leg had most of its feeling back, and I was able to put quite a bit of weight on the bad leg. (However, there was numbness starting at the incision site and travelled down my leg somewhat.) I walked constantly around the house using crutches for extra support. I did a lot of ankle pumps too just to keep the blood flowing and had my leg in an ice machine to get the swelling down. The pain really wasn’t that bad.
On the third day home, we took out the portable pain pump, and I took a shower. Trading the pain pump for a shower was well worth it. I left the little steri-strips on and just gently washed over the wound. I sat down to shower, as I was did not want to stand on that leg without a brace.
I was able to drive 5 days after surgery. I was lucky in that it was my left leg that I hurt this time, as that made driving much easier. However, do not drive if you are still on prescription pain meds!
By the end of the week following surgery, I was able to walk without crutches SOME, but still in the brace. I walked with the crutches just to be safe, but was pleased with how much weight I could put on my leg and that I could walk some. I was not ready to abandon the crutches yet, but it is funny how happy it can make you to just be able to walk a few steps in the kitchen and such.
My Second Week Post ACL Surgery
My leg felt fantastic. By the end of the second week, I had full flexion (with the help of my therapist) at 135 degrees and almost full extension (was at -6 degrees). I was able to ride my home exercise bike to help build up the quad muscles and walked on the treadmill at physical therapy. (That started at about 11 days post surgery.) I still wore the full leg brace to walk around the house without crutches. I did use crutches outside for safety reasons though, as the weather was snowy. I would also say that by two weeks, 85 percent of my swelling was gone, and my surgery scar looked great. Overall, I was very happy with my progress, and just as a side note, I don’t think it is very common to have so much range of motion so early. Keep in mind that my leg was incredibly stiff most of the time and it took work to get to the full flexion and extension.
My Third Week Post ACL Surgery
Leg was still doing great. I had no problem getting full flexion and extension on my own at this point. I walked around the house without a brace or crutches, and was regaining quad and hamstring strength. (I am not advocating that anyone stop using their brace or crutches at that point in the recovery process. That is a very individual decision that needs to be made with your physical therapist and/or doctor.) My knee was still quite stiff, especially in the morning. After three weeks, I was able to walk a mile on the treadmill, but did a lot of icing afterward. Often times, I didn’t even think about my knee! You could barely tell a difference between my two knees in terms of swelling. Still couldn’t sleep on my stomach though, which I missed so much!! Down to 3 ibuprofen a day, which I took at bedtime. Was still icing frequently, 20 minutes at a time, four times a day.
My Fourth Week Post ACL Surgery
The brace and crutches were put out to pasture. Since I ditched the brace, the leg was a little more sore than before, but it was totally tolerable. Stiffness was still there, but not as bad. I still had numbness near the incision and down my leg somewhat. Most of the time, I walked with no gait deviation whatsoever. I only walked though, I didn’t even think about jogging or doing anything strenuous. Still went to physical therapy three times a week and I loved it. It felt great to improve each day! Said goodbye to the ice machine as it was a rental. The money spent was well worth it. I attribute a lot of my recovery to the ice and pressure that was provided by the ice machine.
Six Months Post ACL Surgery
What a great knee! As a matter of fact, I didn’t even think about it anymore. I saw my orthopedic surgeon, and he said the graft is probably about 90 percent healed. (Absorbed by the bone and such.) I was cleared to play some tennis and resume most activities. However, it needs to be a gradual return. The doctor said the muscles and ligaments all need to figure out how to work together again, so my leg needs to ‘relearn’ how to work to a degree. I have played some tennis, and it went great. I do wear a large, metal, Don Joy brace if I do anything that requires pivoting.
The Worst Part of My Recovery
The third night in, my leg started to itch. The doctor made me keep the entire leg wrapped in Ace bandages the first week after surgery, so scratching was not very rewarding. As each day passed, this mysterious rash spread on my leg, and I was up most of the night of days 3, 4, 5, 6 and 7. I was exhausted. The rash was limited to where the wrap was on my leg, so when I got my stitches out after a week, it was suspected I either reacted to something in the bandages, or I was having some strange heat rash. All I knew was that it needed to stop. The doctor prescribed me a steroid pack and some anti-itch pills. I completed the entire steroid pack and the rash disappeared. If you are instructed to wrap your leg with ace bandages, I personally would not get the type that is ‘self adhesive’. I think the adhesive might have been what caused my reaction.
I started PT 6 days after surgery. My knee looked pretty darn good actually, the swelling had really gone down. My cankle was fading and my kneecap was reappearing again, just like how life should be. I was pretty surprised at how much extension and flexion I actually had.
Am I Glad I Did the Surgery?
Most ACL surgery is considered elective, basically because a lack of ACL will not kill you. However, my knee was so lax that I was afraid that I would really screw up my knee if I did not get it fixed. Plus, I would have to give up most activities other than walking and swimming if I chose to not have the surgery. I did read the post-surgery report that described how truly loose my knee was when the doctor tested it while I was under anesthesia, so I would have been at risk of further damage over time.
Post Operative Tips:
- If you are offered the option of an ice machine, do it. Insurance did not cover my ice machine, so I had to pay $300 to rent it for a month. I have to say that I think the ice plus the compression the machine provides has really helped bring the swelling down, and it also helps relieve the pain. A standard ice pack cannot compare to what an ice machine can do.
- If you have any questions or issues after surgery, do not hesitate to call your doctor. Don’t worry about bothering them or anything. You are a paying patient, and you deserve help if you need it. Especially considering you may not remember what the doctor said post-op, you may have a lot of questions.
- If you will be having physical therapy or post-operative treatment, make sure you decide where to go before you head in to surgery. The last thing you will feel like doing after you come home is making a bunch of phone calls and figuring out logistics and such. Word of mouth is very important when it comes to physical therapists, so do some work up front and decide where you want to go ahead of time.
- Listen to your body. The standard guidelines said I would need ‘controlled’ pain meds for about 5 days afterward. Well, I ditched them after one day and was so glad I did. On the flipside, if you are in a lot of pain, act accordingly and don’t overly push yourself (and call your doctor).
- Forget perfection. Life can be hard, and sometimes, commitments cannot be met. In the big scheme of things, who cares? Let go of perfection when healing and focus on getting better. Accept all offers of help too.
- Prepare your home ahead of time (if you can). If you will be on crutches or in a wheelchair, have the house set up ahead of time so you have clear pathways after you come home. Make sure the refrigerator is stocked and maybe even have some meals waiting for you in the freezer. Do whatever you can to make your post-surgery life easier.
- Prepare your body ahead of time. Be in the best shape you can possibly be in prior to the surgery if you can. I am convinced that this knee is recovering so well because I had full flexibility with it going in to the surgery and had decent muscle tone.
- Take physical therapy seriously. Therapy is not only done at the PT location, but also at home. Do not neglect the home exercises, unless you want to really extend your recovery time.
- Remember that each person’s recovery is very individual, as is the injury. Do the best you can and don’t worry about what everyone else is able to do.
So, overall, so far so good. I am quite pleased with my post-surgery knee, and hope things only get better from here.
If you have any additional tips to share that helped you get through the post-surgery time period, please add it in the comments section!