ACL Reconstruction Post Op Blues !

I'm new to this forum, so Hello all :)

I had my ACL reconstruction surgery on my left knee on 17th of this month (17/6). I had Injured it in March of this year out of a silly accident. The orthopaedic surgeon said that he had used a Hamstring graft. Things were going pretty good (albeit a few episodes of pain) until 2 days ago, my leg had started locking up, as in I couldn't bend my knee without stinging fatal pain in my upper right (head) patellar region. I'd get rid of it by supported knee flexion with the help of my brother. So, I'd decided to sleep in a different position - yearner/inverse yearner (I'd been advised to sleep in the supine position with my legs kept firmly straight)

The pain had gone away, but I could see my knee being swollen up to about 2-4 cms, I don't know when the swelling had occured, but I'd noticed it just then, I had also missed out on my pedalling (Ankle Pumps), Ankle Circles, Heel Slides. The following day, I couldn't get my knee to extend fully, as in to 180 degree. I could do that before, but now it would stop at say 170 degrees. Also, I've had trouble with my quadriceps since the surgery, I haven't been able to do the Quadriceps setting exercises fully, I never felt like I was working my quads, I thought my other muscles such as gluteal, etc helped in pressing my knee down, rather than actually using my quads.

Also, I'd been sitting at the PC since past 5 days, my Dad ( a physician ) says that this maybe the reason I'm unable to get full knee extension and advised me to lie on the bed or walk with a fully extended leg (with a brace). Also my Orthopaedic never said anything about RICE (Rest, Ice, Compression, Exercise) routine to be followed post-op, I'd found it being a popular rehab method followed in ACL reconstruction. Would it actually help ?

Please advice on what physio exercises I should follow, and how to deal with my inflammation, Quadriceps usage and Extension issues. Thank you all in advance. :)

Note: I'm a 21yrs old, obese ( 175 cm, 115kg ~ 254lbs ) male, using a walker and a brace (irregularly) as I'd been advised to use them both. Partial weight bearing for now.

Hello,

I just came across your post and thought I could give you some advice. I am not a physiotherapist but 5 1/2 weeks ago I had my 4th ACL reconstruction so I do know about the rehab process quite a bit. It sounds like you are not going to physiotherapy. However, for various reasons I realize that physio is not always possible.

First off, extension is the most important thing in ACl rehab. Sitting on a chair is not going to help you with this. You do need to lie on your back with a pillow or rolled towel under your heel and let your leg hang. Never put a pillow under your knee! Always under your ankle. It is not comfortable but you need to get that extension back or you are in for trouble.

You also need to do lots of quad contractions. With your leg straight, tighten your quads and hold for about 10 seconds. You should do at least 50 of these a day in sets of 10. The quad muscles need to be re-trained after the surgery so it is not uncommon that your quads are weak. Some people use electronic muscle stimulation for the quads if they are having trouble getting them to contract. I have my own stimulator but if you don't then you will have to see a physiotherapist. However, my doctor thinks electronic stimulation is useless but I wanted my own because I think they are neat little gadgets. Oddly enough, I used my quadriceps tendon for my most recent ACL graft and I had no issues getting my quads to contract.

Also, the stationary bike is one of the safest rehab exercises for the new ACL. At about 3 weeks, you should be on the bike for at least 30 minutes a day if not more.

I would not worry about the swelling just yet. I still have some residual swelling in my knee but it feels good and I have full extension. Extension is more important than flexion. Swelling will obviously limit your flexion for a while. Keep icing your knee as long as there is some swelling, especially after doing your exercises.

Sleeping with your leg in an immobilizer might help with the extension so your dad is correct. I usually use an immobilizer for the first week and then I use my own custom ACL brace. My surgeon always gives me compression stockings to wear after the surgery to help with swelling and blood clot prevention. You may want to consider getting a pair.

Things will get better. ACL reconstruction is a major surgery and rehab is not always easy. I will help you as much as I can.

Good luck

Thanks a lot for your reply and I apologize for this late reply, I was taken aback when I saw that you've had your 4th ACL Reconstruction ! I've been depressed, and thought that I was going through a lot. You've inspired me and have instilled a lot of confidence in me ! Its been a while since I've met such a strong person.

I happened to visit my Doc, two days back to get my suture removed. After I had my sutures removed he told me to walk on my own, without any support. I tried, but couldn't do much. He chided me and asked me to get rid of any support ! After that he looked at my swelling and asked me to increase my Quad sets, and sent me down to the Physio for a bit Walking training.

I had a very helpful Physiotherapist who guided me through walking, climbing on stairs and stuff with minimal support. He thought me a few new exercises ( Full Leg raises - 10 sets of 10 counts per Day). I did explain about my relative inability to do Quad sets, he mentioned that it was the most important exercise and needed to be done on all costs, it reminded me how spot on you were on your post !

I came back home and religiously did a lot of Quad sets ( a touch more than 10 -15 sets of 10 counts each ), 2-3 sets of Leg raises and stuff. The Quad sets seem to push on the head of the Patella and cause a bit of pain, I've soldiered on with the pain. Got rid of the Walker, and walk with a slow limp ( which I was advised to get rid off by my Physio ) The swelling has gone down a bit, although the pain is recurring.

Today I'd missed out on my Quad sets could do only 5-7 sets with 15 counts each. Hope to remedy this ASAP.

Extension has improved a bit, and walking is good immediately after my Quad sets. Not so much after a while.

I can't thank you enough for how much you've inspired me, I've been catching in on the Football action and intend to play it again ASAP. So, that has been driving me towards the goal. Hope I do reach it.

P.S. Since you're almost into 6 weeks Post-Op, I hope that you've fully recovered :) All the best getting back to Skiing again ;)

Im 6 months post op, and i kicked a football and all of a sudden herd a painful pop, lasting for a couple of seconds. Any advice?

- - - Updated - - -

Im 6 months post op, and i kicked a football and all of a sudden herd a painful pop, lasting for a couple of seconds. Any advice?

Hey Ameenkhan, sorry to hear this bad news. I think you should pay more attention to your knee so that it can heal faster. In my experience, cold compresses are effective in reducing swelling. At first I used an ice pack. I ordered two big ones, and my mother even wrapped it around her thigh. But they are a bit cumbersome to use and you have to freeze again and again. I find that my arthritis is persistent and I may need something more convenient. Until I checked knee ice machine on the advice of the doctor. It is more convenient than the ice pack. I chose a pad that fits my knees. It can completely and completely wrap my knees and provide 5 hours of continuous freezing.