ACL Reconstruction Surgery! Everything You Need To Know!
Updated: May 7
Today I'm officially two weeks post-op. I started the day with a modified workout, a shower without assistance for only the 2nd time in two weeks, and putting my underwear on inside out, but all in all, it was a pretty good day!
My recovery seems to be on track so far; with every PT session, I gain a little more range of motion. Going into this, I did my best to be as prepared as possible, but it was disappointing that I couldn't find a first-hand account of the experience from a patient's perspective. With that, I'm going to give a rundown of how to prepare, what to expect, and a list of stuff that might make your experience suck a little less because it does SUCK—a lot.
**An important note - I had a graft taken from my quadriceps tendon vs. patella or cadaver.
HOW TO PREPARE
STAIRS: If you live in a one-level home or a building with an elevator, bless! I do not. I have two sets of stairs to get into my house and then three sets of stairs in my home. I knew I would be weight-bearing but wanted to keep the stair climbing to a minimum. If you can get your crutches beforehand, DO IT and practice—videos on how to get up and down stairs weight bearing and non-weight bearing here and here.
ACCESS: Arrange a place to camp out for 4-5 days. By this, I mean you'll want to be near the kitchen and toilet with as few steps as possible because you won't want to move. For example - this might be your bedroom, but for many folks, this might be the living room. Since our bedroom is on the second floor, I threw a sheet, blanket, and pillows on our couch and ensured I had books, magazines, and my computer within arm's reach. The only time I got up was to use the bathroom, which was difficult even though it wasn't far.
CLEAR A PATH: Remove or push to the side any obstacles that might get in your way. In my case, this meant pushing our dining room table to the side, moving the dog's toy box, and pulling the coffee table out enough so that I could get on the couch easily. You'll want nothing in your way that might make you trip.
STOCK UP ON FOOD: Do a major grocery run before surgery and pack the kitchen full of easy-to-make meals and snacks. Do get comfort food and sweets for the first few days. Give yourself grace and eat all of the things.
HELP: You should arrange to have another human help you for the first five days. I'm serious. Whether it's your partner, a friend, a roommate, a family member, or a combination, you will need someone around 24/7. Don't be a hero. Ask for help.
PHYSICAL THERAPY: Select a physical therapist and schedule your first session for your 7th-day post-op. If you're lucky enough to have insurance that covers in-home therapy for those first few sessions, amazing and good for you! If not, pick the most convenient place to where you are vs. the BEST physical therapist in the city. While not all therapists are the same, this type of injury is VERY common, and most physical therapists are well-equipped to treat you. Look for a place with a 4-5 star rating on Google, and you should be good.
WHAT TO EXPECT
SLEEP: Not a back sleeper? You are now. For at least the first 2 weeks.
TAKE THE DRUGS: You will be in excruciating pain for the first three days. Seriously. You will need to keep your leg in full extension and likely in a brace which you will also wear when sleeping. It will suck. It will hurt—a lot. We all have concerns about opiates, but this is the time when it's necessary. Don't tough it out, and if you don't feel your pain is being sufficiently controlled, call your doctor and ask for an adjustment to your meds.
ANTI-INFLAMMATORIES: You will likely get a nuclear dose of prescription Ibuprofen, which is incredibly helpful in controlling your pain. However, if you're like me, it might upset your stomach and make you nauseous. If you can't hack it, downgrade to something less potent like Motrin, but DO take something.
CONSTIPATION: Yup. If you're taking the drugs, you may think you'll never sh*t again, but that is okay because you will. You will sh*t again, I promise. Please do yourself a favor and take a stool softener daily like MiraLAX which (at the suggestion of a friend) I put in my coffee every morning.
RICE: It's cliché but Rest, Ice, Compression, and Elevation are KEY. Elevate and ice immediately - starting the night of surgery. It will pay off, especially if you are diligent about this in the first three days. Swelling can create nerve compression, which causes (you guessed it) PAIN. You'll want to control swelling so you can manage your pain. Renting a compression ice machine from a place like Game Ready is worth every penny. Sometimes insurance will cover the purchase or rental.
SHOWERING: On day three, you get to shower. It will be weird, and you will need help with EVERYTHING. If you have a walk-in shower, you're fortunate; if you don't, it's easiest to have a stool to step on to get up and over the lip of the tub. This is the same concept as going up and down the stairs (see previous videos). You will need to keep your knee dry, and you'll also need to change the dressing covering the incisions. Don't get any of this wet under any circumstances. Having bandaids for the stitches and a large sterile pad to go over the entire knee and then under the ace bandage was most helpful.
WHEN TO STOP BEING A SLOTH: By day five, it's a good idea to get moving around on your crutches and start building confidence with ambulating. This is also when you should consider getting back to some normal habits - like remote work (if that's available to you), eating normally (if you've been eating like a trash panda), and talking to folks on the phone to let them know how you're doing and remind yourself that you can still hold a conversation.
WHEN WILL THE PAIN STOP: For me, the worst of it was over by day seven which is also when you will unlock your brace, start bending your knee a bit, and start sleeping without your brace. As mentioned, this is also the day you should begin PT. That doesn't mean I didn't pop a pain pill in the middle of the night along the way, but I wasn't taking them during the day. Also, this was the day I felt confident getting up and down the stairs and could move back into the bedroom.
STUPID CRUTCHES: You'll be grateful to have them and concurrently annoyed with them at all times. It's best to ask your physical therapist and/or doctor about when you can get around without them. However, I would say that if you feel safe and have decent stability, it's okay to do it in the safety of your house by the two-week mark.
Here are some helpful, sexy items to get ahead of time if you have the means. That small stool is handy for when you sit on the toilet -- you'll need to keep your leg straight -- so think about how that will not work well unless you can rest your heel on something:
A WORD ON OXYTOCIN: Not to be confused with the oxy opioids - though, as I said, you should definitely take those. If you know me, you know I am obsessed with the hormone oxytocin. It acts as a chemical messenger in your brain. It is essential in many human behaviors and social interactions, including sexual arousal, recognition, trust, romantic attachment, and parent-infant bonding. But. Did you know it has been shown to provide pain relief? So what triggers oxytocin? Hugging, kissing, cuddling, and sexual intimacy. Sex might be the LAST thing on your mind, but if you've got anyone (human or furry animal) to cuddle with, trust me, it will be beneficial, and you will notice a difference. Why do you think there are therapy dogs in hospitals?
In conclusion, surgery preparation alleviates anxiety around the big day. I cannot stress enough the importance of practicing getting around your house. If you can get your crutches and brace beforehand, do it. Practice getting on and off the toilet, getting in and out of the shower, in and out of bed, or on and off the couch, and (if you have them) getting up and down the stairs. Lastly, consider how best to sit in the car on your way home from surgery. You might be most comfortable in the back seat, leaning against the door with your leg(s) up on the seat.
GOALS FOR THE NEXT 3 WEEKS
PHYSICAL THERAPY: You may not be going every day, but you need to do your exercises every day!
90-DEGREE FEXION: You're PT will encourage you to be able to bend your knee to 90 degrees during the 3-week recovery. This is particularly challenging when you've had a quad graft.
ICE: Yup, you're still going to be icing. Controlling swelling is essential to the healing process.
NO PAIN, NO GAIN: Understand that there will be pain involved as you gain range of motion, but it will be worth it!
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