ACL Repair Surgery – What They Don’t Tell You (and My Recovery)

acl repair surgery recovery
My knee – after I bust it up in the British Virgin Islands…a few days’ sail from a hospital.

I recently had ACL repair surgery, which most people who follow this blog will already know. For my regular readers, apologies for the break away from my usual travel topic. If you have zero interest in reading about my ACL repair surgery, how about a few travel articles you might not have read yet:

10 Travel Experiences Everyone Should Have in Their Lifetime

Banged up in a Panama Prison

How to Plan Your Own Prosecco Tour in Italy

If you’re still here. you’re either intrigued or facing ACL surgery yourself.

Like most people about to go under the knife, I did a bit of research before my operation and I found all the usual stuff – anatomical diagrams of the inside of a knee, a description of what the actual surgery involves (lights, camera, scalpel).

What I didn’t find was a description of what it’s really like to have ACL repair surgery – and it turns out there were more than a few things that I didn’t know about the operation. So, in this article I’m going to share with you what the surgery was like for me together with how I’ve been recovering in the days and weeks post-op.

A couple of notes:

  • I had my surgery in the UK on the (public, not private) National Health System. I can’t imagine that the experience would differ that widely around the world but who knows…
  • At the time of writing, I’m 3 to 4 weeks post-op, though I’ll try to update the recovery section as time goes by.
  • Advance apologies if you’re squeamish – I’ve included a couple of pictures of my incision so you can see what it looks like. I’ll give you another warning just before you reach them!

ACL Repair Surgery – 15 Things They Don’t Tell You

acl repair surgery pre-op
You know – pre-planning for that awkward moment when the surgeon asks ‘my left or your left’ except you’re unconscious so he has to guess.

1. They shove a tube down your throat while you’re unconscious

acl repair surgery oxygen
Your throat is probably just sore from the oxygen they said…

I’m a grown up. I understand that there are things that need to happen while you’re being operated on. I just wish I’d been told in person (rather than finding out from Google) that they shoved a tube down my throat while I was out for the count. That way, I wouldn’t have been worried about why my throat was so damn dry and sore when I woke up. I also could have pre-planned and got some honey and lemon and throat sweets in for my post-op recovery.

2. They also insert a catheter and suppository

TMI warning

In fairness, they asked me if I wanted a suppository and my initial reaction was ‘urggghhhh. NO!’ until they told me it delivered 16 hours of pain relief. The idea of them inserting it while I was unconscious made me feel a little bit violated but I opted for that over having it inserted while I was awake, which would make me feel violated but with the added ‘bonus’ of a visceral memory of the event.

What they didn’t tell me (and I once again learned from Google) was that they also catheterised me. How did I surmise this? Well, I felt somewhat irritated in that area – something that lasted for around a week and made me wonder what they hell they’d done to me. Seriously, if you’re going to mess around in my ‘downstairs closet’ while I’m asleep, i) tell me about it; and ii) be gentle!

3. You’ll be weak…from hunger

I’m that person who need to eat 10 small meals a day. Ok, that’s an exaggeration, but being nil by mouth from 8pm the night before until 3pm the following day can make you weak. Sure, I was fed tea and toast (which was a struggle to get down because of my dry mouth and throat), it’s simply not enough to sustain me.

The result – I felt very weak and sick when I tried to move from horizontal to upright on my crutches. The nurses were convinced I was having a reaction to the surgery. I was convinced it was something more simple – I was weak from hunger. A sandwich later and I was up no problem.

4. The end to end admission may take longer than you think

acl repair surgery operation
This irritating kit is unfortunately the last thing they remove before you’re allowed to go home.

I was first to surgery (around 10 a.m.) and with an op time of about 1.5 to 2 hours, I had ideas that I’d be home by mid-day. As it turns out, I got home around 8pm. That was partly because I had to sit with my leg in a knee bending machine for a few hours post-op but also because I was too weak to walk (see above).

5. The pain medication will probably make you feel sick

I was given co-codamol (codeine and paracetemol) as my main pain relief medication and boy did it make me feel sick. Ever drank too much coffee and felt jittery/like you want to vomit? That’s what the codeine did to me. It also made me want to nap within 15 minutes of taking it. As a consequence, by day two, I was already phasing it out and replacing it with just paracetemol and ibuprofen instead. The downside – I was in more pain that I probably needed to be in those first few days but at least I was alert and not feeling sick.

6. It hurts (more than you think)

acl repair surgery recovery
My friend bought me these Minion socks – helped with the pain. Btw, that’s a DVT sock on my right leg. You’re advised to wear them post surgery and I was given a couple of packs in the hospital.

Of course I knew the operation wasn’t going to be a walk in the park (nor afterwards!) but the intensity of the pain in those first 3-4 days surprised me. Not feeling able to take the co-codamol didn’t help. The good news is that although the pain is bad those first few days, it does ease and I was on off-the shelf painkillers within a few days.

7. The pain medication will probably give you constipation

Another TMI warning

We all know what constipation is. Fortunately, my physio had pre-warned me and I just chilled out about it, waiting for my body to right itself. Which it did and within the week things were back to normal.

8. The surgical dressings will hurt as much as the incision

acl repair surgery dressing
Getting creative with my clothing to give the incision some air while trying to keep warm! ACL repair surgery is not a cold weather activity.

It didn’t occur to me that this would happen. I possibly didn’t help myself – I’m the kind of person who needs some sort of shower every day to feel like I’m not a slob. This meant I was changing my dressing daily – I had staples rather than stitches and was told not to get them wet (nurse: ‘you don’t want sticky staples’). I also kept my dressing on as long as the staples were in because my body magically started to push the staples out around week one and I didn’t want to snag anything.

Upshot: this constant pulling off and putting on of adhesive dressing took its toll. In fact, I’ve had the dressing off for nearly a week and the skin where the dressing stuck is still tender. I have been using Elizabeth Arden’s 8-hour cream. It’s not your average moisturiser – it has a bit of a medical scent to it and it has amazing repairing properties which have really soothed my skin.

9. The small incision – not as small as they say

Just a couple of camera holes and a small incision. Yeah right. My incision is a couple of inches long – which looks a lot on a 5ft tall person. Pre-surgery, I’d just seen the scars from other people, which were a lot smaller because, well, healing and all that. I know my incision scar will shrink too but that first time I saw the cut, I was a bit shocked. Photos of the incision further below.

10. Bathing is an epic challenge

At the time when you need stability in the shower the most, ACL repair surgery takes one leg out of action. Had it been decent, I’d have videoed the various poses I found myself in while I simultaneously tried to wash my body and hair while keeping my dressing dry. I have to say, my yoga came in very helpful.

By about day 10 I simply gave up and just showered faster.

After three and a bit weeks, I’ve finally had a soak in a bubble bath – I was advised to wait a little in case the fragranced products irritated my skin after having the staples out. To be on the safe side, I bought this Johnson’s Soothing Naturals baby bath foam. Not only was my incision was fine with it, it had a nice scent, too.

The rest of the time, I’ve just been using my L’Occitaine Lemon Verbena shower gel as usual and this week I’m going to buy some Bio-Oil to help reduce scarring. Some articles say don’t bother but I say nothing ventured, nothing gained.

11. Having your staples out is brutal

acl repair surgery staple extractor
My very own staple remover!

I’ve had stitches removed before and apart from feeling a bit queasy (I was 10 years old – I was allowed to feel queasy), it didn’t hurt. For some reason, I thought having my staples removed would be the same. Not so.

It hurt like hell!

First of all, they use a sharp, metal staple extractor – in fact, I was supplied this in the hospital and for a good few seconds I thought I was looking at a DIY jobbie until the nurse read the horror on my face and reassured me it was just to take to the clinic; I didn’t have to pull them out myself at home.

The problem with this tool is that to get the staples out, it needs to fit under the staples – which is right where you skin is most tender at the point of incision. Some of my staples had lifted themselves up a good few millimetres by the time of removal which I was so grateful for. I can’t imagine the pain if they were still flush with my incision. Take pain pills before you go and take comfort in the fact that there are people who have more staples inserted that you would after ACL repair surgery. Plus, the relief of having them out is worth the pain.

12. Initial progress will be quicker than you think

acl repair surgery knee bending
I was horrified I was going to be tortured when I saw this contraption but I give it full credit for getting my knee bending quickly post-op

I couldn’t believe the hospital had my leg bending back to 45 degrees within just a few hours of surgery. Sure, the contraption was fresh out of a horror movie, but it did an excellent job. I was also given stair and crutch training, which gave me the confidence to go home that day. I was told I could weight bear and within a few days I was taking steps without crutches – I’d expected a much slower start to my recovery and I was frankly delighted with myself.

And here’s the contraption in action just a few hours post-surgery…

 

13. ‘Back to normal’ progress will be slower

And those early days gave me false ideas about how quickly I’d progress. Sure, I’m swifter moving around without crutches but weeks 1 to 3 have seen pretty much that same level of progression. I’m still taking stairs by putting both feet on each step and although my knee bend has moved on to over 110 degrees, that’s a bit of a no-man’s land in terms of usefulness – most activities (kneeling, bending crouching, going down stairs) require closer to 180 degrees. Impatience has taken hold. Fast.

(On the plus side, all this feet-up, stay indoors business means I’m finally catching up on some of the books on my reading list).

I should say that I also had  a medial meniscus repair at the same time as my ACL repair surgery. However, as I had a horizontal tear in the cartilage in the ‘red’ blood vessel zone, it just required a stitch, so I’m not sure it’s added that much more to my recovery time (that’s based on zero expert opinions, btw).

14. The physio protocol is impressive

I knew that ACL repair was common but it hadn’t occurred to me how well-established the ACL recovery protocol would be. With goals and exercises for each phase, if you’re a person who likes to have something to aim for and a bit of a tick-list to get through, you’ll like the structured approach to the physio.

15. Having ACL repair surgery is totally worth it

acl repair surgery
In a time not too far away, I hope to get back to some volcano hiking…

I was told that I could live without having surgery and many people function happily without having their ACL in place. However, as my physio said, that’s fine for people with a desk job who maybe go to the gym a couple of times a week. That’s certainly not me.

At only 40 years old, and with one eye always on the next adventure, I wasn’t prepared to live a life limited by forward-facing, even-surface activities. I want to climb more volcanoes. I want to swim with whale sharks again. And if I ever find myself having to outrun an ostricth in the dessert (look, strange experiences tend to find me), I’d like to know my knee has my back.

Mentally, I already feel better knowing that my knee bone’s connected to my thigh bone (ok, not necessarily anatomically correct, but there’s a song in there). Knowing that in time I’ll be able to get back to all the adventures I’m used to, I’m 200% happy I went ahead with the surgery.

If you want to hear my busting my knee story, you can read it here.

My ACL Repair Recovery Experience

Pre-surgery and even post-surgery I’ve done a lot of research on what ACL recovery looks like and apart from a bunch of medical websites that have vastly varying timescales, I didn’t find anything close to a real description. So, I thought I’d share my recovery experience. Of course, everyone is going to be different: I’m 5ft tall so that’s providing some challenges (step height and sitting in chairs); I’m not good with pain; I’m terrified of falling over; but I am diligent about doing my exercises and have the luxury of working from home to commit time to doing them.

I’m currently at the end of week 3 of recovery from ACL repair surgery but I’ll try and update this as the weeks go on. Here’s my experience.

Warning: incision photos in this section!

In hospital

acl repair surgery in hospital

  • placed on a machine to get 45 degree range of motion operating
  • tested on crutches
  • told I can weight bear on both legs if using crutches
  • given ‘stair training’ so I can use the stairs with crutches
  • given 3 exercises to do at home: i) heel slides (lying down, sliding my heel until my knee was bent); ii) straight leg raises (also from lying or sitting down), contraction of the quadracep (flexing the muscle above my knee))
  • told RICE – rest, ice, compression, elevation (but without the compression)
  • bandage and surgical dressings applied

First 24 hours

  • Dressing & incisions: remove bandage day after surgery and change dressing (luckily not much full-on blood but some weeping)
  • Crutches: on both crutches to get around – makes carrying things a problem, especially on stairs. Tip – get a shoulder bag to carry items around (e.g. book, pain meds, water bottle)
  • Pain medication: taking maximum pain medication, added in Ibuprofen and wishing I had more
  • Physio & swelling: exercises hurt so I do them just after taking pain medication. I don’t think my knees ‘that swollen’ (turns out it is)
  • Stairs: (up and down) require one crutch and two feet on each step
  • Sleeping: not able to sleep in usual position (on front). Can sleep on side with support of pillow under my knee
  • Range of motion: without the machine, actually feels like I have less ROM than immediately post op
  • Bathing: ‘sink wash’ with a flannel

After a few days

acl repair surgery recovery day 2
I believe this was day 2 after surgery. Good colours, don’t you think?
  • Dressing & incision changing dressing each day (still weeping). Pretty colourful bruising (front – ACL repair surgery; back – medial meniscus repair)
  • Crutches: down to one crutch at home
  • Pain medication: still taking maximum pain medication and feeling pain in the hour to half hour before the next dose
  • Physio & swelling: exercises still painful but already feeling easier – I should be icing my knee but I don’t (because I’m stupid and think it’s not ‘that’ swollen)
  • Stairs: (up and down) still require one crutch and two feet on each step
  • Sleeping: still not able to sleep in usual position (on front). Can sleep on side with support of pillow under my knee
  • Range of motion: leg feeling generally more stable but range of motion still very limited
  • Bathing: somewhere between a sink wash but with the shower turned on, using a flannel. Able to wash my hair but helps I’m at my mum’s house where there’s a disabled walk-in shower with shower seat

Within a week

  • back home (alone) – feeling a bit nervous in case I tumble down the stairs and die…all alone…I get over this after a couple of goes up and down the stairs
  • Dressing and incision: dressing pretty much clean and now spending a few hours with dressing off to give incision some air. Bruising moving south (thanks, gravity)
  • Crutches: hobbling without crutches indoors but one crutch outdoors (not that I’m going out much beyond physio appointment)
  • Pain medication: ditched the coedine but otherwise still on maximum pain medication
  • Physio & swelling: first physio session just to check how I’m doing. Knee swollen preventing further range of motion – told to ice. Berate myself for being stupid
  • Stairs: (up and down) still require one crutch and two feet on each step
  • Sleeping: still not able to sleep in usual position (on front). Can sleep on side with support of pillow under my knee
  • Range of motion – at 45 degrees (the target I was given)
  • Bathing – back to more regular style of daily showering but it’s a hell of a balancing act trying not to get dressing and staples wet.

Within 10 days

acl repair surgery recovery staple
I was tempted to pull this staple out with my fingers!
  • Dressing and incision: fed up of the dressing – skin feels tight and sore and I’d take it off permanently if I wasn’t worried about snagging a staple. Speaking of staples – my body is starting to reject them and they’re working their own way out (magical)
  • Crutches: without crutches indoors and trying to replicate proper walking (rolling through the toe) but it’s deliberate and slow. Still using one crutch outside. Made it to the supermarket (accompanied) – good to have the trolley for support but getting around is tiring
  • Pain medication: starting to use pain medication more sporadically but still taking something every day
  • Physio & swelling: continuing with exercises – much easier but don’t feel like I’m making much more progress. Ice is helping with swelling but knee still tight
  • Stairs: stairs (up and down) crutch free but using the wall/banister for support and still two feet on each step
  • Sleeping: still not able to sleep in usual position (on front). Can sleep on side with support of pillow under my knee
  • Range of motion – hard to tell – feels about the same as post op, but it’s slowly getting easier to move
  • Bathing – completely over keeping my dressing dry and with ‘staple removal date’ in sight, I shower normally and put a dry dressing on immediately after each shower. Takes a toll on my leg skin but my hair and body feel better for it. For the ladies – annoyed I didn’t fit in time to wax my legs pre-op because there’s no way I can do it now, so forced to shave. Grrrr.

Within 2 weeks

acl repair surgery post staples
The day I had my staples out – 2 weeks post surgery
acl repair surgery staples gone
A bit of a close up…
  • Dressing and incision: staples are removed – hurrah! Hurt like hell but feels good.
  • Crutches: told by physio to wean myself off crutches indoors over the next week or two but I’m already there. Still too nervous to go crutch-free outside (uneven road by my house)
  • Pain medication: taking much more sporadically and most days taking none at all. Needed mostly at night if I do need them.
  • Physio & swelling: back to physio and given 3 additional new exercises (1/4 squat against wall,  1/2 lunge, supported steps going up one at a time). Taken into the gym to try the bike and step. Swelling going down but still there. Told to continue icing.
  • Exercises: advised to get back to the gym 2-3 times a week for 10 minutes of cycling. Frustrating because i) I can’t drive so need to rely on others or take taxis; ii) for just 10 minutes of exercise (and some careful upper body weights if I want), it feels like a big effort/poor use of time but I commit to it
  • Stairs: stairs (up and down) still using the wall/banister for support and still two feet on each step but now in ‘stair training’ practising on bottom step at first, taking full weight on the knee to go up (not enough ROM for going down yet)
  • Sleeping: still not able to sleep in usual position (on front). Can sleep on side with support of pillow under my knee. Seems just as irritating on the incision because now I have no protective dressing.
  • Range of motion – Leg is close to straight when lying down but not when I stand up, making standing painful after a while. Range of motion is up to about 110-120 degrees (full ROM is around 180 degrees)
  • Bathing – back to normal – so nice to put the incision under running water.

When can you get back to work?

The answer to that really is going to depend on what you do and how your recovery goes. I work from home and do a laptop based job and while I’ve been checking emails since week one, sitting at a desk to reply to them has been more of a challenge. Equally, because I can’t fully bend or straighten my leg, my laptop on my lap isn’t a good alternative.

I’m going to try to get back to something close to a normal work week next week (week 4). Fortunately, working from home, I can have a rest/lie down when it all gets too much. I’m also free to fit in my physio exercises as and when. Oh, and I don’t have a commute, so no need to stand on the Tube or figure out how to get to work without being able to drive (an activity for weeks 4 to 6).

If I worked in an office, I’d try to get some work from home time and return on reduced hours around weeks 3-4. In fact, that’s what the hospital told me was a reasonable expectation and it feels about right.

Within 3 weeks (I was here at time of writing – more updates below)

acl repair surgery week 3
Taken 3 weeks after surgery – I’m pleased to say it’s already starting to look very ‘what’s all the fuss about’. Can you still make-out the edging where the dressing was? It’s still spotted and bothered.
  • Dressing and incision: Still need to wear ‘soft’ clothes – jeans are tough and irritate the incision but it’s nice to be staple and dressing-free.
  • Walking: walking is better but still deliberate and slow. Also starting to understand shortened hamstring – leg sometimes feels heavy to lift off the floor, so I shuffle sometimes.
  • Pain medication: no longer taking pain pills regularly – just pop a couple pre-physio so I can get the most out of the time there or if I’ve been doing a lot of leg movement
  • Physio & swelling: exercises are going well and don’t really hurt anymore. Swelling going down but still present in pockets so continuing to ice (and wisg=hing my op had been in summer when ice would have been more welcome).
  • Exercises: Made it to a coffee-shop solo – with one crutch and 30 minute walk instead of 10 but FREEDOM. I want to get back to yoga so badly but I don’t believe I’d be able to get on and off the floor at this stage, so I’m going to have to be more patient.
  • Stairs: slowly introducing one stair at a time for going up – do it for a few steps then revert to two feet on one step.
  • Sleeping: still seems just as irritating on the incision. I feel like I’ve made no progress on this front.
  • Range of motion -struggling to sit in a normal chair for long but most likely because I’m short (5ft) and my feet don’t touch the floor so all the weight it on my knee. Impacting my ability to work more than I thought. I’m finding my dictation software useful for writing this blog article. More awkward for emails.
  • Bathing – Bought baby bubble bath and gave my knee a good soak in the tub – bliss (even if it was a challenge getting in and out of my slipper bath).

What I’ve been told to expect/hope to achieve in the next few weeks

Just kidding via GIPHY

Week 4 – I need to figure out a better way for sitting at a desk or with a laptop on my knee so I can get more work done.

Week 5 – return to physio for the next ‘phase’. Not sure when I will be added to the lower limb class, but I’m hoping around this point.

Weeks 4- 6 – I should be able to return to driving – this will be liberating, but I need to get physio approval first because I’ve injured my ‘clutch leg’ and without that approval my insurance will be invalid.

Week 6 – return to see the surgeon for a check up. Fingers crossed, I’m hoping that’s going to be the all clear on the surgery front – no infection, the graft seems to be holding and no problems with the nuts and bolts or whatever it is they put in my knee (ribbons?) to keep everything in place

Week 10 – rough estimate of when I’ll be able to look at activities like running on a treadmill. That feels both very far off (impatience) and also much too soon (confidence) at this point.

We’ll see how it goes.

Updates since week 3

Week 4

I’m one-day shy of my month-anniversary of having the surgery – where did the time go? Anyway, here’s how I’ve been getting on.

  • Dressing and incision: Jeans still irritate a bit but I’m able to wear my softer ones for hours. At home I’m still in my leggings.
  • Walking: friends and family are starting to comments that I’m walking better. I feel quicker, too. I have a bit of a limp but I’ve given my crutches back and feel confident enough to get around without them.
  • Pain medication: it’s now rare for me to take any pain pills.
  • Physio & swelling: I’ve STILL got pockets of swelling. Sigh. Told by physio to continue the exercises but I can add in leg press at the gym. I’ve also been told to step-up the bending and push my leg a bit harder on that front.
  • Exercises: The bike at the gym is feeling a lot easier although I’m completely over the exercise a couple of times a day regime. It’s only 5 minutes here and there but it’s feeling like a chore. On the plus side, I got back on my yoga mat which was a huge personal success. My practice is still very modified but still.
  • Stairs: I’m also now walking both up and down the stairs normally though it’s still an effort and I need to be careful (no hot cups of tea in hand when going down!)
  • Sleeping: I’m finally starting to feel like I can sleep more normally. My incision can still feel a bit tender under the covers but nothing too unbearable.
  • Range of motion – I’d say I’m probably at about 160 degrees and judging from my physio, I could do more so that’s my focus for the next weeks.
  • Bathing – Absolutely back to normal 🙂

I’ll update again around week 6 when I go back to see my surgeon and have more physio.

So, that’s been my ACL repair surgery recovery experience and a few of the surprises about the surgery. Have you have an ACL repair? Did you have a different experience? Let me know in the comments below. Also, happy to answer questions if there’s something I haven’t covered.

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acl surgery

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Article written by

Jo Fitzsimons is a freelance travel writer who has visited over 50 countries. www.indianajo.com is the place where she shares destination details, travel itineraries, planning and booking tips and trip tales. Her aim: to help you plan your travel adventure on your terms and to your budget.

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  1. Where to Go in Sardinia - Self-Drive Itinerary | Indiana Jo

    […] being assured it’s safe to do so) and it didn’t do a damn thing to speed along the healing of my knee. I’d have demanded my money back…if I’d paid for this free […]

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