My ACL Recovery Timeline (with Scar Pictures)

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In hospital just after surgery, leg under blue hospital cover

This post is part of a series. You may want to start here.

If your want the quick links, here’s the full series:

In 2016 I had ACL surgery. It seemed like a no-brainer since I’m a travel writer and was (relatively) young when I ruptured my ACL, MCL and meniscus in one fell swoop – I say swoop, I mean dancing under a limbo bar. Hey, it was pretty low and I was one of only two remaining contestants in line for a bottle of rum until I heard that heartbreaking ‘pop’. 

I didn’t think that I’d still be updating this post several years after the original surgery. 

Why am I still updating it? Because I’ve come to realise that my recovery is an ongoing work in progress. The doctor advised me that my knee would never been 100%. And since I’m a perfectionist, I am always striving to make my knee stronger. 

In this post I’ll give you full details of my recovery timeline and experience.

I’ve updated this post over time up. Keep in mind that I was 40 years old when I had surgery and I was relatively fit but not the fittest I’ve been in my life (I waited nearly a year from my surgery, which didn’t help). We also all have different levels of pain tolerance and recovery speeds but this is how I found things.

Warning: incision photos in this post. I have included some pictures of my knee after the surgery, including a few days after I had my ACL surgery. Some of them are pretty gruesome. The worst one is under the ‘after a few days’ section. 

Pre-surgery and even post-surgery I’ve done a lot of research on what 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 was at the end of week 3 of recovery when I wrote the first section. I have then kept it updated over the years in case you’re still having niggles down the line. Here’s my experience.

Getting ACL 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

You can read about my surgery experience here – there were a few surprises. 

First 24 hours after ACL repair

  • 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

bruised knee with acl wound 2 days after surgery - with staples
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; 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

a staple working its way out of my knee by itself
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 scar the day my staples were removed
The day I had my staples out – 2 weeks post surgery
acl wound close up just after staples removed - still very scabby and red
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 I return to work after ACL surgery?

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 of ACL surgery

acl scar at 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 wishing 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

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 on my ACL repair – My recovery timeline

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 nice.
  • 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 🙂

Week 6

By week 6 I was starting to get around more, although the stairs in my apartment (the steep Victorian kind of stairs) were still causing me bother. I also got back on my yoga mat for some gentle stretches (avoiding knee and kneeling positions) and it felt good.

I was, however, getting frustrated with what seemed like slow progress. I took myself to a travel conference in London, at Excel (which is almost bigger than China inside, or so it felt to me at the time) and it was way too much for my knee.

In hindsight, two things were going on: i) my expectations surrounding recover speed were too high and ii) I’d gotten a bit lax with my physio routine (after 6 weeks, finding time to do the exercises can feel like a bit of a chore and because I was mostly mobile, I tricked myself into thinking things were fine without the exercises).

Round about week 7, I had a check-up with the surgeon. My knee was x-rayed and the surgeon did a bit of pulling and pushing to check the strength of my knee. All seemed to be well. I was expecting to be discharged at this point but apparently that doesn’t happen until month 3, which was a bit of a glitch for me because I was planning a trip to Sardinia as well as a larger trip to Hong Kong, Thailand and Myanmar around week 16. This meant I would have to declare my ACL repair as a pre-existing condition on my travel insurance, and I was worried about the cost. However, as it happened, ACL repair is so common that provided you only have physio to do, they will add it to your insurance with no extra cost.

All seemed to be going slowly but surely in the right direction. And then I had a physio session and things went to sh!t.

After an intense half hour that included time in the gym and some hands-on manipulation, I woke up the next day and could barely walk. My knee had ballooned, I was in pain and I got my trusty walking cane out because my knee didn’t feel stable enough. This state endured for the best part of 2 weeks and I was frustrated at hell at being set back.

Week 8

ACL incision scar after 10 weeks
My incision scar at week 10 – it’s healing really well.

Returning to the physio in pretty much the same state as I’d been at week 6, I explained the set-back and my physiotherapist told me is was highly unlikely it was anything he’d done (I remain sceptical). I left the session with a few new exercises (lateral stepping) but wouldn’t let him touch my knee.

In week 8 I took my knee to Italy (and ate all the lovely Sardinian food). I took my walking stick as a precaution, which turned out to be a good thing (I was visiting a lot of hilltop towns for a work project). With 16 hour days and a lot of time on my feet, I needed to ice my knee at least once if not twice a day and I was back to taking pain medication at least once a day but my knee held and it was nice to feel a semblance of normal travel life.

However, my physio exercises and gym visits had pretty much disappeared and by 9 weeks I had a long hard chat with myself. To recover, I needed to do my damn exercises and I needed to make them a priority. So, after my Sardinia sojourn, I got back into a physio routine. Every morning I did my exercises. Sometimes I did them at night, too. I returned to the gym (3 times a week), squeezed in a few 15 minute yoga sessions at home, bought a static bike and gym ball for while I was watching tv/not able to get to the gym.

And, d’you know what. It worked.

Week 12

Castelsardo in Italy
A picture from my trip to Sardinia in case you’re sick of looking at my knee!

Thanks to my increased commitment to the physio exercises, by the time I went for my 3 month check-up, I was walking close to normal, my knee felt strong and I was positive about my recovery prospects. As a hyper-mobile person, my knee still hasn’t reached full extension but I’m confident it will get there. My physiotherapist felt happy with my progress and I (almost) skipped out of the session.

At this stage, a few more exercises were added to my routine including jumping, lower squats and use of a theraband. I was also told I could start to add some running back into my routine (I’ve been on the treadmill twice since then and although terrifying, I was able to get in a few minutes worth of running). Weirdly, kneeling and crouching is still a long way off (month 6 apparently).

Week 16

ACL scar at week 16
Incision scar at week 16. I’ve had a couple of days of light sun on my leg. I’m very impressed with the healing.

Around week 15, I boarded a long-haul flight to Southeast Asia for a long-term (2 or 3 months) backpacking trip through the region (but with a suitcase, not a backpack this time). I booked the trip before my op and, to be honest, I’d vastly underestimated the length of the recovery process.

Still, I have gone ahead and so far (10 days into the trip), my knee is holding up exceptionally well. I need to be more careful than I would normally and there are some activities I simply am not chancing – just yesterday I said no to a bit of cave exploration because of the risk of the uneven floor. However, I’m able to have some gentle swimming, and I’m walking a lot, which seems to be strengthening my knee. I also let a Thai masseuse have a gentle ‘go’ at massaging my leg and knee, to great success.

My legs get tired a lot more quickly than they would have before on the same trip, but mostly because I’ve lost a lot of fitness and those first few days pounding the streets of Hong Kong were agony. However, things have improved dramatically in under 2 weeks. I still have some knee swelling, made worse by the tropical heat, but I’m icing every few days, which is helping.

My scar is also looking pretty good. I kept up with bio-oil twice a day until just before I flew to Asia and now I’m going to let nature, the sea and the sun (with sunblock over it) do the job. If any ladies are interested, it’s apparently not advisable to have the site of the incision waxed for 12 to 18 months post op! My waxing lady did a great job of going around the scar and then painstakingly tweezered the rest of the hairs out one by one. Thanks to some lingering numbness, I didn’t feel a thing.

My physiotherapist has advised that I should limit my trip to 2 months instead of the original 3 months I planned – this is so I can start my lower limb class and avoid setting myself back. At the moment, I plan to see how things go. I have a theraband with me as well as the list of lower limb class exercises (a 6 week course I took after I damaged my knee) and I’m going to see if I can build those sessions in as I go along. I’ll let you know how it goes.

Six months after ACL surgery

I’m not great at listening to medical advice and so I ended up staying in Asia for that 3rd month instead of coming home and resuming my PT. And, guess what, I’m glad I did.

Why? Because I pushed my knee far more than I might have done in the UK in winter. Here’s the program I ended up putting together for myself:

  • daily walking and some gentle hiking (round about month 5) – it was so much easier to get out and move about in the warm weather and with plenty of things I wanted to go and see, I didn’t struggle with ‘gym motivation’;
  • weekly and sometimes twice weekly massage. I trust the Thai masseurs more than I trust my own GP and despite the fact that some of the lower leg massages were painful, this did a lot of loosen up my muscles, reduce the fluid on my knee and, I think, even reduce the thick scar tissue. Obviously you should take medical advice before getting a massage and I totally did that :/
  • lower limb class exercises – it turned out that I got to fit this in about once every 10 days rather than weekly but I quickly realised a hotel room served perfectly well as a gym (trampette = hotel bed, FYI) and I wasn’t really missing out on doing the classes back in the UK;
  • small amounts of running on a running machine if my hotel had a gym. I did this only a few times;
  • swimming – in the ocean, with the current. I was very careful at first, especially because of the uneven surface underfoot but within a few weeks of going away, I was gently hopping in and out of boats;
  • yoga – this was the hardest part for me because there was so litle bend in my knee at first but slowly and, I admit, a bit painfully, I have gotten much of my bend back (more on that below). I practised for about 15 minutes around 2 times a week, sometime less. However, it was the week-long yoga retreat that really helped.
  • I saw a physio once while I was away just to make sure I was on track to recover fully and he said I was doing well.

Arriving back in the UK on 31 March, within a few days I had my first catch-up with my physiotherapist since before going away. I was a bit nervous but as it turns out, he was very pleased with my progress.

I have now been medically dischaged – yay! However, because I skipped the lower limb classes, I can start them now and I am taking the NHS up on the offer even though I can now walk and run pretty well.

8 Months after ACL surgery

I’ve been back in the UK for about 2 months now and, to be honest, my recovery has hit a bit of a brick wall. I’m not exercising as much and I’m not as active because – well, work and life have gotten in the way. I have, however, resumed my lower limb class at the gym. By starting the classes so long after my op, I’m pleased to be able to work on really strengthening my knee (standing up from chair on one leg while holding a 5kg medicine ball will do that). I’ve also got the all clear to run outside.

As for the overall health and strength of my knee, here’s how it is at the moment:

  • Strength – so, so, so, so weak still. I didn’t realise that as a pair my legs feel strong but my physio asked me to hop on my injured leg and I could barely get myself off the ground. Clearly I have much work still to do on rebuilding the muscle;
  • Pain – I no longer have pain but I do get the occasional ache – usually when I’ve been static moreso than when I’ve been mobile!
  • Flexibility – as a yogi, it frustrates the hell out of me that the physio program does nothing to increase flexibility – it’s all about strength and stability. Thanks to yoga in Asia, I am now able to cross my legs, get in and out of a crouch position (if I’m careful, but it hurts and I can’t stay there for long) and kneel on all fours (yoga table top position). I’m still struggling to sit back on my haunches but I am practising. Yoga is definitely the key to getting back my flex.
  • ‘Risky’ activities – I’m still giving all challenging sports a wide berth. I did a short hike up Great Orme in North Wales on grassy terrain and it was fine and after way too many beers to be making sensible decisions, I learned some Romanian dance moves in Romania a couple of weeks ago. My next challenge is getting off the treadmill and out onto the road running. I did hit just under 5k on the treadmill and recovered well so I will take it slowly and return to the cushioned runner if I need to. Many people do return to risky sports around now but I’d like to get more strength in my knee muscle before then.
  • Popping and clicking – yep, my knee pops and clicks pretty frequently. Again, this corresponds with how inactive I’ve been. It doesn’t hurt and I’ve been told by my PT and surgeon that it’s fine. It just feels DISGUSTING. I’m hoping it will ease over time.
  • Hyper extension – like with flexibility, there’s little in the physio session designed to get my hyper-extension back and even now my injured knee doesn’t push back as far as my healthy one. However, I understand from the physio I saw overseas that this will happen as my knee muscle strengthens.
  • The scar – I’m really impressed with my scarring. Of course, you can see it but more compared to those first pictures post surgery, I’ve very happy with how minimal it looks.
ACL scar after 8 months

12 months after ACL surgery

It’s been a year since I had my surgery and there are many days when I don’t even  feel like I had the operation at all. However, there are still days when I certainly do feel like my knee is not quite as good as it was. Those days have gotten fewer over the year but I’m not at the point where I can report that I’m back to full knee strength and I’m not sure I will reach that point. Still, my knee is a lot stronger, sturdier and stable than it would have been if I hadn’t have the surgery.

My range of motion is actually pretty good. I can cross my legs, squat, kneel down and I’m working on sitting on my heels for increasing periods of time. I attribute this decent range of motion to yoga which I try to do at least 2 to 3 times a week.

The other physical activity I was very keen on before my ACL surgery was running and I’m pleased to say that I’m back to running outdoors with only a small fear of hitting potholes. My knee doesn’t give me any trouble when running but I’ve certainly taken a hit in terms of my overall fitness and the strength in my leg muscles has dissipated. For that reason, my progress is slow, I’m still largely running intervals and my aches post run are worse than they used to be. But this could also be down to the fact that I am now in my 40s. I used to run 10ks and I’ve got back to 5k running with hopes of increasing my distance slowly over time.

Being completely honest, I could have done more in the past year to strengthen my knee – I’ve gotten out of the habit of going to the gym and using the weights and I know that my knee would have been stronger for it.

I do still have some hideous clicking and crunching sounds, though none of them hurt. My knee sounds like screwed up paper when I go from a full squat (sitting on my haunches) to standing e.g. when crouching at my under the counter fridge and I then stand up. The internet tells me this might be my scar tissue breaking up. I hope so because the noise makes me feel queasy to the point that I loudly shout ‘crunching’ when I stand just to cover up the noise. A bit awkward when I’m in public!

The clicking comes and goes and usually happens after I’ve been pushing my knee with exercise. I’ve got to the point where I stopped worrying about it and it goes away on it’s own. Again, I don’t feel any pain.

My scar is barely noticeable in my opinion and I never give it a moment’s thought.  I am convinced the bio oil helped with scar reduction though, of course, I can’t prove that! My numbness has also gone.

ACL surgery scar after 12 month

My office is located in the attic of my apartment, which is two flights up from my front door. The other day I caught myself running down the stairs, taking the corners at speed to catch the postman. I’ve come a long way in 12 months and to be able to run and twist and turn without too much fear has made the surgery and all the pain and dressings and physio completely worthwhile.

2 years after ACL surgery

Leg elevated with kinetic tape 2 years after ACL surgery - running injury

I never imagined I’d be writing a 2-year update on here. Mainly because I thought I’d be back to full strength. Unfortunately, I’ve recently taken myself back to physio. Don’t worry – I think these are my individual quirks rather than being indicative of what you can expect in 2 years. However, as this post has become popular and everyone has shared their own experiences below, I thought I may as well tell you what’s going on with me.

My two favourite forms of activity are outdoor running (10k but I’ll honestly settle for 5k at this point) and yoga, as well as some hiking. The problem is, I’ve never been able to get back to full strength with running or yoga. I also shy away from adventurous hikes because my knee isn’t as strong as I’d like and I worry I’ll have to be helicoptered off a mountain.

The issue with my running has been pain in my opposite hip any time I get back into a regular (3 times a week) routine. It’s probably not helped by the fact that I now only hyper-extend in one knee. This has had the effect of a few weeks on, a month or two off with the running and I’ve not been able to push through a 5k without hurting for days afterwards.

Yoga has been more of an issue with cracks and pops and, about a year after surgery, development of a noise in my knee that sounds like scrunched paper every time I squat and stand. Cue: vomit.

After spending a few days in Verbier recently, watching from the sidelines as people hiked and biked and climbed, I decided it was time to see a sports physio (private rather than NHS) to find out if I can do anything to progress from basically functioning to returning to sports without fear.

The problem was, I had back to back trips (Verbier then Malaga) and didn’t book an appointment. Then, while I was doing yoga on a hard tiled hotel floor room in Malaga (with a towel under my knee, but still, not smart in hindsight), I felt a jolt of pain in my ‘repaired’ knee.

I returned home and, with yoga on the shelf, I decided to give running another try. I’d bought some ‘Miracle balls’ (more on that above), which seemed to be working for my hip pain, so I was feeling more confident than I had in a while.

About a week into my new running routine, frustrated at my entire lack of fitness, I decided to do some hill sprints. Yes, I know what you’re thinking but we’ve already established that I don’t always make the best decisions in the moment. (Does anybody?) Plus, muscle memory isn’t always your friend. I felt a tiny knee twinge as I tackled the hill but nothing more. In fact, I was quite upbeat when I got home…until I hit the shower and noticed a huge egg shape underneath my knee cap, next to my incision scar.

Dr Google told me I had a swollen bursa sac (fluid in one of the sacs that protect the knee). Mostly likely irritated with the yoga and fully developed by the hill sprints. In fact, bursitis is commonly known as housewives’ knee because it’s usually triggered by kneeling (seriously, someone needs to update that, but I digress). It’s also common in runners. So, bingo. Full house.

While getting bursitis was not the best thing – rest, ice, compression and elevation, hello my old friends – it finally made me book that sport’s physio appointment I’d been thinking about.

And that’s when I found out I have two issues with my knee that are probably hampering me getting back to full knee fitness.

First, my knee isn’t properly aligning. It buckles inwards slightly when I move it. I suspected this right at the beginning of my recovery, watching it when I was doing leg presses at the gym, but I must have gotten used to it over the past two years because I thought it was now ok. With incorrect knee alignment comes pain when I run, difficulties in yoga and that lack of confidence and strength in my knee.

It also seems to have caused the screwed up paper noise when I crouch – more professionally known as crepitus – which is probably caused by my tendon/ligament catching on my knee bone. Nice.

The good news is, both the misaligned knee and crepitus can probably be fixed through the right combination of strengthening exercises.

But not until my bursitis has gone down. (Dr Google was right, btw.)

What next? For the next three weeks I’m on a routine of rest, which is already driving me insane. Then I’m off to China for a couple of weeks. There will inevitably be some pavement pounding and I’ll be visiting the Great Wall of China. But I’m no longer going to include the extensive hike I had planned in the Longji rice terraces (excuse me while I sulk for a bit). I’m hopeful that by the time I get back, I’ll be ready to start on the realignment and strengthening exercises. I’ll let you know.

The main point from this 2 year update (and my biggest lesson): if you’re still having trouble, go and see someone. Just because you’ve had ACL reconstruction doesn’t mean you necessarily have to put up with a bad knee.

2.5 years after ACL surgery

I’ve written a new post about the 15 things I would have done differently during my recovery?

3 years after ACL surgery

Hiking in Curacao about a week after dengue fever. Smiling but crying a little bit inside.
About one week post-dengue, hiking in Curacao. Looking healthy, all things considered (but dying a little bit inside).

I’m still updating this post because my recovery is ongoing. I had a chat with a friend about this the other day. His question was: 3 years after surgery, surely everything is done now? My answer was yes. And no.

Within a year I’d say I was 80% recovered. It was enough to work in an office and go to the gym, for sure. However, I wasn’t prepared to let go of the remaining 20% recovery. Call me a perfectionist (you won’t be the first) – I wanted to get fully back into every yoga posture I’d ever done, even the kneeling poses, and push my practice deeper. I wanted to do more than just go the gym. For those reasons, I pushed and persisted and I got results.

By year 3 my legs were stronger than they were pre-surgery. My running was coming along, entirely pain free and I was deeper into my yoga practice than I’ve ever been. 

I achieved all of this by getting an amazing physiotherapist who I met every 6 weeks and who tailored my physio exercises according to which specific muscles were strong and weak (quads, hamstrings and glutes). She got great long-term results by forcing me to slow the f&ck down with my running and how fast I’d been escalating my distance. I did my exercises 3 times a week. I was so diligent that I recall lying down in my hotel room in Milan, my head next to the toilet so I could use the bed base to do my elevated bridge exercises. 

But then things kind of fell apart. Just after my 3 year ACL anniversary (anyone else not celebrate this?), I got dengue fever and it  wiped me out. Two months on, I’m still recovering my day to day strength and my physio program has promptly fallen apart. It doesn’t help that I’m on an extended trip in Central America and I’m struggle to do my physio work (finding the space and motivation are a challenge). I feel like this steps forwards, steps back approach has happened a lot during my ACL recover but what I’ve taken away from the last year of hard work is that almost 100% recovery can be achieved (at least for me) with the right guidance, dedication and work.

If you are struggling, I’d recommend starting by finding a physio who works for you. 

So, that’s been my experience. Have you have an ACL repair? Did you have a different recovery 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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pink knee tape on acl
Author - Jo Fitzsimons

Hi, I'm Jo, the writer behind Indiana Jo. In 2010 I quit my job as a lawyer and booked an around the world ticket. As a solo female traveller, I hopped from South America to Central America, across Asia, the Middle East and Europe. It was supposed to be a one-year trip but over a decade later, it's yet to end. I've lived in a cave, climbed down a volcano barefoot, spent years as a digital nomad, worked as a freelance travel writer, and eaten deadly Fugu. Now I'm home, back in the UK, but still travelling far and wide. You can find out more About Me.