Hey everyone, my name is Olivia and I am a physiotherapist at the Mudgeeraba clinic! I recently had anterior cruciate ligament (ACL) reconstruction surgery on my left knee. This blog is going to follow me on my rehabilitation journey, and hopefully give everyone good insight and inspiration to help you to achieve all your goals! It will consist of objective measures, exercise prescription, my setbacks, and my wins. I will be following the Melbourne 2.0 ACL protocol for my rehabilitation, which consists of 5 phases:
- Recover from surgery
- Strength and neuromuscular control
- Running, agility and landings
- Return to sport
- Prevent re-injury
This blog will focus on my recovery from Phase 1. The goals of this phase are to get the knee straight, settle swelling, and get the quadriceps firing. I hope you enjoy reading!
Pre-Surgery and Background
This will be my second ACL surgery on my left knee, the first being July 2022. Functionally, I am very good – I am able to walk and even jog without pain. However, I am unable to play sport, or do any cutting/pivoting exercises without feeling very unstable and like my knee is “giving way”. Therefore, I am getting the surgery to prevent any further injuries, with the goal to return to volleyball, basketball and golf by the end of 2024.
I have done a lot of prehabilitation, which means getting my quadricep muscles and other lower limb muscles as strong as possible before surgery. Research shows that doing exercise preoperatively can lead to significant improvements in outcomes such as ambulation, function, and overall quality of life (Moyer et al., 2017).
Surgery Day! (14/12/23)
Feeling nervous! I have been waiting for this surgery since my injury in April, so it is a bittersweet feeling. I feel lucky and grateful that I am able to have this surgery, but anxious about going through the acute stages of recovery.
Week 1 post surgery
Great news, the surgery went smoothly and there were no complications! My surgeon revised the ACL using my quadriceps tendon and also performed a lateral extra-articular tenodesis (LEAT). This LEAT means he took my iliotibial band (on the outside of my leg), and wrapped it under my lateral collateral ligament (LCL). This is to provide more rotational stability and prevent future re-injury. It is not always done with ACL surgery, but is becoming more popular in the world of knees.
To be honest, this week has been painful, challenging, and I’ve needed a lot of help from my support system. I am using 2 axillary crutches to mobilize, and using my Iceman (an extended cold therapy machine) often. I am taking pain medication as prescribed by my doctor and sleeping a majority of the time with my leg elevated. Home exercises include ankle pumps, heel slides on the bed, and isometric quadricep contractions.
Range of motion (ROM): 40-80 degrees
** normal range of motion of the knee is 0 degrees (fully straight) to 135 degrees (fully bent)
Pain score: 3-8/10 depending on time of day, activity, and pain relief
TW: graphic images post-surgery
Week 2 post surgery
So far so good! Every day is gradually getting better and I am able to put more weight through my foot. I stopped using crutches on day 11 and now walk with a limp. Home exercises consist of inner range quadriceps (having a foam roller under my knee and straightening the leg out), straight leg raises, bridging, and gravity-assisted knee extension ranging. It is important to keep it easy the first two weeks to let things settle and allow my body to heal.
Range of motion (ROM): 20-90 degrees
Pain score: 0-6/10
Week 3 post surgery
I finally began walking without a limp, but unfortunately I had a pretty significant set-back. While I was in my kitchen, I slipped on water and fell on my left leg, forcing it into a fully bent position. This caused my stitches to open and a trip to the emergency department, which regressed my recovery process significantly. I am back to walking with crutches and using cold therapy for pain relief. This has been a big setback for me, especially mentally. I am quite bored most days and wishing I could just walk normally again. The lack of activity is also affecting my sleep and I am feeling restless at night. However, I am just trying to stay positive and take it day by day!
For exercises in bed, I am focusing on trying to get back my range of motion and doing isometric contractions. I am no longer able to do straight leg raises or straighten out my knee.
Range of motion (ROM): 20-60 degrees
** decreased range of motion from last week
Pain score: 4-9/10
Week 4 post surgery
My fall last week resulted in a grade 2 (partial tear) of my rectus femoris, one of the quadricep muscles. This was due to the stretch put on the muscle when it forcefully bent into full flexion. This will delay my recovery and push my healing time frames back, but after MRI imaging there is no further damage to the graft or the tendon, which is great news.
I am back at work this week and have a slight limp – which clients aren’t too scared to point out to me (haha). I am also going to the gym to do my exercises, as I find it easier to engage and more motivating to do all my repetitions and sets. My favorite exercise is cycling, because it works on both range of motion and strength. I like to alternate between the seat being close and far away from the pedals so I am working into both end range flexion and extension. I am also doing straight leg raises – which is an important measure of quadricep strength.
I am increasing in function each day and my overall mood is improving. Pain is still present but I am seeing improvements in strength and range of motion, which is the most important for me (can never turn off the mind of a physio!).
Range of motion (ROM): 10-100 degrees
Extensor lag**: 20 degrees – this means that when I am fully relaxed with a straight leg, it has to bend 20 degrees before I can lift in the air! You can see this in the video below. This shows a lack of functional strength.
Pain score: 0-6/10
Week 5 and 6 post surgery
These weeks have been about slowly recovering and getting back on pace with my rehabilitation. I have started doing clinical pilates (with our excellent exercise physiologist – Olivia) and it is really beneficial for me since it is low impact, but high intensity. It has been a really great way for me to work my quads and glutes without any increase in pain.
At the clinic, I am taking advantage of being in a place surrounded by amazing physios, so I have been getting manual therapy a few times a week. This varies between dry needling, massage, and shockwave therapy. All have been helpful to decrease inflammation and help with tissue healing. I have also started to do scar massage to desensitize the area and stop scar tissue from building up.
Through this rehabilitation, I have officially been able to walk without a limp. I am continuing to do my exercises at the gym and because of this – I have full knee extension, the swelling has decreased, and my quadriceps are firing. I am onto phase 2!