I Tore My ACL… Now What? (Part Two)

Surgery or no surgery, it has been determined that you have a complete ACL rupture. If you’ve been deemed a surgical candidate, the next steps are most likely pre-surgical physical therapy followed by surgery. If you are not going to be having surgery, straight to physical therapy you go! Part Two of this blog is meant to give you a sneak peak into what you should expect on the day of surgery, and in the first one to two weeks after surgery!

Surgery Versus No Surgery

I’m somewhat back-tracking here to discuss surgical versus non-surgical intervention as I ignored it in my last blog post. Research has shown that there is an ability to function well with non-operative treatment of an ACL rupture; however, this is not for everyone. The standard for a high-level athlete or generally athletic individual continues to be ACL reconstruction. If you’re thinking about a non-operative approach, trialing a minimum of 6 weeks of physical therapy may be in your best interest to make sure you can function well without surgery. If you decide to not have surgery, does this mean you won’t need surgery down the road? We really don’t know. I just thought that this was an important bit of information for you to have.

So, you’ve opted for surgery…What’s next?

Following your course of pre-surgical rehabilitation (see my last blog post for why we think this is important) and follow up with your physician, you will be given a surgery date. That surgery date will be a dreaded thought on your mind until the day of, and most likely throughout the course of your rehabilitation. I’m going to take you through some information to help get you through the day of surgery, the few days after surgery, and I will also give you a glimpse into your rehabilitation process.

Day of Surgery

The dreaded day has arrived. You will more than likely find out your surgical time the night before the procedure. It will be recommended that you do not eat, and drink minimally 12 hours before your surgery. I can tell you when I was a 16-year-old athletic girl, the thought of not being able to eat made me hungry. What I recommend? Listen to your cravings after surgery and eat! Mine was chocolate peanut butter ice cream. What could be better than that?

You’ll arrive at the surgical center or hospital and be greeted by those at registration followed by nursing staff. I will say, most nurses working at these facilities are extremely well versed at what they are doing and will do their best to make you feel more at ease. You will also meet an anesthesiologist and see your doctor before surgery! Hopefully you don’t mind a temporary tattoo, your doctor will mark your surgical leg with his or her initials in permanent marker before going into the operating room! As scary as it may be, just know this is the beginning of a journey to get back to doing what you love!

You may remember being wheeled into the OR but then things will most likely become a blur until you wake up in the recovery room. In the recovery room you will be surrounded by nurses who are there to help you with anything that you need and your friend or family member(s) who accompanied you to surgery! You’ll more than likely be offered water, juice & crackers when you wake up as they all know how hungry one is after not eating for a while! Also, if you cannot feel your operative leg or activate your musculature it is because you have been given what is called a nerve block. It is 100% normal so do not panic. It may feel odd, but the sensation will wear off in about 6-12 hours. So, what comes next?

Most ACL surgeries are outpatient procedures and you will be discharged the same day. There has been one instance where I had a patient not be discharged due to severe nausea post-surgery (the patient also had a 2-hour ride home from the hospital). Before being discharged, you will learn how to use crutches or in rare cases a walker, and you will also be given discharge instructions. Most of the time these instructions include: a weightbearing status (how much weight you can put on your leg), keeping your bandaging dry (Press & Seal is a lifesaver for bathing), how to properly take your prescribed medication (don’t let the pain get ahead of you!) and how and when to wear your post-operative ACL brace. You may have increased restrictions based upon whether there was meniscal or other ligamentous involvement, but the nurses and staff will let you know! After you’ve been cleared by the MD & nurses- off to home you go!

Weeks 1-2 After Surgery

Okay, so it’s only week one and you’re going stir crazy, right? It happens to us all, but you’ve officially started your ACL journey (or should I say, “jourknee”). The pain is still present, you’re doing your four or five basic exercises they gave you at discharge, and you’re already tired of crutches. But what should you know?

Don’t let your pain get ahead of you! I know pain medication is a scary thing- but I suggest using it when needed. You’ll notice that the first few days may be a bear, but as time goes on throughout the week, you may need less of your prescribed medication and will move to a less potent form of pain reliever (Tylenol, Advil, etc.). PLEASE-listen to your doctor’s recommendations. Sometimes, we want to wait at least 48 hours before taking a true NSAID (Advil, Motrin, Ibuprofen, etc.), just to aid in the healing process! Little do many of us know, inflammation is the first state of tissue healing!

Make sure you are eating! Proper nutrition is imperative for tissue healing. After surgery you should be consuming more calories than you were before! I know, I know- you can’t exercise and are afraid of gaining weight. Well, in that case make proper food choices and do not eat too much sugar in the process! It won’t hurt to ask your doctor or physical therapist for a referral to a dietician throughout the healing process if you find it is needed.

You will most likely follow up with your physician one week (maybe two) post-surgery to discuss your next steps! He or she will likely remove your post-operative dressing and instruct you on the next stage of wound healing. Most likely you will move to the steri-strip stage of wound-care at this point. Please, whatever you do, let these little guys fall off by themselves! I do know that at this visit is also the moment that some go, “ Ugh, I’m going to have those scars the rest of my life.” Well, friends, join the club! This is now your battle wound and when this is all over and done with, you can tell some crazy story about how it happened (shark attack, running from a bear, etc.). For me, it was a five-foot person’s mistake to attempt racing hurdles.

So, at your first follow up the most exciting thing is that you will most likely be cleared for physical therapy which means- yes, you get to leave the house! Some physicians differ in protocol; however, research is showing that an earlier start to physical therapy means improved recovery! We enjoy seeing our patient’s as early as two to three days after surgery! Before we start examining the phases of rehabilitation (which will be discussed in part three of this blog), let’s answer one main question!

When Can I Play Again?

So, you’ve been cleared for physical therapy and the one question on your mind is, “When will I be able to play again.” Well, let’s just say this varies from person to person. Research shows that there is 51% decrease in re-injury rate every month until 9 months post operatively. So, the next question- “Well, Adrian Peterson completed his rehabilitation in four months, why can’t I.” Guys and Gals, I hate to break it to you, but we don’t have the same genetic make-up and our full-time job isn’t to attend 2-3 PT sessions per day for months on end. That guy is just some kind of ACL miracle. We’ll just leave it at that.

So more than likely your rehabilitation will span at least 9 months’ time. This is what current literature recommends. I will say, that some people may be 8 months, some may be 24 months! Just because Sally from soccer finished in nine months, doesn’t mean you will be ready then. Everyone is different and we must respect that! So, what will your physical therapy look like?

Phases of Physical Therapy Rehabilitation

I can hear the thoughts in your head- “What in the heck will I be doing in physical therapy for nine months?”. Well, there will be several phases that you will go through and set standards that you will have to meet in order to progress in your rehabilitation. You will start in the acute phase and make your way through the strength building, return to play, and return to sport and performance phases!

Stay tuned for part three of “Uh Oh, I Tore My ACL…. Now What?”, to find out what to expect during each phase of your ACL rehabilitation journey! In the meantime, if you have any questions- please do not hesitate to call us at Feldman Physical Therapy and Performance!