Episode 172 | Should Your Knee Feel The Same After An ACL Injury?

What is up team and welcome back to another episode on the ACL Athlete Podcast. Today we are answering the question: Should your knee feel the same after an ACL injury or maybe after an ACL surgery? Basically, we’re answering, should it return back to normal or feel normal if you will, after you had this injury or surgery? And let’s say it has been, especially time since that period, should it be feeling the same again. This is actually a very interesting question. I think if you’re an ACLer, especially if you’ve maybe done this once before, you’ve gone through this process, then there’s a different answer there potentially than someone who is on the clinical side who maybe has seen, especially a higher volume of ACLs. 

I think that there is this general assumption that your knee is supposed to feel the same like it did before the injury. This is something that I have to talk through with my athletes because sometimes there is this thought like, okay, well, it just doesn’t feel the same as it did before. And before meaning before this injury had happened. This is something that I want to tackle because it comes up a lot. I think that there is this myth around it if you will, of thinking that, “Oh, it’s just going to naturally become normal again, because you’ve had the surgery, you’ve done the rehab and you’re good to go.” But I really want to tackle this first through the lens as a patient, having two ACL injuries, myself and two ACL reconstructions. And going through this recovery process and now being out. 

It was 2008 when I had my first ACL injury and then 2013 when I had my second ACL injury. It has been a very, very long time. I want to make sure I tackle this because my first experience is actually a little different than my second experience. It’s two different knees so it wasn’t like it was a retear on the same name. I want to tackle it through that lens first. 

And then secondly, I’m going to tackle this question through the lens as a physical therapist, as a performance coach myself, who’s worked and consulted with over hundreds of ACLers at this point, from repairs to reconstructions, multi-ligament (LDTs), multiple procedures involved, youth athletes or pro athletes, multiple retears, complex cases. These are all from this simple, simple, simple cases from an isolated ACL, all the way to these complex cases. So that’s another lens that I wanted to speak through because obviously there’s more volume with that is on a one-time experience that I’m just looking through a single lens of my own experience, but also working with a bunch of different athletes in our team, working with a bunch of different athletes going through ACL injuries. 

Let’s tackle this first through my answer as a patient. I tore my right knee ACL, that was my first one, that was in high school playing football, non-contact injury. Of course, I went through that whole process, did my rehab process and, I came back and I felt very confident on my knee. I almost felt more confident on my ACL reconstructed side. And so this was very interesting. Looking back at this, I’m almost curious if it’s because we didn’t really pay attention to my uninjured side very much. And there was so much emphasis on my injured side that I just became more confident on it. There were more reps with it. I felt naturally just more confident with that knee with doing certain movements. I’m a little weird, I’m left-handed but lower extremity wise, I do stuff with my right foot. I’m a little ambidextrous, if you will, with certain movements or just kind of flip-flop on size with dominance, depending on the task. But with that said, my right knee felt very good, to be completely honest. I didn’t really have any return-to-sport testing. Who’s to say, what those numbers really look like, or if I was feeling good, but not necessarily performing at my best. With that said, I came back and I didn’t really struggle, or I think about my knee that much after my first ACL injury. I felt pretty confident, I could do all the things, no deficits. 

When we come around to my second ACL injury, which was in college. And that was whenever I was in my senior year of college. This was something that was a little different. To back up for my first ACL injury, we did a hamstring graft. One of the things I didn’t know if that is that my hamstring did feel a little bit weaker. That was probably the only thing that I noticed because it was a hamstring graft. I would strain my hamstring a good bit with sprinting and things of that nature. So that was probably one noticeable aspect of it. But other than that, the knee joint itself and performance felt fine. 

For my second ACL injury in college, I had a hamstring graft there as well. And this one was not my normal run of the course like my first one was, two very different experiences, had a much harder time with my second ACL injury and the recovery process, where they took the ACL graft, the hamstring graft. I didn’t like the surgical technique, the incision, there was scar tissue that built up with the way he did the technique. I wasn’t a big fan of it. So right off the bat, I was having issues with my knee because of where that surgical incision was, which was on the inside of my knee crease, where that tendon will kind of run into the medial aspect of the knee. And so this was very interesting to compare it to my first ACL injury and that process. But, it’s something that I always noticed that it just was a little bit more delayed. I didn’t have as much of a fluid process. And who’s to say whether it was because maybe I was younger, I was in high school for my first one. Maybe there were some things I did during that rehab process that allowed me to focus more. I was focused on sports more, I was training a lot more. Versus my second ACL injury. I was working. I was trying to kind of build up my own portfolio, if you will, to be able to get into school. All of these different things. I wasn’t having as much attention on my knee on the second one. And plus the surgical process was a little different as well. And so I noticed hamstring deficits weakness, more so on my left side on the second one. This is something that was very interesting. And then as I got further out from my second ACL injury and surgery, I still notice deficits a little bit more. 

Now, I did end up coming around to being able to feel confident, playing sports again and training, but it took a lot more time to recover. I felt like I noticed just different things in my knee and my left side a little bit more. Now, this is something that is interesting because as time has gone on. I have always noticed. My knees just don’t feel “normal.” It doesn’t necessarily mean that it’s bad. It’s just more so my knees don’t feel like nothing’s ever happened to them. And I noticed a little bit more now on my right side, because I’m dealing with some bone spur issues that, could be just some early osteoarthritis stuff. That could just happen just due to the nature of ACL injuries and the progression of them. But I manage it well, currently. 

This is something that is also interesting being years out from my ACL injury that I just noticed some differences in my knee. The thing that I want to make sure I touch on with this is that it’s not that it limits me from performing or doing things, it’s just more so that they feel different. I know that something has been done to my knees. I know that,when I go to kneel down, for example, sometimes my incision site can feel a little sensitive on their ground, on my right side. And that’s okay. It doesn’t limit me from kneeling down. I just noticed that sometimes, um, sometimes my knee joint itself can kind of feel a little bit stiff on just random days. This is just stuff to be completely raw with you guys. And I think the thing that’s always interesting is that people would just expect for us to how did this injury, have this surgery, you move on and you never feel it again, for example. And I know all of my ACL is listening to this. 

Now, if you’re early on in this process or you’re going through it, don’t lose hope. Don’t think that like, okay, my knees doomed forever. It’s just something that is different. And that’s the thing that I want to really hit home today is different, but it’s not bad. The next thing that I also want to answer this as a PT and a performance coach is that this ACL injury and this recovery process, whether you go surgical or nonsurgical is so-so different for each person. 

It very much is an N=1 type experience. And we can line up a hundred people. With the exact same injury, where it was injured, the sport they were playing, maybe they had an isolated ACL or maybe they had a ACL plus and MCL grade 2 sprain plus a medial meniscus. You know, tearing the tear was the same, right? 

If we lined up a hundred of these people, I guarantee you that every single person would progress differently. They would have some variations in what they feel. And that’s just because humans are so different, person to person. There’s no person that is exact same. Even if you talk to twins and you see twin studies, there are still differences that exist within twins and their genetics as well. The thing is that I want to kind of talk about from this lens is you have to think about the factors that impact this entire recovery and why it can’t just be the same outcome for everybody. Thinki about age, think about genetics, the previous injury history to the knee, the injury itself. What happened? How did it happen? The trauma of it. How intense was it? What tissues were impacted? What’s done in the surgery if you have surgery. Think about an isolated ACL versus meniscectomy versus a meniscus repair. Versus, you know, maybe an MCL repair, maybe there is an let that’s done. Maybe there is an internal brace that’s added in. There’s so many different things that could be done in there. Even something as easy as cutting away some loose debris in the knee or a chondroplasty, for example. Something where you’re kind of shaving the back of the kneecap a little bit. 

This could all change the interfaces and how the knee is responding to those surgical procedures, or maybe there’s a non-op process that’s different in and of itself to. What about the graft that’s used? A cadaver graft.? What type of cadaver graft? Is it a bone-patellar tendon-bone? Is it an Achilles. What kind of like body was it harvested from? We don’t typically know these details. But it’s just factors that think about whenever we think about, okay, should I feel normal after this? If the graph is taken from yourself, was it taken from the quad, the hamstring, the patellar tendon, those are things that factor in. What’s the rehab process like? How was your rehab from the post-op to the mid stages to late stages? 

And honestly, the thing that is just the uncontrollable factor in all of this, is how your human body decides to respond to all of this. The healing, how your physiology changes the biology of your body. Like all these things are going to play such a huge role in terms of the knee feeling “the same.”

So as far as expectations go. Sure, you can hope that the knee itself feels exactly the same as pre-injury and hopefully even better where you don’t notice anything. I hope so. And that is something that I feel like I fell for a decent window of time with my right knee. I didn’t really notice anything. I felt strong, no deficits and that was awesome. But then my second ACL injury was very different. And so this is the same person with two different knees. Now, you can imagine this with different ACLers and their experiences, even based on the factors that I mentioned prior to. But instead understand that this might be different. 

The knee might feel different. So answering this question, should your knee feel the same after an ACL injury? Honestly, it just kind of depends. And I would say more often than not, it’s going to feel different. And I’m not saying different is bad. It’s just different. And that’s what I tell my athletes, because we got to think about this because something that has been done to the knee that has basically interrupted what you were born with. This is something where there has been trauma to the knee. The ACL has been torn, so that native ACL tissue will never be the same, even if it heals. We don’t know what is comprised of, is it just scar tissue? Does it still have the same tensile strength, the ability to load and handle stress the same way as it did before. We don’t really know that yet. Even with the emerging research of ACL’s healing. 

With that said, this is all things that we need to make sure we factor in to our, our thinking, if you will, because the knee itself has just been traumatized. And then you go and have a surgery and you think about a second trauma to it that it needs to heal from. And you just have things in there that are just not naturally in the body. You’ve got some buttons or some screws. You’ve got some different, wires that are helping to anchor this thing down and wrap around these screws or buttons. You might have some other additional supportive screws. There’s so many other things in that knee, especially post-surgery that you’re having to consider that your knee is starting to “normalize” 

Some of these things are biodegradable where the knee absorbs it, but then there’s some things in there that are just anchored in there like a button. It’s just there and it’s not going to go away as long as you have that knee there. So these are things to just consider and think about when we are expecting our knee to feel normal after this ACL injury and surgery when it’s really gone through these series of events. So there’s this sense of knowing the joint really has gone through something and it’s different now, different again, not being bad, just different. And guess what? Just know that’s okay. What’s important is that for that different to not be negatively described as a more painful, swollen, weak, limited mobility type knee, etc. That’s what your rehab should hopefully clear up and help address. Getting you back to performing at a top level, just like you were before and better ideally than pre-injury. That is something that is doable. That doesn’t necessarily mean that knee is back to normal. It might just perform at the same level or better. But with that said, does it feel normal? It’s never been operated on or injured? Probably not. And that’s okay. It’s different. But long as you can do what you love to do and continue to take care of it, we can be good with that. 

And this is that N=1perspective more than anything due to the factors I mentioned before. Because there are plenty of people who probably have the surgery and go on to say, yeah, my knee feels completely normal. I don’t notice it anymore. Just like I did after my high school surgery. I’ve got a 13-year-old, whenever I talked to her, she is someone who says, yeah, my knee feels normal. I don’t notice anything at all. And then there’s a high schooler that’s like, yeah, it just doesn’t feel the same. But when we compare their injuries, even their rehab process, the grafts that were taken, it makes sense. It’s just different. And so this is something that I don’t want people to feel pressure on themselves of thinking that it needs to feel normal or this expectation of feeling normal, especially you’ve been told by this, by your surgeon or your physical therapist or whoever it is that is communicating, oh, it should get back to normal. And the thing that I would encourage you to do is define what you mean by that, like before the injury, because sorry, it’s going to be really hard to chase that feeling because at the end of the day you had an ACL injury, this is your story. It’s a part of the fingerprint, if you will, of your injury history and that’s okay. It’s something that will honestly make you a better person. And it’s something that will just be a part of your specific story that you get to tell. 

This is something that we just want to make sure that it’s just not something that’s this expectation that you’re putting hard on yourself to be able to achieve when you know that there has been a difference in that name. But if it’s the deficits in the knee that you’re dealing with, then maybe it is something you still need to tackle with rehab, training and guidance. So that’s where we need to come back to defining, I just don’t feel normal right now where my knee doesn’t feel normal. Is it deficits that you’re feeling or has it just doesn’t feel the same as it did before? But you could still do all the things that you want to do. Well, in that case that’s okay. But just know if it is that different feeling—that’s normal. I would say majority of ACLers know that something has been done to their knee and they’re not just walking around and being like, yeah, it feels the same. And majority of those people feel that way. When in actuality, most people know that something has been done there. 

Allow yourself to exhale and not set an expectation. You may not be able to control the outcome of. And that’s the biggest thing that I want to hit home here with this episode because I do see a lot of ACL errors. Putting that pressure on theirselves. When it’s not necessary or they’re kind of waiting for it to come or find this threshold, when it honestly doesn’t arrive. So that’s where we got to make sure we check the boxes of symptoms and physical performances that you have, all based on criteria and testing, and you being able to do the things you want to do. Then that is something that I would say, all right, then if the knee is still feeling different or just not normal, then that’s okay. But if there’s still deficits that exist, then it’s fair for you to still be concerned about the knee, not feeling the same, because we still need to get it to a certain place for you to do those things you want to do.

I hope this hit home for you guys, especially for those of you that might be worried about the way your knee does feel, and you might be months and years out. You can exhale a little bit and allow yourself to have that space, and making sure that you just kind of keep doing the thing, keep working on your knee. And just understanding your story and where you’re at with this process. 

That is going to be it for today, guys. Before I sign off two things: One, there’s the new texting feature where you can send us a message, sharing how this episode or podcast has helped you, or you want to relay any message to us. It’s only one way where you can send me the message. I can’t see your number. It’s private. Don’t sweat that if you’re wanting to send us a message. I will not bother you. Don’t delete that code that’s in there. If you do decide to do that. Because that’s how it connects us to the texting and the podcast. You can find that in the show notes.

Second point here is that we have a form that you can actually fill out. It is also in the show notes, but I want to include you guys more in, on these conversations. I created a form where you can submit any type of ACL question or topic you’d like for me to tackle and we might be rolling out some Q and A’s here. If you do have any of those, I’ll start to tackle some of those questions. Wanted just a central place where you can go and be as specific and helpful with this podcast as we can. So then that way we can tackle any questions or particular topics that you guys might want addressed. As always, I appreciate all of you for listening. This is your host, Ravi Patel signing off.