Episode 40 | Preparing for ACL Surgery – Part 1

What’s up guys, and welcome back to another episode on the ACL Athlete Podcast. Today is episode number 40, yeah, four zero. We’ve been going at this for 40 weeks now, which is wild to think. And your messages are the main reason why I keep going with this. You’re probably like, how does this guy talk about ACLs for this long? But we are just getting started. I just want to say thank you all for your support and the messages. Keep them coming. It really means a lot to me and it fuels me to continue doing this, so thank you. 

For today and for this series, we’re actually going to be doing a three-part series regarding ACL surgery. And it’s all focused on preparing for ACL surgery, reconstruction, repair, whatever you want to call it. I say ACL surgery because it’s very easy to follow and understand. Most people probably see reconstruction, whichever one you want to use. This is a question I get a lot, and I spend a lot of time with my athletes making sure that they are ready for surgery and they know their expectations. What is going to look like before, during, and after? I think it’s really important for you who is listening, whether you’re an ACL athlete or maybe you’re a clinician, or parent who’s helping someone get ready for this process.

This is a three-part series and I want to make sure that it’s detailed. Each episode is very digestible and not too long. I want to make sure that I give you guys the details of the whole process because being as prepared as possible for surgery can really help with the recovery after. And I know the mental piece is so huge, especially for the person going through it, especially if it’s your first time, you’re probably like super stressed out. There definitely is some anxiousness to it, a little worried, and not sure about the unknowns, which is always a little scary. All that stuff is normal. Having a plan and being prepared can really help with all of these feelings and make sure that this process can be as smooth as possible. What I will be doing is sharing my own two ACL experiences, sharing the things that I’ve learned over time through this process as a pt. As a strength coach working with different surgeons and ACL athletes who have gone through this process, whether it’s their first time or multiple times. There’s so many different things that can happen during this, and being educated and equipped with this knowledge can be really helpful for the mental piece, but also the physical recovery of it as well. 

As always, guys, check with your surgeon and PT, whoever you’re working with, especially specific to your case if you have any questions or maybe something sounds a little different than what I’m describing. This is purely educational, so just make sure that you are taking your own situation into account. But I just want you guys to know about this. And one of the things that- let’s just go ahead and assume for the purposes of these episodes is that it’s established, you’ve torn your ACL. Maybe there are some other injuries that happen, a possible meniscus tear (MCL), maybe there’s some bone bruising. What we know is that you’ve decided you’re having ACL reconstructive surgery, and you’re going to get a graft that is new, whether that’s from yourself, the patellar tendon, quad tendon, hamstring, or maybe it’s an allograft. You know what the date is. You’re possibly doing prehab, which means rehab prior to surgery. Maybe you’re not even doing it and you’re just getting ready for surgery. Side note: If you are not doing prehab, look into doing it. If you don’t know where to start, message me. But that’s going to be really important here. Let’s say all of those things are established and surgery is literally the next thing.

Now, what I want to do is walk you guys through my own personal journey and experience through my two ACL surgeries and what that looks like. You know visually kind of what to expect. And then I also want to talk about the expectations of this entire process, especially for the surgery itself, but also looking ahead of that.

So let’s talk about my own personal experience and what exactly that looked like for my surgeries. So having an ACL surgery, all that’s planned out. Let’s talk about the night before surgery. I took a shower. I made sure that I ate and drank the night before. So showering, you might not be able to shower the first day or two after surgery. And then for eating and drinking because you are going to be using anesthesia to put you to sleep for the surgery in most cases. There’s a limitation on how early you can eat and drink. So typically it’s the night before and then the morning of you’ll have an empty stomach, so you can’t eat or drink anything. So that’s one of the things that I remember doing the night before for both surgeries and then you fall asleep. Try to get some rest if you can, because obviously, sleep is going to be tough with the surgery afterward. But I wake up the next morning, I put on clothes that are comfortable and ones that you can fit, essentially if there’s a knee wrap that is protecting the surgery and potentially a brace. Maybe it’s shorts or maybe it’s something that’s pretty baggy that you can fit that over. And then we get in the car, we arrive at the surgery center, and the nurse will come in and get you prepped. They’ll get you into a surgical gown and then talk through exactly what the process will look like from surgery to after surgery.

And so I remember, changing out my clothes, putting my gown on, and then exactly that. She just kind of talked me through how everything is going to look. The doctor came in and checked on me during the first surgery. This is what typically happens; but not always. I know my second one did not come to check on me at the beginning before surgery, so this can kind of vary, but in most cases, this will happen where they come in pre-surgery. I got the IVs hooked up to me. This is where the anesthesiologist will start to give you some sedatives and electrolytes to be able to prep for the surgery. And then you’ll get a nerve block. Typically, it’s not always the case, but I know I got nerve blocks in both of mine, so I ended up getting a femoral nerve block, which we will talk about nerve blocks later.

The next thing you know, you’re pretty much asleep and then you wake up five minutes later. What it feels like when typically surgeries can be anywhere from an hour to two hours, depending on the case. And you just wake up and the surgery’s done. And I remember waking up being completely out of it, being like, wow, that was really fast.

And then you get moved to a recovery area where a nurse is monitoring your vitals. As the anesthesia wears off, you’ll slowly come back to reality, waking up. You’ll kind of be like, what just happened? It’s kind of this weird, fuzzy gray feeling. And then you’ll slowly become more and more awake as the anesthesia starts to wear off. Typically after the surgeon will come by and confirm how the surgery went, and what had to be done. For me, the surgeon came by and told me there was no way to repair my meniscus. He had to cut some of it away, and the graft went as planned as a hamstring graft, which is what he liked to use at the time. Then is getting you ready to go home once you’re stable, awake, and able to leave. The surgeon or the assistant will give directions on post-op care.

One thing I will say is to make sure that you have someone with you and who is paying attention to these instructions. They will also give you a post-op care paper for you to kind of go through, any frequently asked questions and guidelines on certain movements and exercises and medications and things like that. But, If you’re with somebody, that’ll be really helpful because they could pay attention. Because you probably won’t remember much. I know I don’t remember much of the direction. But the things that they’ll talk about is the medication, whether you’re taking a narcotic to help with the pain, your weight-bearing status of whether you could put weight on that foot or not, that depends on the surgery. Wound management and care: making sure that it’s scabbing up. What rehab will look like and when you need to go pt.

Typically, this will be within the first one to three days, immediately after, and then a follow-up with the surgeon’s office. This will typically happen pretty soon after the surgery, whether it’s with the surgeon or the assistant in their office to make sure everything is proceeding as normal and to check in, and then you’re cruising.

Well, kind of, obviously you just had surgery. Now, it’s onto the road of recovery. And with this, I remember when we’re talking about all of these different pieces of medication and weight-bearing, wound management, and all of that. This was obviously all new to me. And so for me, medication, I had some that I was taking, especially for the first five days, and then weaning off of it. And a lot of it is just because of the pain and because that can impact your sleep and your recovery. This is something we’ll talk about in detail later. But I do remember using that for a little bit to help ease the pain, especially I had a lot of discomfort in my hamstring graft site, and then obviously where they did the tunnel drilling and things like that.

My weight-bearing status was weight-bearing as tolerated. I was able to start walking pretty quickly as long as my range and my quads were coming back, which luckily they did. And then wound management, I remember I didn’t really shower for the first day to two days, and so that took a minute for me to get used to. I had to use some wipes. It’s just a part of the process and that’s pretty much how that all went. I started rehab, and PT stuff the next day, which I think is very vital and important. So those are kind of the logistics of how that went for me. And I hope that’s helpful for you guys to be able to provide some insight into how it moves from the night off, to literally getting home laid up on the couch post-op.

Now, what do you specifically need to know about preparing for this ACL surgery? And we’re going to finish this episode off by talking about setting expectations, which I think is really important for this process and for surgery to know what to expect and to be able to be prepared for it, as we’ve talked about. And then in further episodes, we’re actually going to go into more detail about it. First, the expectation is to know the journey is long and hard. And for someone who says it’s easy and not hard or not painful, they’re full of it. I think as quickly as you can come to terms with this, it’ll make this process even easier, if you will, by knowing it’s going to be long and hard. You’re looking at 8, 9 to 12-month process. If someone is telling you six months, three months, five months, they’re wrong. I don’t care who they are, and until they can show me the science and the research supporting that and reduced re-injury rates because of that, we’re going to stick with at least nine months as the barrier to entry, for returning to any type of higher level sports, if you will. It doesn’t mean you won’t get to do other things earlier. But if you’re talking about trying to get back on a field somewhere, or a court, or competing and really using that knee, you’re looking at nine months. If you can get that timeline at least in your head, that will be really helpful to know. It’s not just going to be a three-month process. 

There is a protocol that most surgeons will have. And remember, it’s a protocol. These are guides. They’re mostly based on time. We’re starting to see some that are based on criteria alone, which means share time plays into it, but then there are certain objectives per phase that will help to clear you into the next phase. And those are the types of protocols, if you will, that are a bit better. But at the end of the day, they’re very generalized to anyone and everyone. And sometimes you’ll see some graft type specific or with meniscus type repairs or other injuries that also got repaired. But a lot of the time what you’ll see is that they don’t take into account, individual factors like those things, whether it’s the injuries, the surgical procedure, the graft type, all of these different things play into how your recovery is going to be. 

I had an athlete just recently who had ACL reconstruction surgery. And it is not her first go around. She had to have backup screws put in place. She had a lateral extra-articular tenodesis. Some other areas had to get cleaned up. It wasn’t just a simple surgery. And so her recovery’s been different than what the protocol if you will, was saying she should be at. Just know, and I’ve stressed this before that it is just a guide. Humans are very individualistic, and your body is going to vary based on the healing, and the surgery you’ve had. Some people progress fast and some people don’t progress as fast. So don’t beat yourself up. If the protocol says you should be walking within two weeks and it’s been three weeks and you’re not there yet, that’s okay. When in doubt, ask your surgeon or the physical therapist that you’re working with. 

The next expectation is you’re going to think you’ve messed up the surgery, probably 20 or 30 times. I can’t tell you how many athletes I work with who will be like, oh-oh, this happened, or I noticed this or that. They feel like they’ve undone the entire surgery. It’s okay to feel this way. You will feel this way at some point in the process. I know I did with both of mine. Even if you’ve gone through it once, you’re going to be like, did I just do something? My leg fell off the prop, or whatever it is. And you’re going to be like, oh no. Some of the things that you’ll feel are going to be all these random pains and aches because they literally just went in and did carpentry work to your knee, and so it’s normal for pain to be there. Your body is kind of freaking out like, yo, what just happened? And pain is a normal response from the body. Just know that that’ll be there and that should ease up over time. Some of that will be dictated by your nerve block, so typically around 24 to 48 hours can be the length of time. We’ll talk about that in a little detailed in episode two. But the pain will be there. You’ll probably feel some popping or clicking. There will definitely be some swelling. 

The wounds, you’ll probably be checking on that. All of that is normal. The popping and things like that, just know that because there has been surgery, as well as the joint dynamics are a little different because of the swelling. So that fluid can put pressure on different places depending on where it’s settling into. The kneecap is not moving the same in normal knee sequence compared to when there is no fluid there. All of these things are normal to feel and it’s also okay if you’re questioning them. But here’s a pretty good rule of thumb. In most cases, if you haven’t had any type of fall or traumatic event with it, there’s a good chance you’re okay. When in doubt, always check with your surgeon and PT. But if there’s not something that traumatic that has happened, then you’re probably going to be in the clear. 

This is something that has actually happened with one of my athletes last week. He was walking with his crutches and he was by himself and he went to go open a door at work because he had to go back to work. The door kind of slung up and hit him and his crutch fell and he fell, which is something you do not want to happen. He got really concerned and worried that he had messed it up. And I asked him, if was there anything that had happened from a traumatic standpoint, in terms of, did you feel the knee pop/twist. Did it get caught? Did it bend in a certain weird way that you didn’t want it to? And then what was the reaction afterward? Did it swell up a lot? His pain significantly heightened for a long period of time, all of these different things. But he essentially said no to all of these things. He might have had a little bit more swelling. But other than that, he was okay for the most part. And his surgery’s still going fine. His ACL is intact. Everything is good to go. He even had a meniscus stitched down. Of course, you want to feel a little worried and scared, but that’s okay with his situation, and using that rule of a fall or a traumatic event or something crazy that happened, that’s the kind of thing that you’ll want to gauge and see, okay, if that didn’t happen, you are likely okay. 

The other things that you’ll feel going into a little bit more detail are going to be different pains. Sometimes they can come on suddenly and then just go away. I remember there were random times with my hamstring graft was taken, where it would just go into this shock of pain for maybe 5 to 10 seconds and then go away. The body’s weird, guys. I can’t tell you why, but it just happens. You’re probably going to feel some changes in temperature, especially with the blood flow, surgery, and swelling. Your body’s trying to get fluid out, get it in. Sometimes you’re going to be laid up a little bit more. As long as this isn’t something that is lasting super long, then you’re probably in the clear. But again, check with the surgeon and PT, if you are having concerns about that. But it is normal to feel that. And to feel maybe like the knee is a little warmth, obviously, you just want to make sure you’re monitoring it over time. And that’s the thing that you’re trying to track over time, what are the changes? Is this lasting too long? And the same thing with color. Maybe you’ll notice that your foot can potentially turn blue, or the knee is a little red. Again, the same kind of rule of thumb here is to track the trends and see if it is improving or if is it just a very short duration of it. These are the things that are normal to feel and making sure that they just don’t last very long. 

And then the last thing is the sensation changes that you’ll feel. Because they are going in, they’re cutting and they might cut some superficial nerves that provide sensation. This other athlete that I’m seeing, has some sensation changes on their shin, not the whole shin, just like closer up towards the knee. That’s completely normal. The goal is hopefully that that will regenerate over time and you can even provide little tactile sensations to that area to see if that sensory will come back. And for me, for example, on my right knee where I touched my scar, I did a lot of scar mobilization, trying to help to provide sensation back to the area once things had healed. Even if I still rub that area on the opposite side of the shin where they actually got my graft, somehow there’s some sort of connection where it provides a weird sensation when I touch the wound incision site and the other one feels it. Guys, it’s normal. And there are very many athletes who will have this. 

Obviously, if you can’t feel a darn thing in your entire knee, that’s a little different than one little patch of skin. So when in doubt, call your surgeon, call the office, or ask your PT just to make sure. But you’re not crazy if you’re thinking all of these things. Because I remember thinking all this and after having so many ACL athletes go through this process as well, I get these questions all the time, so totally normal. 

Next up is focusing on the foundations. Don’t rush this process and get too far ahead. The foundations mean the essentials, which we’ll talk about in part two, which is the quiet knee plus preventing deconditioning. But the foundations are important, just like the structural integrity of a house. The foundations are what are going to be the building blocks of being able to get stronger, getting more powerful, getting faster, and being able to cut on the field. All of these things are important. But if you have a knee that can only extend to, maybe five degrees and not even into the negatives, that’s a problem. It is going to be really important to work on these foundational pieces. And just as an expectation with this, the early part of this process can get a little repetitive and monotonous and boring like the range of motion work. You’re going to be so tired of heel slides and doing quad sets. But it’s an important part of the process and important for the PT you’re working with to help keep you engaged in this process. Sure, some things will change, and it’s all going to be based on your status. But just know this first early stage, you are going to be doing things that feel a little bit more repetitive. It’s also probably going to feel like a part-time job or a full-time job. Because you’re going to be working on your range multiple times a day. You’re going to work on your quads multiple times a day, or at least you should be, and then work on building towards walking whenever you have the clearance to do that. And then you’re going to be working on making sure you’re keeping the other areas healthy and making sure that they’re moving and don’t get deconditioned. And that can vary how often you’re doing it. But for a lot of my athletes, they are doing things throughout the entire day and especially for those first few weeks because it is going to help really get them ready to on-ramp this process of ACL rehab and recovery. 

The next expectation is that there will be tough days, really tough days. Some days where you might want to give up. You might be like, I’m just not going to even play my sport again, it’s not even worth it. This is way too hard. And that’s okay. Just focus on making it to the next day, I promise. Just make it to the next day and it will get better. If it doesn’t, that next day will get better. Really try to focus on this. And if you know that these are coming at you, then you can know that there will also be an end to it. And this is where a mindset is everything, literally everything in this process. Sure, it’s very physical in nature, but it’s just as important to have a gauge and a pulse on the mindset piece. Because that’s what’s really going to dictate your actions and how you feel and being able to stay positive during this experience. This is something where even if it’s your second or third time, you might be inexperienced in some realms. But just know that the second or third time isn’t necessarily easier. If anything, it can even be harder. Just know that your mindset is really going to impact how you are operating. I’ve talked about this before and go back to that 42nd podcast. If you haven’t listened to this, but look at this as an opportunity rather than, why did this happen to me? Why is this all happening? It’s okay to have those moments. It’s totally fine. But then it’s time to shift the perspective to look at this as an opportunity. An opportunity to build from the ground up, and become the best athlete that you can be. An opportunity to focus on other areas of your life and really evaluate maybe your identity and also your purpose and things that you love other than your sport or your activity. This can be a really good opportunity. And then bringing this all together, celebrate every single win. I’ve talked about this before, but I can’t stress the importance of the win. If you are able to put your heel down with less pain, that’s a win; if you gain five degrees of flexion in your knee, that’s a win; if you can see your quad a little bit more, that’s a win. All of these different pieces are wins and you need these small little wins to stack up, to keep you moving, keep you motivated, and keep you positive. And there’s some days where it’s not going to feel that way. But I encourage you to look through everything. A different piece of this and be able to see, okay, what was a win from today and reflect on it. Because that’ll be super important in this process to help navigate the mindset and the physical recovery of it.

And then lastly, with the expectations, this is not a time to be independent. This is a time to lean on your support system, lean on your friends, lean on your family, your teammates, coaches, rehab professionals, whoever is on your support team and in your corner. Make sure that you lean on them because it is, like I said, going to be a tough time and you’re going to need help. There’s not very many people I have ever met who go through the ACL rehab and surgery process, especially surgery, and are able to do it all on their own. And I would just suggest not doing it because why do it when you can have some help from your people. Lean on your support system. They will be an integral part of this process, not only during surgery but throughout the entire journey.

So that’s going to do it for today, guys. This is part one. Stay tuned for the next couple of parts here, because we are going to dive deeper into these different categories. I’m also going to be providing some useful products and things like that, that can be helpful for this process. But especially being as equipped as possible and making sure that you’re making the right decisions from leading up to surgery up until right after. And that is going to lay the foundations and be able to give you the best outcome possible, which I think is very important. And I want you guys to know that. 

If you have any questions, please send them my way. Otherwise, we will talk next time on the next episode. Thank you all so much for listening. This is your host, Ravi Patel, signing off..