This is Part 3 of a series outlining my recovery. There’s an impressive set of information online about how best to recover from an ACL tear, but I wanted to share my own story for a few reasons. There are a few critical resources online that made an outsized difference to me that I’d like to share. I also wanted to actualize the story I wanted to tell when I got to the other side. Finally, for me it was comforting to read the journeys of others going through the same process. I hope you find this helpful and do reach out with any questions you have.

Part 1 - The Injury

Part 2 - The Prehab

Part 3 - The Surgery [this page]

Part 4 - The Early Rehab (weeks 2-7)

Part 5 - The Middle of Rehab (months 2-6)

Part 6 - Late Rehab (months 7-10)

Surgery

On May 2nd, Leah drove me to be checked in for surgery at 11:30am. I hadn’t eaten since dinner the night before, and my last sips of water were just minutes before 7am. In anticipation of being constipated from anesthesia, I ate high fiber and vegetable meals the previous day; in anticipation of being thirsty, I put down nearly a liter of water that morning. I had to pee a bit more than usual that morning, but I was never thirsty leading up to surgery.

I was given a small sip of water with preemptive Tylenol. My resting pulse came in at 45, even lower than I would have guessed. I was mostly relaxed, and knew I had nothing to worry about. Having Leah by my side put me at ease. The nurses were sweet and both Dr. Fuchs (my surgeon) and the anesthesiologist came separately to have a chat with us. Dr. Fuchs had a magical way of relaxing me even more. Despite having done nearly a thousand of ACL surgeries (and nearly 5,000 surgeries overall), his presence was so warm and caring. He explained the procedure one more time: a patellar autograft and he’d see if anything needed to be done to the meniscus. Before he left, he wrote his initials on my right leg confirming that’s the one they’d cut open. The anesthesiologist asked if I’d be interested in an adductor canal nerve block, which apparently 10% of patients turn down. I happily accepted.

As I was wheeled towards the operating room and said goodbye to Leah, the nurse gave me a heads up on what to expect within the next minute. I’d soon be mobbed by a team of medical professionals all working on me as if I was a Formula 1 car. The doors flung open and I was greeted by Dr. Locknane, the Ortho specialist who first broke the news to me that I had a torn ACL. He’d be assisting Dr. Fuchs during the surgery. Even though I had only interacted with him briefly, I was so happy to see him. He had done a lot for me emotionally by breaking the news with the right level of tenderness, but also giving me the confidence that I could bounce back. During the minute before I was put to sleep, they were asking about my recent bike trip. Dr. Locknane did a double take and asked me to repeat the stats of my bike trip (480mi, 42,000ft). He enjoyed the occasional triathlon and looked like a strong athlete, so I had a smile falling asleep knowing that he was impressed with my prehab.

Discharge

The procedure lasted 90 minutes and I had been asleep for another 90 minutes. When I woke up, I assumed the nurse was my wife because I had been dreaming of the bike trip. Within a minute, I realized where I was and had a huge grin on my face. I was on the other side! I happily accepted the nurse’s offer of ginger ale and apple juice. I also ate a cup of vanilla pudding and fig newton bars. I was fully expecting to have no appetite based on what everyone told me, but that wasn’t the case at all.

When Leah arrived a few minutes later, I was smiling even more. She might have assumed it was the drugs I was on, but I really was just happy to be eating and doing so without pain. The nurse gave us some instructions and photos from the surgeon, informing us that I could be weight bearing since there was only a 5% meniscus trim. I was incredibly relieved at this news.

I hadn’t practiced on crutches before, and promptly forgot what I had learned on Youtube about how to get up and down stairs using them. Instead of trying, I decided to butt-scoot my way up our townhouse to the third floor bedroom, where I’d be settling in. Reflexively, I was avoiding putting weight on the foot even though I was cleared to do so. Once in bed, I ate some more (fruits, salad, vegetable curry with rice) and removed the post-op brace that had me locked in at 10 degrees. I felt incredibly lucky: no meniscus repair, big appetite, zero pain.

I only needed to keep the brace on while walking and sleeping. That first day, I only had time to do 20 minutes of in-bed exercises and an hour of the CPM at 50 degrees. My wound dressings were so thick that the cold therapy machine couldn’t get through, which was a bit annoying. I think my surgeon wasn’t a fan of putting the ice machine bladder on beneath the wrap because of the pressure it would cause with the knee brace. I ended up having a decent night of sleep and my pain levels continued to be at zero so I stayed off the Oxycodone.

Pain levels

Before I went to bed every night that first week, I made sure to keep the Oxycodone pills close by. I knew I needed to stay ahead of the pain. Fortunately, every morning I woke up I was still numb from the nerve block. I became quite anxious for when the hammer would drop and I’d find myself in a world of hurt, but it never happened. By Friday (three days after surgery), I was starting to wonder whether this was a problem. I coincidentally got a call from the anesthesiologist who said I was quite lucky. The first three days are considered the most painful because of the swelling, and I skipped over all of that. He said the timing of the nerve block is variable and can fade after a day or last up to a week. The drug I got was Bupivacaine (brand name: Exparel), which has been around only a few years. It releases from these fat-based particles in bursts, sometimes more at a time and sometimes less, which explains the variability in how long the relief lasts for.

My nerve block lasted til five days after surgery, but I wasn’t sure if it had actually worn off because I expected a lot more pain. I confirmed it had worn off when I could finally feel touch but the pain in my knee was simply a dull ache that maxed out at 1 or 2 out of 10, and only when I bent my knee after being straight for an extended period of time. Since my pain levels were close to zero, I stuck to 1000mg of Tylenol every 6 hours and 220mg of Aleve every 12 hours (staggered). On day 8, I decided to halve my Tylenol and Aleve intake, and would quickly taper off entirely. Dr Fuchs also had me taking a small dose (81mg) of aspirin every 12 hours to prevent blood clots for two weeks.

I used an Oura ring to keep track of my sleep. Since I wasn’t in pain early on, I never got a bad night of sleep. In fact, I got better sleep the week of surgery than the prior two months. In the first night, my resting heart rate shot up to an average of 54 bpm (low of 49), and then quickly returned to normal in the following nights.

Range of motion

My surgeon insisted that I rent a CPM machine which they helped arrange. My insurance stopped covering it last year, so I’d be paying out of pocket (~$24 per day). Someone came by to drop it off the day before the procedure and gave me instructions on how to use it. My surgeon wanted me at 120 degrees of flexion by the time he saw me for the post-op appointment 8 days later. The plan was to start at 45 degrees the day of surgery and use it in 1-hour sessions three times a day, increasing by 5 degrees each time. I could always do more if I wanted. I started at 50 degrees and ended up using the machine at least four hours a day, never increasing by more than 15 degrees in a given day. By Sunday, five days after surgery, I was at 120 degrees on the CPM and I was told to keep that level of flexion til my post-op meeting on day 8.

I was cleared to return the CPM, but thought about holding on to it. I loved how it loosened me up (in a good way) and gave me something “productive” to do when I wasn’t grinding out PT exercises. On day 9 though, I realized that I really didn’t need it at all. Between my full extension and the 110+ degrees I was getting, my knee was feeling normal.

Exercise

I’m glad I met with my PT before surgery because he gave me a set of exercises to work on while being idle. I never lost quad activation nor did I lose the ability to do a single leg raise with a flexed quad. I noticed my quad muscles begin to slim down on day 3, which wasn’t fun to see. I also never lost the ability to fully extend my leg either. Here’s what my exercise regimen looked like in the first week with the goals of reducing swelling, increasing flexion/extension, and minimizing quad muscle atrophy. Three times a day I would do the following:

• Knee extensions, firmly pressing down for 10sec on the quad (while sitting up with a towel underneath the ankle) x10

• Calf stretch with a strap for 10 seconds (while sitting up with a towel underneath the ankle) x10

• Hamstring stretch with a strap for 10 seconds (while laying down) x10

• Heel slides with a strap for 15 seconds (including a 5 second hold) x10

• Quad sets with a towel roll under the knee for 10 seconds (while sitting up and looking at the quad to establish a mental connection) x25

• Straight leg raise holding a quad set (while laying down) x25

This routine took 45 minutes and I took special care to execute the the last two exercises perfectly since these would be the ones to help me resist atrophy the most. I finished each set with 27 minutes of strong NMES while my leg was elevated and I did ankle pumps. The quad sets and straight leg raise were the most mentally taxing. They never caused pain, just mental fatigue.

Besides the exercises the PT had me doing, I wanted to ensure the rest of my body was getting some movement in. I adapted my elaborate daily morning stretching to my new limitations and needs. Every morning I’d roll my shoulders, stretch my torso, neck, and deeply stretch my uninjured leg, hips, and groin as best I could. After a four days, I was feeling confident in doing some pullups, so long as I landed carefully on my good foot. I also did standing pushups with my hands on a dresser and messed around with 5lb dumbells for light shoulder work.

I eagerly wanted to move on to the more fun exercises that would have me hopping around but I knew I needed to unlock those levels by ensuring I had range of motion, extension, and reduced swelling.

Icing

My ice machine (DonJoy Iceman Clear) was pretty useless for the first two days when my incision dressings were so thick that the cold wouldn’t penetrate. I relied on ice packs instead, and wasn’t too mindful about when to use them. However, once I removed the cotton padding on the wound (leaving gauze and ace wrap), I had a more regular routine with the ice machine. I had to be aware of how long I kept the ice machine on, and planned to use an Alexa smart plug to set a schedule. It ended up being a lot more convenient to just plug the unit in and set timers with Siri.

I had read that frozen water bottles were easier to use than ice cubes, and I was prepared to go that route, but we found that just adding ice cubes two or three times a day cooled the water a lot more. I am curious whether a more expensive ice machine like the Bregg Polar Care Wave (which I bought for my mother a few weeks earlier) or even renting a GameReady that has compression would be worth it. My surgeon didn’t think much of the compression so I didn’t bother. I did plan to use a Normatec 3 Legs system on the leg once there wouldn’t be any concern with the incision site.

Injury site

I first got a look at the incision site when we had to change the gauze under the ace wrap, 48 hours after surgery. Fortunately, the nurses provided us with plenty of extra material. It looked like there was some significant bruising on the inside of my knee, but far less than what I had seen others post photos of online. Apparently it would look worse before it got better, so I took photos to track progress. I won’t show those photos since they’re a bit graphic. By day 8, my bruising was minimal.

I did use a massage gun on my calf and quad, being sure to avoid the knee, hoping it would help with the bruising by moving the blood along. I also bought arnica gel that I planned to use later to help with swelling. Just like the supplements I was taking, I couldn’t tell if it would make any difference but I figured it wouldn’t hurt.

Diet

I put a lot of thought into my diet. I was fully expecting to be constipated from the anesthesia and the Oxy (which I never took), so I kept a few packets of stool softener on hand. I never ended up needing them and had kept to my regular bathroom routine. I resumed taking my supplements the day after surgery: turmeric, tart cherry, glucosamine, multivitamin, fish oil, Vitamin D, and collagen peptides. I also continued avoiding alcohol to allow my body to heal at full capacity. I wasn’t a coffee or tea drinker; I read THC would help with pain, but I fortunately never had high or even moderate levels of pain. I also wanted to guarantee I had maximum mental capacity to focus on my exercises.

For eating, we had done a Costco and Whole Foods run beforehand. Breakfast would be my usual protein shake (almond milk, honey peanut butter, fat-free greek yogurt, protein powder). Lunch was always a salad kit. Snacks would always be dark chocolate, good bread, apples, pitted prunes, or oranges. For dinner, I’d have rice with my mom’s frozen curries (from a home vegetable garden) brought over a month ago. Leah asked if I wanted her to bake me anything, and I resisted. I wanted to avoid any treats or indulgences. I was treating my body like a machine. Clean fuel only.

We stocked our fridge full of different brands and flavors of sparkling water. It was a nice treat with lunch and dinner and the variety helped keep things interesting. I had great hydration habits before the surgery and kept to them. This of course meant I’d be getting up to pee pretty often. My surgeon wanted me to get up regularly to avoid blood clots and other issues from being idle for too long, and being able to bear weight made things a lot easier. At night I kept a pee bottle near me that I’d use just to avoid having to walk in the dark.

Mobility

I was able to bear weight on my injured leg on the day of surgery, which helped tremendously for getting around. Going up and down stairs was possible since day 1, but I felt more confident about it on day 4. On day 5, when the nerve block wore off, I began to feel the blood rushing down to my leg when I’d stand up. I didn’t like that feeling, so I’d prop my leg up on a table or even a stool when standing for a while (e.g., brushing teeth). I was quite grateful for my flexibility and the aggressive core exercises I did in prehab. All that helped me stay stable when I’d put myself in precarious body positions with the braced foot in the air, sometimes above my head (e.g., to reach for something).

For sitting on the toilet, having a step stool to prop my immobilized leg on was very helpful. I saw someone improvise this by stacking new rolls of toilet paper, but that looked unstable.

It was massively helpful to have a bedside table that you find at hospitals. I was initially skeptical because no one seemed to be recommending it online on ACL groups. It ended up making my life so much easier and I can easily sell it later.

By day 8, I was preferred just one crutch when walking around the house, but generally wouldn’t use any crutches at all for short walks in the same room. Of course, I’d take two with me when I’d go outside.

Mental state

I was mostly in a great mood the entire time. I felt like my recovery was going a lot more smoothly than I had expected. I felt particularly great when I figured out what my ideal routine would be. During my exercises, I’d watch Youtube videos of professional athletes recovering from ACL injuries or other major surgeries. I made a commitment before the surgery that despite not having a fully dedicated team, I’d do my best to rehab like a pro. Watching these videos put me in the right mindset. Here are a few that I liked:

• Billy Kemper (big wave surfer) rehabs after ACL, MCL, meniscus surgery

• Mark McMorris (snowboarder) returns to win Olympic gold after a devastating injury

• Connor McDavid (hockey player) rehabs his PCL without surgery

• Hector Bellerin (soccer player) openly shares his journey with recovering from an ACL tear

• Andri Ragettli (freeskier) comes back from a devastating knee injury with multiple setbacks and continues to perform at an elite level.

Since I wasn’t on Oxy, I felt comfortable doing some light work. My job never asked me to come back nor did anyone apply pressure. I kept tabs on what was going on and dialed in to some meetings mostly out of boredom. Anything that required real brain power, I deferred to later. Officially, I had taken a full week off, and I planned to be intermittently in for up to the third week of recovery.

Besides writing, it helped to plan the future. Instead of planning mountain adventures, I was planning out where to go eat. Leah was excited to park the car downtown with the handicap placard I’d have for 3 months. I also scheduled a big celebratory dinner with friends to celebrate a month of recovery.

I shared a few updates on my IG story about how things were going, and it always felt wonderful to have my friends acknowledge my recovery in any way. Jason offered to cook or order delivery for us. Other friends and family texted regularly for updates, and some called. I was surprised that others didn’t bother reaching out at all even though they were aware, but I didn’t think any less of them. Instead, what I learned was how I could be a better friend to someone going through a medical procedure in the future.

Having Leah with me was a huge boost to my mood. In addition to making my life easier, I always felt loved every time she looked at me and smiled. Each night I’d share with her what I was grateful for, being sure to highlight even the smallest wins of my day.

My routine

This is what my Day 1-8 looked like with 95% accuracy.

• 6AM - 1000mg Tylenol. I’d wake up naturally to take this without alarm

• 7:30AM - wake up without an alarm. Chug water to compensate for being dehydrated overnight

  • Morning full body stretch with podcasts, use toilet, clean pee bottle. Wash face, use wet wipes to clean body. I didn’t take a shower until day 9.

• 8am - Drink protein shake and eat half a bowl of high fiber/low sugar cereal

  • Get on the CPM machine for 1hr with an ice wrap for half the time

  • Check messages from friends/work

• 8:30am - 220mg Aleve

• 9am - Morning supplements and 81mg Aspirin

  • Begin leg exercises, set #1. Watch motivational videos while doing this

  • Use NMES and massage gun for 27 min while doing ankle pumps

• 11am - Light upper and core workout

• 12pm - 1000mg Tylenol. Salad for lunch

  • Get on the CPM machine for 1hr with an ice wrap for half the time

• 1pm - Begin leg exercises, set #2. Watch motivational videos while doing this

  • Use NMES and massage gun for 27 min while doing ankle pumps

• 3pm - Full body stretching, focusing on core (e.g., hanging leg raises), pull-ups, chin-ups

• 4pm - Get on the CPM machine for 1hr with an ice wrap for half the time

  • Eat fruits as a snack

• 5pm - Begin leg exercises, set #3. Watch motivational videos while doing this

  • Use NMES and massage gun for 27 min while doing ankle pumps

• 6pm - 1000mg Tylenol

• 7pm - eat dinner, CPM + ice machine

  • Watch a 90 min of a show or movie with Leah

• 8:30pm - 220mg Aleve

• 9pm - Evening supplements and 81mg Aspirin

  • Read in bed

• 10pm - lights out

• 12am (midnight) - 1000mg Tylenol. I’d wake up naturally to take this without alarm

At random moments throughout the day, I’d be doing ankle pumps with an elevated leg or I’d be doing quad sets. I’d keep myself entertained by doing Duolingo, writing, or editing photos from the recent trip. I did my best to limit my movie/show-watching to when I was exercising. I did my best to keep myself fully focused on one task at a time. I also asked myself if there was more I could do each hour to push myself, and usually there wasn’t.

Post-operation appointment

On day 8, I had a morning appointment with my surgeon to follow up on my progress. I was looking forward to this moment because I knew I had been doing well. After seeing my extension and flexion, as well as hearing how my week had gone, he noted that I was “in the top 1% of 1% of patients” that he’s seen. I was flattered and my heart was full hearing that. All the dedicated work had been validated. My incision was also healing really well. His assistant changed my steri-strips and I got some more gauze and ace wrap for the future. We scheduled an appointment for 6 weeks later.

I went to my first post-op physical therapy appointment immediately after. Nelson, my PT, was amazed by my progress. My knee extension was equal to my other leg and my unaided flexion was 110 degrees before I felt tightness or pain. He said he had never seen any patient progress this quickly. I felt like I would burst with joy. He then took a measurement of my quad and to my amazement, the measurement came back exactly the same as the day before surgery: 48cm (compared to 51cm on the good leg). While he massaged my leg and worked on patellar mobilization, he said that I’m far ahead of the standard protocol, so we’d try walking with my brace unlocked using crutches. It was scary to do so at first, but I slowly got the hang of it. I took 10 steps, breaking each movement down thoughtfully and speaking aloud what I was doing. He didn’t want me to try this at home yet, but it was valuable for me to realize that I needed to relearn how to walk. Nelson then had me demo a few more advanced exercises that I could incorporate into my routine. I asked when I could get on a spin bike, since that was more fun. He started to list out the criteria, and then stopped himself by saying “Well, you’re already demonstrating the pre-requisites, but let’s wait another week.”

PART 4 - The Rehab

All this validation for the work I put in during the first week has made me even more determined to throw it down harder (without being stupid by going beyond what I’ve been approved to do). In the next part, I’ll cover the rehab that gets me to a point where I have a normal gait!