How I Recovered From ACL Reconstruction With Quadricep Graft
How I Tore My ACL
After working, living, and skiing almost every single day since Thanksgiving, it was about to be February 1st. I thought my legs were strong, and I was having a great day of skiing. Then out of nowhere, my right leg ski caught an edge on a green run, shot out to the side, and "pop."
I felt a strange sensation, and my mind wouldn't let me even attempt to move my right leg. My ski didn't pop off and I was lying there in a twisted up position yelling and moaning for help as my boyfriend snowboarded up to me. He popped my ski off, and I knew something was very wrong with my knee. I tried to stand up but had zero stability and couldn't put any weight on it.
A ski patrol brought me down the mountain, and I went to the hospital. ER told me to wait a couple of days for the swelling to go down. I got a pair of crutches and hoped for the best—maybe the knee would get better on its own in a week or two.
Two weeks later after an MRI and X-ray, they called me with news I was not expecting. I was already walking and weight-bearing on the leg at this point, still with a limp and pain, but I thought I was getting better and didn't damage anything. The report was bad news.
- Fully ruptured ACL
- Partially torn MCL
- Severe Tibial bruising and swelling (luckily all my bones were fine)
I had even skied again on the injured leg only seven days after tearing my ACL! But that really made me realize I had damaged something serious.
After several appointments with the surgeon and many mental breakdowns, I committed to getting surgery only 4 weeks after the injury occurred. I wanted all of this over ASAP to move on with my life.
Pre-Op PT Appointment
I visited a physical therapist once before surgery for Pre-Op PT, and she was very impressed with how I was moving around and how strong my leg was, granted I couldn't straighten the leg all the way without serious pain (in surgery they had to fix a meniscus tear which might explain this pain). My PT said she was confident I was ready for surgery, as you want to go into surgery with strong muscles to help with post-op recovery and therapy.
Then out of nowhere, my right ski caught an edge on a green run, shot out to the side, and "pop".
Why Did I Choose to Get a Quad Graft?
I am only 24 years old, live an active lifestyle riding horses, skiing, hiking, yoga, stand up paddling, surfing. So I knew I wanted to return 100% back to sports. My sister also went through ACL reconstruction when she was around 21 and is fully recovered and says the knee is stronger than before the injury. However, she used a knee patellar graft and has pain when kneeling. My surgeon was an Australian who convinced me that the rest of the world uses the Quadricep graft (basically the top of the knee patellar graft) more than the US. He discussed the graft with me a lot because I couldn't find much information online.
The graft has an initially more difficult recovery because your quad muscles are the most important to full recovery after ACL reconstruction. Getting the quads to fire again after taking a piece of the quad tendon out, is so difficult as I later found out. People can warn you and tell you, but you never really know until you are experiencing it. It was HARD. But, as I write this, I am 9 weeks post-op and have nice quads again, and my leg works.
Anyways, my surgeon convinced me that the Quad graft is what I want. It's strong once healed, like stronger than your normal ACL. And doesn't have long lasting pain effects if you do everything right. So, I was in. We set the surgery date, and I was off to surgery.
Getting the quads to fire again after taking a piece of the quad tendon out, is SO difficult as I later found out.
Day 1 Post-Op
This day was awful. I will not under talk how bad this day was. It was my first surgery and the first time having to take opioids. I thought I was dying at one point. This entire day was a haze of puking, yelling at my poor mom who was taking care of me, and looking at my leg like it was a dead piece of limb attached to my body. My stomach rejected the opioids, so my mom had to pick up different types of pain killers that wouldn't make me through up. When the opioids wore off, I as in so much pain. Interestingly enough, my knee didn't hurt that badly, but my calf muscle felt like it had been pulled and was in the most pain.
Rest of the Week
Most of this week was spent actually recovering my body from the reaction I had to the opioids. I couldn't eat an actual meal until about 3 days after surgery. I didn't even focus on the leg that had surgery because it was wrapped up in tons of bandages, had a heavy brace on I could grab onto to move the leg around, and had crutches. I had to focus on eating and getting strength back from the hell of surgery. When I finally was able to eat, and feel like a human again, here's my pain med regiment which I would also set an alarm and wake up throughout the night to take meds.
- Opioid OR Extra Strength Tylenol (1,000) every 4 hours (this was the lifesaver)
- 'Pain Ball' attached to my hip which I was to squeeze every hour to put more numbing stuff into my leg
- Aspirin every 4 hours (prevent blood clots)
- Ibuprofen if needed (didn't really take any of it)
- Ice machine on the leg every hour or so (also lifesaver)
- Compression sleeve on leg 24/7
Most of this week was spent actually recovering my body from the reaction I had to the opioids.
First Physical Therapy Appointment
After 2 days at home, the nurse called and said I could remove the bandages and shower. Remove the bandages and shower?? It seemed like a cruel joke. Did they know that I could barely even stand up and go 3 feet to the bathroom without almost passing out? I also didn't know how I was supposed to get the bandages off because I had no way of moving my leg without my arms grabbing the giant brace. My leg was completely dead and useless without the brace on it to grab. I explained to the nurse through tears that I couldn't get my own bandages off because I couldn't move my leg at all. She said that's totally normal! I explained to her again, no you don't understand. I can't get the bandages off! I have no idea how! So, we booked a physical therapy appointment.
I took some pain meds and mustered to get to the PT. He helped me a ton and said everything I was feeling and doing was what everyone goes through. It was totally normal, I looked good, and my sutures looked great. We started quad sets in the hospital. Not that I could even get a slight reaction out of it. But he put his hand behind my knee while I was laying down and told me to push down into his hand. I could feel a TINY bit of effort from my leg, which made me feel so good. The leg wasn't dead!
Showering seemed like some sort of torture. I needed a ton of help from my mom. We had to take off the brace, compression sleeve, then I had to move the leg without the brace which is incredibly difficult and terrifying over into the shower. I then showered as fast as I could possibly shower (maybe 40 seconds). Crying, screaming, hyperventilating, being terrified.
It wasn't painful, but it is really scary to have to get into a situation you could fall down and hurt yourself in. Not having the compression sleeve and leg brace on completely shut my brain down to even doing anything that had to move the leg. I got into a bad habit of hyperventilating when I had got close to the shower to get in.
I only showered about 3 times a week for the first 3 weeks after surgery. I used a lot of body wipes instead.
It wasn't painful, but it is really scary to have to get into a situation you could fall down and hurt yourself in.
After 10 days I was getting more comfortable with my new lifestyle of dependence on others and no use of my right leg. I was lucky to have an NMES machine that I patched the pads onto my quads and shocked them awake. It did wonders. I would do my quad sets with the machine on and it really got the blood flowing into my muscles and knee.
I was seeing my physical therapist two times a week, doing exercises that she would give me, and make me feel like I was accomplishing things. Other than going to PT, I was laying down in bed pretty much all day. Using crutches when standing up and still icing my knee every hour. Still sleeping terribly.
I was still taking extra strength Tylenol every 4 hours and would be until about week three.
PT Week 2: Day 9 Post-Op
First off these exercises were very difficult (could barely get the leg to move) in the beginning but dramatically got better each day. Like dramatically, sometimes from the morning to the afternoon.
- Extension (laying down with leg fully straight, propped heel up, and sleeping with my leg fully straight..so uncomfortable)
- Quad sets (laying down, pushing knee down into a towel behind the knee. Sometimes with NMES on)
- Heel slide in bed (just trying to slide my heel back toward my butt and get some knee bend)
- Calf stretch (stretching the back of the calf by just standing up straight)
- Heel slide on floor in a chair seat
- Heel slide on wall above bed (if I could even get the leg up on the wall, this helped a ton with getting my knee bend and ROM)
- Walking weight shifts (focusing on shifting weight onto my right leg)
- Standing still weight shifts (great hip stretch)
Day 9 PT Exercises
- Walking with one crutch
- Weight shifting
- Quad sets
- Leg lifts from sitting position
- Knee bends (wall, chair, heel slides)
Things are getting easier, just 2 days after getting these exercises. Showering still is terrifying, walking is still super slow because I focus on form over speed. It's also winter and snowy and icy everywhere so I have to go slow. Still in compression sleeve, still taking Tylenol, still sleeping terribly, and still have barely any Quad function.
Day 14: Sutures out
I had an appointment with the PA to take out my sutures and then a PT appointment the next day.
- 90 degrees of knee bend achieved (very painful in calf muscle)
- massaging around the knee and scars to avoid scar tissue and move fluid around (feels so good)
- Walking heel to toe extension with weight transfers
- Heel props to achieve full leg extension, looking good (kind of painful after 2 minutes)
- Leg lifts on chair (from a bent knee to a straight knee using the other leg to help lift the leg while focusing on engaging the quads. Also done with NMES)
- Knee bends while standing (holding onto something, lower back into the start of a squad, then stand up straight)
- Multi angle knee bends (while standing, put foot up on chair with knee bend, bend into the knee and point the knee over the big toe, small toe, half circle, straighten leg and repeat)
At this point, showers are still terrifying actually. I'm still very reliant on a leg brace for safety and security. I'm still in a compression sleeve and taking aspirin.
I started to drive but am living in the country and can't imagine trying to drive in a city having to push the brakes and gas a lot.
Day 17: First Straight Leg Raise
After using the NMES machine 2x a day and doing PT exercises everyday for at least 3-4 hours throughout the day, stretching, bending, etc.... I finally was able to do a straight leg raise.
I use my normal leg a lot to get my brain to think about how to activate the surgical leg. For example, I'd do a straight leg raise with my left leg, then immediately try to do it on the right leg so your brain knows how to activate those muscles. Or I'd do it with the NMES machine on to get the muscles to fire with my brain thinking about firing them.
Here are the milestones of day 17:
- Still wearing compression sleeve
- Still working a ton of knee bend, extension, quad sets.
- NOT WEARING BRACE during PT
- Able to shower more confidently
- Able to get around with 1 crutch!! (not in public or grocery store)
- Able to start getting on a bike!!
- Walking form: lift knee up in front of body more
- Biking rotations: don't over push it. slow revolutions if you can
- Mini squats standing (holding onto something in front of you)
- quad sets (pushing knee into something under it, NMES pads, standing and walking weight transfers)
- Multi angle knee bends
- massaging knee and scar tissue spots
- side steps
- 1 leg balance
Week 4+ Goals
My PT gave me the goals I needed to achieve after 4 weeks.
- Knee bend to 120 degrees
- Full-extension controlling end range and doing straight leg raises x 20 reps
- Normalize walking gate
- Balance and side steps
- Strengthen my calf muscle (this may have been more difficult for me because of an old sprained ankle injury)
Coronavirus pandemic kicked me out of my employee housing dorm so I ended up having to move. Thankfully, my boyfriend helped me a ton as I couldn't lift anything. I moved into a bigger space with stairs that actually helped speed up my recovery a lot. After 4 weeks, I was able to move around much better and progress got more dramatic...such as:
- Walking without crutches
- No more compression sleeve
- Quad firing on command
- Knee bend coming quickly, no calf pain anymore
- Sleeping better
- Showering confidently
- Not wearing my brace inside or during exercises
- Biking full revolutions w/ out resistance
The Light at the End of the Tunnel
The first 7-10 days were hell, but I stuck with the exercises I did, did a ton of PT, followed everyone's advice, and I made it out to see the light at the end. After 14 days, things started improving dramatically.
Massage was really a savior for me. It helped me achieve knee bend, get the muscles working, and helped prevent tons of scar tissue. I use a Vitamin E oil and it works wonders. I can put it directly on the scars.
I kept my scars really clean while they were healing and didn't start massaging directly on the scars until after week 4. The Vitamin E oil worked great for massage around the knee, work on knee cap mobility, and on my quad muscles.
The first 3 weeks I also basically was laying in bed all day. But I made it a point to get out of bed at least once an hour to do something, knee bend..whatever. I also started going for daily walks outside on a sidewalk, no matter how far...but it was good to get blood flowing and I wanted to normalize my walk and be able to walk outside ASAP.
As I write this, I am at 9 weeks Post Op.
I have a smaller knee brace to wear for doing things like biking outside incase I have to slam my brakes or something.
I walk almost completely normal, my PT has gotten more challenging because I have to push myself more, my knee is still popping working through scar tissue, I no longer ice it, my quad fully fires and works and is getting bigger, and I am on my way to full recovery.
I start running at week 12. WOW!
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.