There are many parts that must come together in a cohesive manner to assure the best chance of success following an ACL injury. Those parts include:

  • Having a well prepared, well educated and motivated patient. (See ACL Part I and ACL Part II )
  • Being under the care of an experienced ACL surgeon.
  • Being under the care of a physical therapist who is well voiced in the unique needs of an ACL injured patient.

The success or failure of an ACL reconstruction is not simply determined by placing the ACL properly during the surgical procedure. That is merely one step during a long process that requires meticulous attention to detail.   Having an educated and motivated physical therapist in equally as important as executing the ACL surgery properly. Proper physical therapy following ACL injuries is of paramount importance, both before and after your ACL surgery.

I would like to extend a sincere thank you to Julie for sharing this post for our blog.  Julie is one of the best educated clinical thinkers in the ACL recovery physical therapy universe.  She travels worldwide in search of knowledge and has an extensive history of treating a multitude of professional athletes and weekend warriors alike.  Her credentials are listed below and I encourage you to visit her site.  I especially encourage those of you involved in the training and care of athletes to download her book on prevention strategies … since an ounce of prevention is worth 10 pounds of cure.

physical therapy acl surgeryWhat patients really need to know about physical therapy and their recovery following an ACL injury?

There are approximately 100,000 ACL tears in the United States each year at a financial cost of $1.7 billion (Silvers, 2014). The number is not decreasing and it is unclear if it is simply because more people are participating in unpredictable activities which involve cutting, pivoting, and jumping or if we are just becoming more prone to injury from lifestyle and environmental factors.

No matter the reason, more injuries are occurring and orthopedic surgeons are busier than ever reconstructing knees of athletes everywhere. Additionally, the risk for a second injury remains high in those who have experienced one and return to sport.  “Athletes in the knee and ACL groups were 6.8 and 19.6 times more likely to sustain a knee injury and 14.4 and 892.9 times more likely to undergo a knee surgery during their collegiate careers compared with controls.” (Rugg, Wane, et al; 2014)

Here are a few key messages I wish more people understood regarding their approach and choices for rehab following an ACL injury.

1. An ounce of prevention is worth its weight in gold…almost literally.

There is an ever-growing body of research showing that neuromuscular-based warm-up programs used 10-15 minutes prior to practice/games each week can reduce the incidence of ACL injury by up to 88%. (Mandelbaum, Silvers, et al; 2005) The soccer governing body in New Zealand has implemented mandatory injury prevention program use with all soccer teams in their federation and estimate $8 in health care savings for every $1 invested in prevention.  A quick search of researchers such as Ekstrand, Hagglund, Hewitt, Padua, Silvers, and Walden (to name a few) show the real progress we are making in understanding that we can significantly reduce the number of these injuries from happening in the first place.  Now we just have to put this knowledge to use; coaches are the #1 barrier to making this happen.

 2. What you do before your surgery can make a big difference.

In a 2013 study (Shaarani, et al) on the benefits of prehab prior to ACL surgery, the average time for a return to the sport for those who took part in a prehab program was 34.18 weeks compared to 42.5 weeks for those who went into surgery without participating in prehab. In addition, the prehab time is invaluable for both the physical therapist and patient to build a positive rapport with each other and get to “test drive” how the rehab process might work. Will it be a good fit? Does my physical therapist understand my goals? Does the patient understand my standards?

Three big items in prehab should include:

  • Symmetrical range of motion compared to uninjured side
  • Minimal to no swelling
  • Excellent neuromuscular control and strength of quad.

I typically get patients started on some of the exercises and activities they can expect after surgery in rehab (single leg squats, single leg stabilization activities, functional lifts -not machine based activities, posterior chain work, etc) so they have a chance to learn them prior to surgery.  The rehab is about training or retraining the brain as much as the body and this gives them a jumpstart on the brain side of the rehab. It also provides patients with a preview of what to expect in terms of activities and time needed each day to get rehab in.  A better understanding of the process leads to better compliance and thus better outcomes.

3. Do your homework on your surgeon and make an informed decision!

Choose a surgeon who does a large volume of ACL reconstructions a year.  85% of orthopedic surgeons do less than 10 per year. (Harner; 2004)  You want a surgeon who specializes in this type of surgery and is motivated to stay on top of the latest techniques including anatomical placement of the graft, limiting a number of allografts used in young athletic patients, and trained in using more than just a single type of graft.  Above all, you want a surgeon who listens to your goals and places you at the center of the equation.  When in doubt, ask a physical therapist who rehabs a lot of ACLs – I often get asked what surgeon I would recommend for ACL surgery based on what I see on daily basis with a wide variety of ACL reconstructions from different surgeons.

4. Do your homework on your physical therapist and choose wisely!

Your physical therapist is the second half of the ACL surgery equation. If the surgery is poor the rehab will suffer; if the rehab is poor – it is a waste of a great surgery. If both are good, the likelihood of a good outcome is high as well. Know that you have the power to choose your physical therapist. It’s your knee, your body and your quality of life – make yourself a priority.  Ask around to surgeons and those who have had great rehab experiences what physical therapist they would recommend.

Some things to look for:

  • Does your physical therapist understand your sport or activity you are trying to get back to? If they have a pretty limited understanding of what the real physical and mental demands are of your sport and role; find a PT who does (or is willing to put the time in to learn and step into your shoes). In addition, your rehab should be performance-based and in many ways feel like training for your sport (while still respecting graft integrity) once you are out of the immediate post-surgical phase.  If it looks strangely similar to your grandfather’s rehab from a total knee replacement you may want to reconsider the direction you are going.
  • Does your physical therapist map out the rehab process for you…in specifics? Can they tell you the criteria for moving from one phase of rehab to the next and ultimately what specific competencies you have to demonstrate to determine readiness for full return to competition? ACL rehab is not a cookbook rehab; they shouldn’t be planning your session each day from a book full of protocols. Time from surgery should not be the main determining factor marking your rehab progress; it is a bare minimum guide for the biological healing of the graft only. Your physical therapist should be spending considerable time evaluating how you move in progressively more functional movements – squatting, hopping, lunging, cutting, sprinting, stopping, pivoting…and then again later in an environment that is unpredictable and full of distraction…and related to your sport.  A set of body weight squats or wall sits and balancing on one leg with your eyes closed isn’t going to do the job; neither will 3 sets of 10 reps in whatever leg machine of your choice.
  • Does your physical therapist take into consideration the psychological component and do they bridge the gap from the clinic to the field?  Spending a minimum of 20% of total rehab time on the field/court in competitive athletes is a good starting point for two reasons: Psychologically the athlete will tend to feel more comfortable and find it easier to feel “normal” again; and it also affords the opportunity to put athletes through the full demands of their sport to see how they move in their sport environment while minimizing both the mental and physical gap in performance from the end of rehab to the start of return to competition.  In addition, I use an outcome measure/questionnaire during various stages rehab to track how patients are assessing the function of their knee with respect to athletic activities.
  • Do not rush back. Does your physical therapist and surgeon communicate? Many people assume they do, but that is often not the case. Paperwork gets stuck on piles, inboxes, etc. The best of both professions will have strong communication channels and use them effectively so the pathway from prehab to surgery to return to competition is smooth for the patient. Don’t assume because they are housed in the same building that communication is happening or that it isn’t simply because they work independently from one another.

70% of ACL injuries are non-contact – meaning the reason you got hurt is most likely a factor of how you move and the compensation you have developed. These don’t happen overnight and don’t resolve overnight either. Just because a certain amount of days has ticked off the calendar and your graft is no longer deemed “fragile” and your quad is strong does it mean you are ready to play. Take the time to overhaul your body and how you move so you don’t find yourself back in the same situation again.  The rehab is a marathon, not a sprint. If you do it right and with the right plan, you should be a better overall athlete at the end of it.

Julie Eibensteiner PT, DPT, CSCS is a physical therapist and founder of Laurus Rehab and Performance, an independent physical therapy practice specializing in ACL injuries of competitive athletes in the greater Minneapolis-St. Paul area.
Twitter: @laurusrehab

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

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About the author:

Howard J. Luks, MD

Howard J. Luks, MD

A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communications, proper understanding, and shared decision-making principles – all geared to improve your quality of life.

251 comments on “Physical Therapy and ACL Injuries : What You Don’t Know Might Hurt You

  • Hello,

    My knee had been swollen and painful for about 2 weeks. It was hard to straighten out completely and putting weight on it was unbearable after a while.
    I finally got in to see the doctor, I was diagnosed with a Baker’s Cyst and sent for x-ray.
    From the x-ray I was advised to see an Orthopedic doctor. I have and the first thing I learned was that you can’t see a Baker’s Cyst on an x-ray, secondly is that I have a small ACL tear.
    Now I do have a Baker’s Cyst and it has gone down substantially, but the doctor has advised no surgery for the ACL tear unless it really bothers me. No jumping or impact to the knee; not even kneeling on it and wearing a compression sleeve.
    It’s irritating, but not painful. I get a slight click sometimes but I can still squat.
    My question is: Can you live pain free with a small ACL tear, a Baker’s Cyst and still workout?

    Thank you,

    • Partial ACL tears do not hurt… they may cause instability, but will not cause pain. If you have a Bakers cysts then you have fluid in your knee. The question that needs to be answered is why do you have the fluid? It is not because of the ACL. It is usually because of arthritis, a meniscus tear, or something else.

      Good Luck
      Talk with your doc again.

  • Hello Doctor
    I over extended my knee doing the lawn mowing, I couldn’t believe it.
    My knee would give me grief when I had to climb up and down into my vehicle. It was sore but without any noticeable swelling. The range of movement was restricted until I started exercising it 4 weeks later
    Have been to a physiotherapist who has given me a range of exercises to do, which I do 4 times per week.
    Is it normal to feel a little bit stiff and tight the next morning? How long until I feel normal in my knee? Are we talking months?
    Thanks for a great article.

    • Hey Mick ..
      Recovery from a significant injury can take months. But again, not everyone recovers fully. Sounds like things are progressing fairly well for you right now.

      Good Luck

  • Hello Dr. Luks,

    I am 18 years old and my sister Ana is 22 and we are both soccer players. In 2013, we both tore our ACL in our right knee. We went through surgery in February and now it has been 8 months since the surgery and we are slowly restarting to play soccer. However, our knees still hurt, not much while we play, both after we play and sometimes the pain happens during the day even if we didn’t practice any sport recently. Is the pain normal even 8 months after the surgery?

    Thank you,

    Juan and Ana

    • Sometimes your knees can remain sore for a while. It is not common, but it is possible.
      If you are concerned you should speak with your surgeon.
      Good Luck

  • Hello Dr. Luks,
    I’m Saurabh lele. 23 years old. I had a partial ACL tear in my right knee while playing soccer 2 months ago. I underwent a surgery a week ago. I had not gained full range of motion of my knee (<90 degrees) before the surgery. I've started my physio sessions, its been a week. I still feel the pain on the lateral side of my knee bone(outer side) while pushing my knee down or while sliding my heel towards my buttock. Is it bone contusion? And the MRI did say that i do have a grade 1 injury to my Popliteus tendon. Will the pain go as I proceed with the physiotherapy?

  • Hey Doc,

    I strained my knee last December playing soccer, and the MRI should that it was a partial tear in the ACL. My orthopedic said i don`t need a surgery all i need is some physiotherapy and then i can go back to sports. Now the thing is i did some physiotherapy for some time and my knee was getting better but then i stopped and it started to feel unstable again i even couldn`t do squats without feeling the instability. Two months ago i went on a two months holiday and did lots of activities that aren`t good for my condition like hiking, jungle trekking climbing a mountain and lots of walking on the beach, and now it really feels unstable and it`s hard to do the bed exercises my physiotherapist gave me and there is clicking. I will visit a doc asap but the question is, did i put myself in danger? and what is your advice?
    Thank you for your helpful article,

  • I have a tear acl I have had it a month now. i was playing with my dog the other day and I guess I twisted my knee the wrong way and now I can’t straighten it out or bend it and it is swollen. the dr told me to go to physical therapy so I did and they told me it was swollen I did everything they wanted me to do and the next morning when I got up it was swollen even more. My question is did I re Injured it when I was playing and how can I get the swelling down? Also could my physical therapy hurt it more?

    • Time to see your doctor again.. if your knee is locked and can not bend, there is a chance you have torn a meniscus.

      Good Luck to you
      Howard Luks

  • According to my doctor and the MRI results, I tore my ACL…I was playing rugby and was untouched when the injury occurred. That was in late September. My surgeon was recommended to me by my coach. He informed that I “shredded” the ACL and recommended I have ACL reconstruction using auto-graft BTB and medial meniscectomy (does that mean I tore my meniscus as well). I have been doing prehab for 4 weeks now and feel great. Still minimal pain when straightening the leg but nothing serious at all. I can bend the leg fine. I was able to go for a run and felt fine as well. My question is if I returned to Rugby without the surgery am I taking a big risk? if its already torn and I feel good do I need surgery? I want to be back at the competitive level but 9 months out for a surgery most dread scares me to the point where I don’t think ill be back to normal.

    • Great questions !! I would read through our most recent series on ACL injuries. Not everyone who has an ACL tear requires ACL surgery. We tend to reserve surgery for those who have instability, for people whose sports or jobs put that at significant risk (roofers, climbers, etc). If you do not have instability and you completed an agility program with a therapist then you may consider non-surgical management. BUT… you need to clearly understand that with sports like rugby there is a chance of having an instability event, where the leg gives way, and you can injure other tissues within the knee such as the cartilage or the menisci. Most of us would brace someone considering non-surgical care to try and limit the risks.

      Good Luck… I would have a long sit down with a few high volume ACL surgeons and see what they say.

      Howard Luks

  • i have ruptured my right leg ACL for the second time. after the first time, 9 years ago, i had a cadaver graft put in. this time i am not so sure, as i am now 50 and not actively playing sports-other than golf. i do have instability in my knee but am going through the therapy to try to increase my legs strength. what should i ask of my ortho when i see him in 10 days? my knee has bothered me for the last 2-3 years. sore after climbing ladders and the like (i am a mechanical contractor).

  • I’m a 57 year old male. I torn my ACL almost 5 years ago playing indoor soccer and then had it reconstructed with a cadaver graft. It took almost 2 years to the day to finally feel “normal”. I play soccer 1 to 2 times a week, tennis 1-4 times per month and golf weekly if I can. My knee felt totally great once I had fully recovered and I could play without restrictions. I recently took a 3 month break from golf but continued with my other activities. Then, following my participation in a golf tournament, I noticed that my reconstructed knee was painful again, not swollen, just painful…immediately below my knee cap on the long bone. Do you think that my golfing aggravated my ACL injury? Do you think that it may be reinjured? What would you suggest. Thank you for your reply!

  • I had ACL surgery 14 months ago. I like to run and I used to run marathons right up until my surgery. I am not young- 44 yrs. recovery went well. However, I am not pleased where I am at this point. I still have pain in the back of my knee- this has always been an issue. I didn’t know if this was part of the “healing” process or if I’m overusing the knee (I run 7 miles 4 days a week sometimes- not often- I will run 11 miles and I strength train 3 days a week). Please advise

    • Hard to advice without examining you :-(

      Perhaps a second opinion for a fresh exam and a fresh set of ideas will be worthwhile.

  • Hi, I’m 37 years and an active gym goer, 2 weeks ago while playing football i sprained my knee and heard the famous popping sound..I knew something was wrong so did an MRI 2 days afterwards which showed a contusion in the lateral condyles and fuzziness around the femoral attachment of the ACL.,other than mild effusion and pain, there are no signs of instability so doctor advised surgery after 2-3 weeks of pre-hab and the other said that my ACL tear seems old and i may have been coping well for quite some time! and that this was just one episode of giving way due to a wrong move so he advised i do PT and wait.
    I want to return back to sports (running, cycling, gym, squatting,..etc) and not necessarily football..the issue is that so far i feel stable and don’t want to go for surgery as long as i don’t have the symptoms, but at the same time i don’t want to hurt my knee further especially that i have some OA signs under my patella in the MRI. My meniscus is intact except for a very small medial meniscus horn tear which is insignificant as per the doctor.
    What do you advise me to do?

    • ACL reconstructions are usually reserved for people with instability after an ACL tear. Without instability there is no clear reason to reconstruct your knee. An ACL reconstruction will not prevent arthritis from setting in.

  • My daughter jump stopped last night during her basketball game. She felt a pop in the knee she had ACL surgery on a year ago. She’s tender in the back part of the knee now but otherwise seems fine, perhaps some slight swelling. I’ve been told that it’s most likely scar tissue that popped. Is this something that’s common or should we have other concerns?

    • Tough to say Steve … ACL grafts have no nerve endings and poor blood flow… so there might not be much pain or swelling if you tear an a reconstructed ACL in the first few years — especially if an allograft was used. I would have her checked out by her AT, or Orthopedist just to be safe.

      Good Luck

    • Any luck with this? I had a similar situation this morning, I bumped into someone playing basketball with the reconstructed acl knee, but I did not hear any pop, and its been about 7 hours now and no major swelling but there is slight pain behind the knee and tender. Could this be just a strain? I really hope I did not re tear my acl.
      Any advise?

  • Good morning! I had surgery to replace my ACL 9 years ago following a sports injury. I successfully had the ligament replaced using a piece of my patella tendon. I completed my physical therapy with flying colors and all has been well. I have not had any issues even when playing basketball, soccer, and snowboarding since then. My issue is that for the last month or so my knee has been really stiff. It is reminiscent of how it initially felt after the surgery. I am having trouble bending it, lifting it with any ankle weights, forget about kneeling (ouch!!!), lifting my weight to a standing position with it is nearly impossible and extremely painful. It has even begun aching just straightening it to lay in bed and often wakes me in the middle of the night aching. It is swollen slightly, although the swelling seems to be concentrated in my quad just above my patella and on the outside edge just below my kneecap. There was no major trauma to cause this change. What I am wondering is if it is possible for the surgical procedure to have deteriorated over time or does this sound like maybe a different part of my knee having issues. I know I had damage to my meniscus and they had to remove some of it that was too damaged to repair. Any help would be greatly appreciated!!!

  • Hello Doctor, im a 32 year old post ACL surgery (2 weeks) I first experience slipping of my knee when I was 17, and went all these years with knee pain n slipping(knee popping out of place), and my torn ACL n torn meniscus went undiagnosed all these years until this year. I had surgery to repair both the ACL n meniscus. Now im in therapy. Surgery went well, very minimal pain just some swelling. What is a normal timeline for weight bearing and bending my knee. I feel like my PT office is overcrowded and im just rushed in n out.

  • Hey doctor i had a knee arthroscopy surgery about 1 month ago. I was wonder when I could start doing physical therapy and how some will it be before I could go back to play soccer.

    • All depends on what they did at the time of surgery. It is a good question to ask your doctor.

  • Hi, I injured my right knee (ACL)3 years ago whilst playing football, I had an ACL surgery. Since last year I felt my knee was getting weaker and on several occasions I slightly twisted it but I could still walk, however about 2 months ago this I twisted it bad and made me unable to walk. I did an MRI scan and it showed that the ACL and meniscus was torn. Now I am awaiting and appointment to see a knee specialist. I wanted to ask you what would be the best option for me in this situation, if I do have and operation again will this have any long term negative affects on my knee such as walking and ability. And If I do not what can I expect to happen, will it heal by itself?

    Thank you in advance

    • Goran … Obviously we like to limit the number of times we need to operate on a knee. Unfortunately ACL failures occur .. and if a patient wants to remain active and avoid instability episodes then a revision ACL reconstruction is usually advocated for. When considering a revision ACL reconstruction it is very important to have a surgeon who performs many of these.
      Good Luck

  • Dr. Luks,

    I would love to have you write a guest blog on my website at some time in the near future about your experience with ACL injuries. May be something along the lines of the types of grafts and what you personally recommend.

    Thank you,


    • HI Eric … I have plenty of info on this site about graft choices, etc. Feel free to look through and shoot me an email — [email protected] if you want to reprint something.

      Thanks !
      Howard Luks

  • I have some concerns,

    Let me shorten a story to what happened to my knee injury, It was during Freshmen in college football, big dude slips through the plays and ram through my knee causing a complete tear ( I mean all of it ) of the MCL and ACL combined. Ive been doing follow up with the physical therapy, Im training for the olympic Greco Roman wrestling and also doing MMA training in colorado.

    My biggest concerns is that my knee is never the same, Ive passed so many physical therapy tests. but still loose. If I lay my right leg out straight to the right and just turn over. it still feels like the bone to bone is popping out. Ive already had an ACL donor surgery done almost 2 years now. Ive done Hindu squats, icing it, taking inflammation supplements. I still dont feel very strong with my knee. It just doesnt feel right. I feel like its double jointed now lol. That is NOT good for wrestling and MMA. Whats your best suggestion I should do?

    • Hi Steven … I suggest a second opinion by a high volume ACL surgeon. Many things might be causing your feeling that the knee is loose. First it can be the ACL itself. Was it put in correctly ? Was it tight enough? Did it loosen? And perhaps most important is the status of your MCL and an area we call the poster-lateral corner. Missed injuries to the poster-lateral corner can cause a well performed ACL reconstruction to fail fairly quickly.

      Good luck… I hope you find the reason why you still feel loose.

      Howard Luks

  • HI Doc, I am a 44 year old male who had reconstructive ACL surgery using hamstring tendon. My injury was from basketball, 11 years prior to surgery. I finally got the surgery done and at present am 9 months post op. I cannot straighten my knee, and experience pain when trying. My knee can be slowly worked to full straight position, but then after will swell and get stiff. On examination, it feels resistant, but not blocked. I am concerned that my knee will never be close to normal again and feel crippled (pain whenever I walk, not able to get up and walk without pain after sitting, etc.). I am due to see my surgeon next week, and he has said he will send me to op, and loosen up or fix the issue, but it is a painful procedure.
    Any advice is appreciated, thanks!

    • Sorry to hear that Tom… Loss of motion following a well performed ACL is luckily rare. Sometimes a “cyclops” lesion can limit your ability to straighten the knee. And arthrofibrosis (an extreme cases of scarring) can also occur, but is quite rare.

      Good Luck to you. I can not tell you how painful it will be without examining you and determining what treatment, if any is necessary.

      Howard Luks

  • Hi Doc,
    I am a 31 years old female. I had an ACL reconstruction in my right knee 7 years back but it still doesn’t seem to be perfectly normal.. maybe this is the way it’s supposed to be now. My concern is that I have almost continuous pain in the same leg (top to down.. extending to my foot) and I’m not really sure what’s causing this. Is it the acl or something else.. Could you please help? Thank you in advance.

  • Hi there-

    I have had a torn ACL for a few years now and for the past few days I have been having a lot of pain behind my knee, up through my thigh and also shooting pains into my ankle. Why would my torn ACL being torn cause this pain? Thank you.

  • Hi,

    How can I know what ACL technique my surgeon used ? When did the anatomical technique became gold standard ? I had a brief discussion with him before the operation and he seemed to think that the ACL anatomical technique was a buzz world (marketing). He is one of the best here in Australia and do ACL reco for most of our top athletes.
    My main worry is to limit early OA onset ? How can I achieve that ? Do I need to modify my activities ? I am 43 with an acl tear and menisci tear left in situ. I am happy to give up impact sports but still want to do skiing 2 weeks per year and do gym work to make my hamstring and quads strong

    • Your Xrays will show where the tunnel are. It’s hard to imagine that nature intended the ligament to be anywhere else except where it has been for millions of years :-) An anatomic technique simply places the new ACL exactly where your origianl one was. It’s not a marketing gimmick. The ONLY reason docs put it elsewhere was because we were limited by our desire to drill both tunnels through the same hole. Anyway. .. Most all high volume ACL surgeons use an anatomic approach to a reconstruction. There’s nothing you can do to avoid OA … worrying about will only limit your fun.

  • Hi Dr. Luks,

    I’m a 37 year old male and 6 days post ACL surgery. I foolishly kept a pillow under my knee for the first 4 days and was sitting up in bed… I though everything was fine and progressing very well. Pain wasn’t so much and in the physio exercises at home I was achieving 120 degree flexion and hyper-extending OK. However, I am hyper mobile so maybe that’s why. But two days ago I read it was a big NO NO to put pillow under knee and since then have been resting with pillows on ankles and elevated above heart. But the pain is now pretty nasty. I’m taking 2x30mg codeine phosphate tablets w/ 1000mg paracetemol every 4 hours plus icing all the time and still can’t sleep, but am persevering. I fear I have let scar tissue build up and am now paying the price as I try to stretch it out. Should I continue doing this ankle rest despite the pain? I hope I haven’t trashed my recovery with this silly mistake. What do you think?

    Thank you very much, doctor.


    • At 6 days it is unlikely that all hope is lost :-). Physio and hard work will help you get your motion back.

  • Hi I underwent ACL surgery 12 days ago, I can flex my knee when I’m sitting down but to walk my knee bends and it hurts in the back of my leg. In approximately how much time can i walk decently?

  • Hi, Doc, I am a 21 years old male who had reconstructive ACL surgery using hamstring tendon. My injury was from basketball. I do physio at physiotherapy centre about 1 month and went to other place study which far from the centre, but still do the exercise that given. I have been doing the exercise for about 5 months, but my knee still feel pain especially the cartilage, and behind my leg thigh still feel like been pull. When i lean back on wall and bend my knee about 30 degree, i still feel pain on my knee. Should i keep doing exercise or stop it? I will be go back to consult the doctor next 3 weeks. Sorry for my poor englishr but hope you understand. Thank you.

    • Sorry Sheng .. without examining you I cannot comment. I hope all goes well when you see your doctor.

      Howard Luks

  • My son is 12 and has a torn acl I have to decide which surgery to do (tunnel or band surgery) because of his growth plates. Or We can wait till he is through growing. Which will have him not playing sports for a few years. I need some advice..thanks

    • Very difficult decision for a parent. The recent literature shows that children are at very high risk for associated injuries after an ACL tear.. e.g.. cartilage injuries, meniscus tears, etc. Those secondary injuries can have a lasting impact on the performance of his knee over his lifetime. Most sports docs favor early reconstruction of a pediatric ACL tear. The technique of choice varies depending on his skeletal age (which may not match his true age), and other factors as well.

      It truly is a difficult decision for a parent. I wish you.. and your son good luck in your decision making and outcome!

      Howard Luks

  • Hello Dr,
    I am 63 and I had a meniscus repair 5 weeks ago. I was making progress in my healing but it was until 3 days ago that i decided to do some slight dancing for 10 strength my knee I feel after that my knee hurts as if were the first week after surgery. I am thinking that maybe the repair, which was done with a BioStinger, device is gone due to such an exercise, How can I know that the meniscus repair is still fine and is not torn again?.
    Thank you very much Dr.

    • dancing and exercise 5 weeks after a repair is a bit too much, too soon. See your doctor and they can help determine if you re-injured yourself

  • Hi doctor,
    I am a 36 year old man. I used to play soccer every week (not in professional leagues) and since last March, I have found that when I jump and landing, at some particular position, my right knee (outside part) starts to feel pain and I will lose my stability. I stopped to play soccer ever since. But I still can engage long distance running, work out and rock climbing with no pain. My knee never swell; but till today, I still can feel the pain if I twist my knee to certain position. I don’t plan to go back and play soccer; but I never want to give up running and rock climbing. Do you think this is ACL and do I need to go through the reconstruction? I am scared by the surgery, any kind.

    • You need a good examination and possibly and MRI. There are certain meniscus tears that can give you a feeling of instability too.

      Howard Luks

  • Thanks doctor. I live in Cleveland area; do you have suggestion for a good doctor in CCF or any other doctor in the neighborhood. NY is too far for me.

  • Hello Doctor, I had a football injury last year, Iv’e underwent physio and treatments, I had an x-ray check, was not clear so I later had MRI check, they said It seemed to be a slight acl tear. I later went back for a opinion, they recommended surgury or just relax, physio, no sports for a couple months, It’s been quite a while, maybe a couple months, I feel really good and I am doing physical activities with no pain or any feeling of any instability, Question is should I continue to take it easy, and keep doing physio, and play next season? I am 15, Thanks!

    • HI Anthony … It would depend on what your examination shows. I can’t comment unless I examine you.

  • Dr. Luks-
    I am in need of an ACL revision surgery after a long, lovely 23 years on my patellar tendon graft. You have mentioned a few times the importance of seeing a high volume surgeon, particularly for revision. What is the best way to get this information about area surgeons? I am planning to start cold calling ortho practices and asking them for numbers but it seems there might be a better way…
    Thank you.

    • Good question Sandra… it’s not easy. You need to find someone who performs a lot of revision procedures. That information is not available online. Cold calling, and perhaps going for multiple consults will hopefully five you the answer.

      Good Luck

  • Hi Doc,
    I have a torn ACL and medial meniscus tear in left knee from landing incorrectly in volleyball. In your past experience, how long would you expect one to be on crutches and out of work. I work a desk job.

    • Hi Stu… For many it will take a number of weeks of therapy to gain back motion and strength following the injury. Following the surgery, it take a bit longer. Most people can return to a desk job within 3-4 weeks on average.

  • Hi, I had a full ACL reconstruction with Meniscus repair (right half) surgery done on my right knee. Its been 2 weeks since the surgery. I started my PT after a week after the surgery. Now at times, when I place my leg in certain positions (normal positions with my brace on) – I feel some sprain kind of a pain in my right side of the right knee. Is it normal ? or is there something that I should consider about ? But this kind of pain goes totally away when I change the position.

  • Hi doc,

    I’m 9 weeks post acl surgery. I still can’t walk properly, or get proper extension. My knee gives me lots of agitation when walking around on a daily basis for work. Is this normal ?

    • It’s a little slow… talk with your doc, or a second opinion if you are concerned.

  • HI There,
    So here is my story- Had reconstructive ACL Surgery in 2005 due to Soccer injury. Healed thought I was good to go- in 2008 Went Snowboarding Re-tour the ACL – Now I have a steel brace when I play or do sports. I have not gone to get a second surgery and My knee just popped out again today – slid on the snow and Bam popped out- It is a bit painful but not like when it first happened. It goes right back in place just very uncomfortable. Do you recommend me go back to my surgeon or is there any ways this will heal on its own? I’ve been living with this sense 7 years . What will happen if I don’t go and get the surgery again?

    Look forward to your reply

    • Hi Meaghan …

      In knees that continue to give way you run the risk of tearing up the menisci and injuring the cartilage or cushioning on the ends of the bones. If your knee remains unstable and you wish to try and remain very active then it would be worth talking to someone experienced in revision ACL reconstructions to see if you may be a candidate.

  • Dear Dr. Luks,

    Great article and informative blog. I just tore my ACL and MCL on Christmas Day and am currently in a brace and on crutches having just started Physical Therapy. I am 59 and right now the doctor hopes to avoid surgery. I found your site informative and encouraging as I start this process and looked at other sites as well to make sure I do not overdo in the healing phase and go a step backwards. I will see the doctor again in a couple of weeks to review progress, etc. and so forth.

    My meniscus is intact right now. Curious on further web sites and resources for rehab program without surgery since this is currently where I am (although that may change). Is there a danger on overdoing the exercises too soon? I do tend to be the type to push things and I think this may be where I need to know the cautions on what to avoid during the first 6 weeks of the injury and how quickly I progress. I am currently doing what exercises I have done in PT two times a day. Thanks for any advice you have.

  • I just had surgery last week with ACL reconstruction and a stitch in my meniscus. When i woke, I was told not to bend or put weight on my leg for 3 weeks from surgery. I did not expect to have this meniscus repair done when I went into surgery so this is a complete surprise. What i want to know is why? Why cannot I not bend it and why not weight it at all except for balance. Is it ok to have very limited bending, less than 5 degrees?.

    thank you
    Jesse Paster
    Los Angeles

    • Hi Jesse … That’s between you and your surgeon. He/she knows what type of meniscus tear you had etc… Not moving the knee is risky, but some Orthopedists still treat meniscal repair this way, especially if it was a large tear.

  • Hi, I had a complete tear in my ACL and underwent a successful surgery last year. Now I am back to playing sports but ever since I have started picking up the paste and exerting effort, I started feeling stiffness and a small tick every time I walk for the next couple of days. My leg feels stable and there is no pain or swelling. Is this normal or should I be scheduling an appointment with my orthopedic?

  • Dr. Luks,

    I am 46 years old and completely tore my right knee ACL this past July playing softball. I took three months before surgery to rehab my knee and then I had an ACL reconstruction using an alograft (cadaver) in mid October.

    I had terrible pain and swelling the first month post surgery at bi-weekly PT sessions and just started to improve my walk and range of motion at the three month mark with the use of a non-anti-inflammatory drug called Refalen.

    My surgeon says my range of motion progress is slow (currently a degree or two away from full extension and 138 at best for flexion), but to wait on the manipulation under anesthesia, and to use the stationary bike to get ROM, and that he could perform a MUA if needed at the 6 month mark and to not fight biology. However, my physical therapist, who now sees me 3X a week, says to skip the painful PT sessions and move forward with a manipulation under anesthesia.

    Is there a window of opportunity for MUA, so that I do not risk losing my FULL range of motion (160+ degrees)? Right now, three months post surgery, it takes MUCH assistance to get me to 138 degrees flexion and that is the best I can do at the moment.

    Also, is the reason I do not have full range of motion due to adhesions because I lack fluid between the ligaments for proper gliding due to surgery and dryness? I read the following article and this is what I think this nurse was saying…. true?

    Should I drink a special ligament or muscle building energy drink? Like body builders do?

    Any thoughts are welcomed – thanks!

    • Hi Jennifer… MUAs after an ACL are very very rarely necessary. Some people take longer to get back their motion than others. An exam and seeing an Xray would be needed before I could comment any further.
      Good Luck !

      Howard Luks

  • Hi Doctor, I was waiting a year until I had my ACL surgery and in that year I lost balances frequently and shooting pains up my leg would occur. I spent the year leading up to the surgery strengthening the muscle around the ACL, swimming (front crawl), cycling and cross training. I did nothing that would cause impact to my knee. However my I’m a fireman and I rely greatly on my knees so I desperately needed this surgery.

    Anyway it’s five months sine my surgery now and I’m being sent for another MRI because it’s unclear whether it’s worked. Reason being I’m not losing balance like I was before, but I will still get the shooting pain that would accompany my leg giving way, but the leg holds. Another reason is whenever I move my ankle/foot up towards my shin a very loud clicking noise is heard in the middle of my knee, it doesn’t cause any pain however. Furthermore my leg doesn’t out from the back but it seems to move 5 ml forward, like the kneecap is sliding down. The lachman,drawer test and MCL showed laxity grades 1 – 2.

    I should add that I can run 8 – 10k on the treadmill and do squats, however I felt I could do these things before I had my surgery but didn’t because I knew my cruciate was torn.
    Anyway what I want to know is it possible for partial successful operations? As my leg seems to hold, but it’s definitely not as stable as it was and doesn’t feel like it ever will be without another op.

    • HI Brian …
      Unfortunately not all ACL procedures are successful. Perhaps a second opinion with a high volume ACL surgeon would be worthwhile.

      Good Luck
      Howard Luks

  • Hi, 34 y.o., had a complete ACL tear on december 14, fighting a fire. Went from no bend(had to walk onto my pants to put them on) to regaining 90% leg never has stability issues when being examined, but ive had a few incidents where walking and foot getting caught for a second or hitting a chair leg makes my knee feel like it briefly pops over for a second then back into place..also almost tripped and caught myself..same that whats happening? Also dr has apparently scheduled me for phys therapy..but yet to visit a orthopedic doctor…is that common? I construction where its very common to carry 150 + pound windows..would also like to get back to firefighting eventually.. i seriously doubt phys therapy alone is going to fix this. Kind of get a feeling of lack of communication. Should probably ask for a game plan, huh? They keep having to get permission from the county insurance to do stuff

    • Hi Ryan …
      For some patients who are constantly working in precarious situations or those who rock climb, etc many surgeons prefer to reconstruct the ACL sooner rather than later. In these cases, one episode of instability or giving way could result in injury to you because of your occupation and where you might be when the knee gives out.

      I would talk with your surgeon about how your job influences his decision about how to treat your injury.

      Good Luck

  • Hello, Dr. luks
    My age is 20 year. I used to play soccer every day but since last October I have found that when I jump and play soccer, at some particular position(Before visiting Doctor), my right knee
    starts to feel pain and feel like I will lose my stability(As it gets twisted). I stopped to play soccer ever since. But I still can engage long distance running, & work out with no pain. My knee never swell; but till today, I still can feel the pain if I twist my knee to certain position. I want to go back and
    play soccer. Doctor said there is partial tear ACLx (Grade 2) for which he suggested to do surgery. I am scared by the surgery, any kind.
    Sir, Is there any physical exercise for me to reconstruct ACL and what kind of food and nutrients should i prefer???

    • HI Ganesh … If you have an unstable knee with an ACL injury then you may need to consider surgery if you want to return to playing soccer. There is no harm in trying physio first…

      Good Luck

  • Hi Dokter Howard,

    My name is Tim, and I’m from Belgium. I have a minor Reverse bankart lesion. They took an MRI about 4 months ago. I am complaining about my right shoulder over almost 10 months now. There happened nog trauma, and it never dislocated. So I guess it’s probably for overusing it, and training too heavy.

    I am a natural bodybuilder, using no stimulants, except supplements such as protein powder and fatty oils.
    I do train very heavy, and exercises like overhead presses hurt when I go heavy right now. Also my right shoulder is hanging lower than the other. I can see that difference during some exercises such as pull ups and overhead presses.
    They also did isokinetic testings, and concluded there is a difference in shoulder strength between front and back. The specialist said I also have a micro instability.
    I’ve been doing rotator cuff exercises for months, and I’ve been doing a lot of pullings, but I still make nog progression.

    Do you think I should keep trying to fix the stability and is it possible to get this completely fixed?
    And is it possible to get back to a 100% level without performing a surgery.
    If you want to take a look at the MRI scan, I can always send you the login. It would be very helpful.

    thank you in advance,


    • HI Tim …
      Unfortunately, without examining you — just looking at an MRI will not help me to help you. The MRI is a tool we use if a diagnosis is uncertain or if we are planning on operating on someone who has not responded to non-surgical measures. Speaking with a patient, listening to a patient, and examining a patient is critical in arriving at the right diagnosis and treatment plan.

  • Thanks, Dr. Luks for suggestion
    But my family is not permitting me for surgery. So they are indirectly opposing me for playing soccer. I daily run 400m track near my home so there is no problem in knee. But when it gets twisted(In rare case) i lose my stability the very next second.
    Sir, I want to know can exercise help me out with proper nutrients. And how much time will it take for reconstruction of partial tear of ACL if i take complete rest.

  • I had a total ACL reconstructive surgery with patella graft and three screws in 1997. I was in ARMY and ran 3 to 6 miles five times a week until i got out in 2005. My x-rays and physicals at Veteran’s Affairs show my hardware to be sturdy and in place. My problem is my knee swells and fluid builds and i also have a piercing pain after prolonged standing or an active day. What should i be tested for to rectify this problem? Thank you

    • Hi Dale ! Thanks for your service to our country!!

      Your next step is a good exam and perhaps an MRI if your doc thinks it is necessary.

      Good Luck
      Howard Luks

  • hello Dr. Luks I had my acl surgery on 25 Dec . now feeling better. This is my 4 th week my problem is while walking the operated knee is slightly paining . Is this pain is common after the surgery or else some other problem is there ? Please provide me a suggestion for my problem.
    Thank you

  • last year i was playing football and i was running for the ball and got hit in the side of my knee and i did;t feel the pain until i tried to get up and after the game i went straight to the doctor and got an MRI but the said i was fine and when i lift weights i still feel like a knife is cutting my leg my trainer wants me to stop but i think it will heal is this true or not and will i hurt myself if i do

  • My son is 15 years old and had surgery on his acl 4 months ago do you think he should start squating passed 90 degrees with weight on

    • Many of us follow the MOON protocol when we rehab our ACL patients. Some physicians do not. The MOON protocol is a milestone based protocol and not a time based protocol. Your doc may or may not utilize the MOON protocol because of a personal preference or because he/she repaired something else at the time of surgery and is holding your son back.

      You need to ask your surgeon or therapist about his recovery since they know the details of his particular case.

      Good Luck

  • I have a quick question doctor. I tore my acl 10 years ago and had it reconstructed using my hamstring. I had minor issues with my knee in the past 10 years. Last week I was walking and my knee buckled on me. I went in for an MRI and the surgeon said I have a huge bucket tear of my meniscus. My acl is fine but he says that the placement of my acl graft from 10 years ago is not ideal and that it is more vertical than he would like. He suggests that when he removes the damaged part of my meniscus that I should also consider having my acl redone so it is in a more optimal position. What are your thoughts on having my acl repaired even though it is not torn?

    • Hmmm … it’s true that vertical grafts can lead to failure and poor results… but many questions exist. Why did your knee buckle? Your ACL might not be working well. Why did you tear the meniscus? Common with an instability event. What did your exam show? Is the knee loose? Does it “pivot”. It’s not an easy question to answer and one where I would definitely need to examine you before I could offer any advice on how to proceed. But I do not like the “while we are in there” approach. And I would favor repairing and suturing a bucket over removal.

      Good Luck.

  • Hi doctor, I have a quick question… Should I pre-rehab even if I have a contusion in a condyle? Because my surgeon just told me we have to wait about 2-3 weeks untils it heals in order to have my ACL surgery,but he did not mention anything about pre rehab. Thanks!

  • Dr. Luks,
    I had bone patella tendon bone acl surgery on my right knee about 4 months ago due to a motocross accadent there was a small miniscus tear but nothing that needed stitches just need to be “cleaned up”. Physical therapy has been going awesome in till we started to step up the program and started dping more jumping, high knee runs, etc. After physical therapy I went went to the gym as I allways do and i was doing the elliptical when i noticed a little cracking sound with a little pain but i thought nothing of it because my knee pops all the time. Since then i have noticed my knee hurting more and I have found some of the Knee excersizes i used to do are harder now. Should i be woried or could it have just been scar tissue popping? Could I have re injured the acl?

  • I hate to be a bother but I’m really getting worried about graft failure could my graft have failed?

    • Hi Grace… I realize you are nervous… I can only tell you if the ACL is injured by examining you.

      Howard Luks

  • Hello
    I injured my left knee at work, I have since had an MRI which revealed a complete disruption to the anterior cruciate ligament. I have been off work since as my job is very demanding and includes a lot of climbing up and down manholes. I have an appointment with an orthapedic surgeon in 3 weeks to have the knee assessed, I still get the occasional knee slip (it doesn’t give way and lock it just slips) and it doesn’t feel right going up and down stairs especially down, I feel quite nervous when I’m doing that. What can I expect from the assessment as I need to return to my job. Thanks

    • You need to be very careful Dave. If your knee gives way at the wrong time you could suffer a very significant injury. Also, each time your knee buckles you risk tearing something else. be careful and good luck.

      Howard Luks

      • Thank you
        Should I be pushing mt surgeon for a reconstruction or will intense physio put it right ?? I don’t want to end up having to return to this situation in 6 month and find I need reconstruction then

      • Tough to push a surgeon… But i would explore all possibilities with him or seek another opinion

  • Hi,
    I am a 37 year old woman and have been very physically active my entire life….triathlons, tennis, rock climbing, hiking in 20’s and 30’s. Long story short, I tore my lateral meniscus 8 months ago and had a repair done. It has been a very slow recovery for me (which I understand is typical with a repair). But, it is 8 months now and I still can’t run because I’m not strong enough. I’m becoming more physically active in the last month, but my knee is now sore and hurts a bit behind the knee. It doesn’t bother me when I’m laying with leg straight, legs bent, swimming, or biking…just mainly when I’m standing and walking around…it is uncomfortable. It isn’t swollen at all and it looks fine (but it feels like it is swollen on the inside of the knee)…I don’t see anything visually though. I can’t get a straight answer out of my physio, which gives me more concern. She just said it might be my hamstring. It doesn’t feel like my hamstring. I just want to know if this is normal. I realize all patients will have a slightly different response and case, but I need to know if this is a normal response or not 8 months after surgery….or, is this a sign that something is wrong?

    • Hi Karen… Perhaps it’s time to see whether or not the repair worked?
      Good Luck
      Howard Luks

  • I tore my ACL (left knee) in ballet in May 2014 and had surgery on June 20, 2014. I was having pain still and on December 5, 2014 so I had a second surgery to shave down bone spurs and tighten the screws. That problem has gone away but I’m still having problems. My knee continually will buckle and go out of place. I also have swelling on the outside of my knee and lots of pain, even to the touch. My surgeon doesn’t think anything of it. Any idea of why this is happening?

    • I would consider having someone else give you an objective opinion on how your new ACL feels and whether or not it is tight enough.
      Good Luck

  • Hello, I tore my acl in a football game and had my surgery October 16,2014. I’ve been going to physical therapy and it’s been doing well. The only question I have is I have a popping sound in my knee Everytime I straighten it out. Could you tell me if you can what it is?

  • Hi Dr. Luks,
    I am 18 years old, and I’ve a completely torn ACL and meniscus tears from doing martial arts. I’ve been waiting for my surgery appointment for about a little more than 4 months now. Lots of complications with appointments, and I’m still waiting on getting to meet my surgeon in probably 2 weeks or so. My surgery won’t be until the end of this month, making it 5 months with a bad knee.
    I was wondering what kind of exercises would be advisable to do before surgery, to strengthen my quads and what not. And I am also wondering if there are any negative side effects for putting off my surgery for this long? The first month was extremely painful, but after i could finally walk without much help from crutches, it started getting better until recently. Occasionally i would feel a sharp pain in my knee where it is injured. Is that normal?
    I know I should probably wait till i get to see my surgeon in two weeks, but i figured that I could use this two weeks to start doing small exercises which I’ve lacked for the past few months.
    Sorry for the loads of questions! Really appreciate it, thank you!

    • quadriceps and hamstring exercises are very important… so is working on your balance and stability. Physical therapy for a small period of time before surgery can help you and point you in the right direction. Sometimes waiting has its downsides, but often it doesn’t.

      Good Luck

  • Hello Dr. Luks,

    I am recovering from an acl and meniscal surgery that I had approximately 15 months ago. I believe I had a good sergeon and everything went well, I did a lot of rehab during the first 6-7 months after surgery and had to take a break for exams etc, I’ve been rehabbing once again for the last 3 months but now I’m experiencing some pain on the back of my knee and also on the medial side where I had the mesniscus repaired.. I’ve been to the Physio recently and he assured me that no more surgery would be needed. I’m just wondering if these slight pains are common for someone looking to return to sport after an acl tear? Do you think these issues will persist if I keep doing my gym and filed work?
    Have you seen many patients with a similar problem?



    • Hi Conor … It might be worth having the knee evaluated to see if the meniscus tear healed. Assuming that your surgeon had sutured or stitched it back into place.

      Good Luck

  • Dear Dr Luks,

    I tore the ligament in my knee three years ago skiing, and had crutches for two weeks followed by three months physiotherapy. It never healed properly as every so often it still hurt. Now i can feel it pulling every time i walk causing slight pain and un comfort, is there any exercises you can suggest before i can see my dr in 3 weeks.

    • Sorry Abigail … without examining you I can not make specific recommendations.
      Howard Luks

  • Hello Dr Links,
    Thank you posting this. I tore my acl, had it repaired then went to the ER 5 weeks later and spent a week in the hospital because the knee joint was infected after surgery. The graft and screws were taken out and I was on a PICC line with Antibiotics for 2 months then Blood thinners for a PE. With the infection gone and the blood thinners done, my new Ortho is ready for me to schedule the next surgery. My question is, would there be any harm in me waiting 5/6 months before getting the next surgery (to repair the ACL again)? I’d like to work out more and get some of my quad strength back. And enjoy some time out of the OR and hospital.

    • Sounds like a good plan. Just be sure to avoid activities which could cause your knee to buckle or give out. I would also suggest a hematology evaluation to be sure you are not prone to blood clots. If you are on oral birth control pills you should consider stopping them too. What is your plan for preventing another blood clot ?

  • Dear Dr Luks, My son (now 20 & college Sophmore) has played sports most of his life (High Scl Level: Golf, Soccer, FtBall, Bskt ball etc). Still playing @ intramurals levels now. Off & on hes had the usual (wears & tears / sprain) around the thigh, knee & ankle areas but never an actual break; that is until now! We live in Cola., S.C., & our Medical Univ @ USC has an awesome “Sports Medicine Group”. Per the MRI & Consult my son has “ripped his ACL” & is going to need surgery. Heres where I’d appreciate any & all sincere advice. (I apologize ahead for even asking)….. My son planned his “Springbreak Trip to Cancun Mexico & paid ahead”. IF he were your patient and can tolerate being uncomfortable for three more weeks until he’s back from this trip. do you think it’s “safe” to let him wait for surgery (I’m of ofcourse going to get our own Orthos opinion) but curious what you think since he’s not in excruciating pain right now. My own “Motherly Instinct” is to keep him out of Mexico and safe as possible until his surgery. (The surgery date hasn’t been set yet). I’m So afraid if he goes on the trip & messes around that he’ll end up in some foreign hospital. Sorry for this long msg but I sincerely appreciate any medical advice and wisdom you can send our way. Sincerely, Sabrina 2/18/2015

    • Sabrina … I am asked this question in a similar manner very often. Your son is 20 and should be able to act like an adult and understand his limitations and the implications of not following the doctor’s orders. I usually leave it up to the patient (if they are over 18) … but they have a very very clear understanding of what the possible injuries are if they do not listen to my restrictions.

      Good Luck… tough decision.

    • As long as his knee is relatively stable, he should be fine on vacation. I continued to play soccer after i tore my acl for 6 months, and didn’t have surgery for a full year after the tear.

  • Hi Dr Luks

    I had a soccer injury back in October from fast change of direction which tore my acl along with meniscus tear and grade 1 MCL sprain. I’ve undergone keyhole on the 11th and debrided the notch for acl repair. All that’s left is acl reconstruction and to repair the meniscus tear. The problem I have is I can’t bend down, as in squats or just in general. I tend to use right knee bent and left knee out in front which has made me lose a lot of muscle in my left qaud. It really hurts to bend any further past the pain and from what my surgeon is saying is that my acl shouldn’t be preventing me from bending down fully and to speak to my physio about exercises to help. I’m abit concerned as it just doesn’t feel right and it’s still going to be a problem after surgery.

    • Unusual story Phil … we do not usually scope someone in preparation for an ACL surgery. I’m not sure what the purpose of your first procedure was ?? A meniscus tear could be responsible for your inability to bend the knee without pain.

      Good Luck

  • hey i m 15 years old and i have complete ACL torn. I just want to know can i return to soccer and save my knee from now injury I can t live without soccer ! help me

    • In order to play competitive soccer it is likely that you will need a new ACL reconstructed for you. Just be sure to find someone who performs a lot of ACL surgeries and is comfortable with surgery in a 15 year old.
      Good Luck

  • Dr. Luks,

    I got ACL surgery about 7 months ago on my left knee and pt has been going great, i should be returing to sports in the next month. But, i was concered about experiencing pain in my other knee. Lately I have had pain in my right knee similar to growing pains that I expereinced when I was younger. Is it possible that this means I may be injuring my other knee? Is this normal with an ACL recovery?


    • Tough to say Hannah … Pain in the other knee is not very common. Have your doc evaluate you and see if they think it is worth looking into with further studies.

  • So I tore my ACL my sophomore year in football (2 years ago) and this year I stretched it in football again. What does this mean?

  • I had my reconstruction last Feb 13 (hamstring tendon graft). I am on my fourth week now with my rehab. I am scheduled to do a follow-up check-up on Friday and to do some x-ray. Is it normal to feel pain whenever we do bending stretches on my patellar tendon and I usually feel pain near my incision. Slight swelling by the way. Is this normal because i’m afraid that the screw is loose or there’s a complication?

  • Hi Dr. My daughter is a very active 15 year old, playing soccer and basketball. On Nov. 1st she tore her ACL. Surgery was Dec. 2nd (hamstring graft). Due to many issues with her insurance, she did not start PT until 3 weeks after surgery and then was only given once a week sessions so she does her own exercises at home as well. At this point(14 weeks post op) she still can’t get full leg extension and still walks with quite a bit of a limp. Her therapist says she has alot of scar tissue due to lack of PT. She still has pain after her sessions as well. At this point, I am worried she will never be able to get full extension and will always have a limp. Is this something that will fix itself as time goes on? Thanks for your time!

    • Sometimes it can be stretched out.. sometimes we need to assist you. That may mean another arthroscopy to remove any scar tissue in the front of the knee… You should have a long discussion with your surgeon, sooner rather than later.
      Good Luck

  • I tore my left ACL 9 years ago, and after a trip to the ER was put immobilizing brace for nearly 6 weeks until I was able to get into the orthopedic surgeon. By that time my leg had atrophied, and although I had my ACL repaired, my leg has never been the same– I have trouble keeping muscle in my quad.
    Recently it seems like my knee is slipping out of joint again, even while I am not using it (it has happened multiple times during th night while I am sleeping). I have pared down on gym time, isolating my quad, but so far no change. It has been so long since surgery (and it was done by a military doctor who has long since moved on), that I am not sure whether I need to be seen by an ortho doctor again or work with a physical therapist and really strength my quad.
    Help! Thank you!!

    • HI Michelle … I would suggest that you see a second opinion to be sure the ACL is functioning well.

  • Hello Doc,

    I had ACL Reconstruction with an allograph as well as medial and lateral meniscectomy on my left knee in May 2013. First question is: Why am I still experiencing that “clicky/cracky” type of feeling in my knee when I bend it (no pain included in this)? The feeling at times is similar to when your thumb or fingers feel like they need to be cracked. If you don’t understand what I mean by this, it’s okay, ignore this paragraph and please just address my next question because that is the one I care more about anyway.

    Alright second question. The other day I was playing basketball, I was going right put it behind my back and went left, when I took the third or fifth step going to my left, I got this sharp pain in my knee. I immediately stopped playing and just sat out the rest of the game to feel it out. I ended up playing another pick up game on it soon after and it felt good but I was playing 60%, being cautious. The sharp pain I got on the step going to my left existed for probably 1 second. I only stopped because of how much it grabbed my attention in that second not because of continuating pain. I had no swelling at any point, but being 2 days after that day my knee is kind of sore. Should I be concerned? Is there any type of self evaluation I can do to be sure it is okay? I’m going to be pretty nervous the next time I play a pick up basketball game.

    • HI Tim… have your doc examine your knee. That may improve your confidence if you know that the new ACL is ok or not.

  • Hi,
    my name is Faiz and I had had snapped my acl while playing football and got a surgery done around 10 months ago. I do not have complete range.. have about 5 Degrees lack in straightening and 20degrees in bending. Due to the lack in straightening I have a limp.. the strength is good but the range is a concern.. kindly advise.

    Thanks and Regards,

    • There are many reasons why you have loss of motion… without examining you and seeing your X-rays I can not accurately comment on your case. Sorry.

  • Hello Dr., I’m 37 and I used to have an active lifestyle prior to my surgery. Nine weeks ago, I had my ACL reconstructed (autograft – hamstring), meniscus and patella repaired. I just started putting 50% of my weight on my knee when I walk (still with crutches). The swelling it’s going down but at a very slow rate and the inflammation gets worse when I’m standing, even if it’s just for a few minutes. I take 1800 MG of Ibuprofen daily but it doesn’t seem to be helping much. I feel that the swelling is slowing down my recovery; I can only bend to about 90° and I’m not able to strengthen my knee completely yet. I’m going to therapy 2-3 times weekly and I try to do all the recommend exercises daily. My next appointment with my surgeon is on April 22nd. I’m very concerned as my therapist tells me I’m behind schedule for recovery. I want to be able to walk without crutches and get the swelling down. Do you have any suggestions for me? Your guidance will be greatly appreciated. Thank you! Douglas

    • You are on the slow end of the recovery curve. Some people become stiff after surgery. It happens in a small percentage of patients, but it can increase your recovery time dramatically. If your knee remains very swollen then you may want to see your surgeon sooner.

  • Hi Luks,
    Thanks for all those replies. We are really grateful to you.Myself Lokesh, aged 28. Recently I was talking to one of my friend when my bike was in running condition unfortunately my bike moved bit back and bike picked up and became uncontrollable and fell down the bike was almost stopped when i fell but unfortunately it directly fell on my left knee. There was no swelling and no pain in knee. When i tried walking my knee gave up but i didn’t hear any sound as such. Then i travelled all the way to hospital in wheel chair and tried moving around in hospital my knee started giving up. After few days of strapping i can walk and i didn’t see any giving up. When i went for MRI doctor told me that i have torn my ACL (full thickness rupture) and should go for surgery and the reason for that is to prevent arthritis and to prevent injuries to other structures of knee. I met one more surgeon who is really well known orthopaedic surgeon who has done very complex scoliosis surgeries and he is the go to person for most of the bone surgeries. I am really not sure how many ACL surgeries he has done but his opinion also to reconstruct ACL and the reason being to prevent arthritis. and the way he explained to me it looked like ACL reconstruction is very simple surgery and there is no way it can go wrong.

    I am software Engineer who rarely play games of any kind , I usually do treadmill and ready to give up if required. But since both the surgeons felt that surgery is way to go i am really confused. If preventing OA is the reason then the surgery is of no use and if i am unlucky i might end up with more pain after the surgery.
    Could you please advice me if surgery is required to prevent OA considering that i do sitting job which involves little to no knee involvement.

    I am surprised one of the best known surgeon went on to say surgery is required to prevent OA and it seems it won’t prevent OA even after surgery.Unfortunately back here in India there is tendency where people rush you to surgery if they get to know you have insurance but deep down they have other opinion and it gets really difficult.

    Your reply would be really helpful.


    • ACL surgery will not prevent osteoarthritis. But is will stabilize the knee to prevent injuries to the menisci. IF a meniscus becomes torn then your chance of developing OA increases significantly.

  • Hi Dr. I am 19 years old and tore my ACL on April 14th, 2011. I had surgery on June 17th and I am now almost at 2 years since my surgery but never gained back my complete range of motion and quad muscles. I also seem to have pain in my shins that has never gone away… I run with a limp and I’m just scared I will never be able to exercise fully again!

  • I tore my acl and after rehab one day I heard a loud pop kneeling down could I have re torn my acl

  • Hi,

    My daughter had ACL surgery for a total separation injury. She is now six months post surgery and has been instructed to start running in straight lines building up to 5k. However she is now getting pain in her upper shin below the knee is this normal what should she do.



    • Some pain is not abnormal… but stress fractures can occur. Have your Orthopedist check her out and stop the running for now.

  • I had ACL surgery using my patellar tendon and also a meniscus repair in my left knee three months ago. I currently have 0 degrees straightening and 121 degrees flexion. However, my left knee is warmer than my right knee. Is this normal? Also, my knee doesn’t feel normal and is still weak. Should I be concerned? Thank you so much!

    • Without examining you I really can’t comment… but slight temp differences are usually normal. It can take a long time to gain your strength back too. Good Luck

  • Hello I’m a construction worker and hurt my knee months ago I’m waiting for workman’s comp to approve an mri. The doctor was sure it was an acl or pcl injury due to the loosening from pulling my lower leg from my knee my question is if I have to have surgery for either acl or pcl how long would I be out before returning to work

  • Hi Dr.Luks,goodmorning..I am Rico 28 years old. I had acl reconstruction last February 2011 but my knee becomes unstable again after a year so I had my Acl revision last November 2013 and now 1 month ago I feel pain in front of my knee below my knee cap but now the pain is gone but my knee is grinding and popping..and I think my knee is loose but I can still fully bend and fully straighten my knee and I can still run,no problem in stairs..I am just worried because my knee is snapping? What could be the reason Dr.. Hoping for your comment Dr.Luks.. Thanks in advance.. Godbless.

  • P.s.
    I can also see that my tibia is moving forward…is it possible that I tore my acl graft again? Sorry for many questions Dr.Luks.. Thank you again..

    • Hi Rico … Time for a good examination by someone who performs many revision surgeries. Revisions are more complicated then the first ACL reconstruction.

  • Hello Dr. Luks. # years ago I had a full ACL repair with a quad graft and a medial meniscus repair from a bucket handle tear. After months of physical therapy I got worse and had an MRI. The hardware “shifted” and the meniscus was re-torn. One year after the first surgery a new surgeon went in and removed some of the meniscus and since he could not get the hardware out, he “shaved” it down. (quotations are what I was told by the doctors). After months of physical therapy I still did not recover and had a new surgeon take a look. He determined there was a neuroma. One year after the second surgery I had a third, to fix the neuroma and repair another meniscus tear, and to debride “fragments of the biodegradable screw”. I am now 4 months after the third surgery and I am in great pain daily. Some days I cant walk without crutches. Daily pain is dull and long lasting, and there is intense intermittent pain deep in the knee and in the patellar region. I had an MRI 3 weeks ago and a new meniscus tear was found, along with potentially “more fragments of the screw” in the joint. My surgeon wants to go in with a scope again and remove the fragments next month. Do you have any advice? I do not understand how this screw can fall apart, and its been a horrible 3 years. Do you think the fragments could be causing the subsequent meniscus tears? Thank you very much for any help!!

    • Nicholas … this is not a common problem… but any hardware in the knee can and sometimes will move or back-out from its original position. I would get a few opinions before heading in to surgery again. But loose pieces of a bio screw should be taken out .. they can damage the inside of the joint.
      Good Luck.

  • Dr.Luks , thanks for all the useful information above and the time you take to answer people’s concerns ..
    I am 43 yo fairly active female , injured ACL while kickboxing a year ago . Finally underwent surgery 10 weeks ago today. Had allograft placed with lateral meniscus repair ( found at the junction of the outer and inner rim of the meniscus) . Meniscus tear was found only intraoperatively.. My concerns are inability to achieve full extension ( short by 3 degrees compared to opposite knee) . I am at 0 deg extension on the operated knee . Flexion is still a big challenge as I can get to 128 deg after physical therapy session but to 120 on my own. I felt a lot better from week 4-8, than I do now :(( still having pain especially on the medial joint line and some on the patellar tendon. Doing all exercises as suggested but quads are still weak and I can limp easily if not paying close attention to my gait . Also I cannot hyperextend my leg while walking as I do on the normal side . I feel helpless . I would greatly appreciate any suggestions/ advise. Will I ever be normal again.??

  • Just had all surgery in December but my knee just caught on to some and popped out. Is that a bad sign

  • Hi Dr. Luks, and thank you in advance for your support. I am a young male (17) who plays rugby union, who has undergone two shoulder reconstructions (one each shoulder). This was mid last year and there was a 7 week gap between them. I have been through rigorous rehabilitation with my rugby gym coach who is an ex professional sporting team gym coach, as well as with a local physiotherapist, which has led to me lifting weights nearly every second day to strengthen my muscles to ease the workload on my shoulders. I have just got the ‘all clear’ to partake in rugby from my shoulder specialist, who is a reputable shoulder surgeon through a national sport (NRL), with the recommendation of me starting from the bench and increasing my minutes as time progresses.
    However, after partaking in my first semi-serious contact training session, my shoulders felt sore, with my left feeling nearly unstable during collisions. Is this natural in the process, or am I further from healed then thought? This is whilst using a shoulder brace for my left shoulder.

    • Hi Tom … reconstructing shoulders in contact athletes is stressful for us. You are in a group with a high recurrence or failure rate because of the physical nature of your sport. The soreness is probably not unusual. But the instability is troubling :-( If it persists it might be time to see your doc again.

      Good Luck

  • Good morning Dr. Luks,

    I had ACL/Meniscus surgery in 2010 (hamstring graft), rehabbed hard for 9months, started playing basketball again after about 14months after surgery. Everything went smooth wearing a knee sleeve while playing for about 10months before I tore it again. Had surgery again around 2012 (cadaver graft) and rehabbed for about 6months with my old PT and then continued on my own at the gym/home. However, I don’t feel like I ever truly dedicated the time I needed for self-rehab. Few years later and my knee still does not feel fully stable.

    Would going to get an MRI be a wise step? Is it too late for further PT at this point? I have played light sports here and there but do not feel comfortable enough to play at full-speed. Knee/hamstring/quad do not feel strong. What is your opinion doctor?

    Thank you.

    • HI Victor …
      A good exam can tell you if the graft is working well. Start there… then your doc can determine if PT would be beneficial.

  • Hello Doc,
    I had ACL reconstruction surgery (with hamstring graft) and Meniscus repair about a month ago and doing PT twice a week and exercising every day at home. Knee is still swollen and very painful when trying to bend…after so much time I made it to 80 degrees and I am worried that I can’t go pass this level. I am a 51 yo and pretty active and trying to go back to skiing, biking, hiking, swimming, etc. Is another MRI going to say why this very painful PT with not much progress (I can feel the scar tissue). I am able to climb 6″-8″ steps but not come down.

    • HI D … Maybe get a quick second opinion to be sure all looks OK. Some knees simply progress slower than others despite a good quality reconstruction.

  • Hello Dr. Luks,

    My 13 year old son was just diagnosed with a complete tear of the mid portion of the ACL. He snapped it during a baseball practice a few days ago. He is 5’9″, 110 pounds and still growing. (dad is 6″, older brother is 6’1″ at 18 years old). He is active in year round sports including basketball.

    I am very concerned about his growth plates if we decide on surgery now and its effect on his legs growing normally. If they drill in a different spot, will that mean a less effective repair?

    Do you have suggestions of specific questions for us to ask the surgeon as we meet with Surgeon next week to discuss treatment and surgery options in regards to a child this young?


    • Hi Scott…
      The risks of a growth plate injury are relatively low. The risks to your son’s knee if it gives out and he tears a meniscus, injures the cartilage or tears another ligament are more of an issue.

      You need to be sure that your doc:
      1 Performs many ACL reconstructions each month…
      2. you need to know how they approach a child with open growth plates and how often they deal with ACL recons in this population.
      3. graft choice … most would use a hamstring AUTO-graft — your childs own tissue. IF they mention allograft that is a deal breaker since the failure rate of allografts at your son’s age is VERY high.
      Good Luck : To you and your son.
      Howard Luks

  • Hello Dr. Luks

    First of all, allow me to thank you for advising troubled patients. You are doing a great help!!!!

    Two weeks ago, I underwent knee surgery for ACL reconstruction and repair of medial meniscus bucket handle tear with 7 fixes implanted. Currently, I have 10degree FFD and 0-80 degree of ROM.

    Though, am taking alternate day help of physiotherapist but am worried about FFD and ROM of less than 90degree, even after 2 weeks of surgery. Is this below normal or normal performance, request your guidance. How much time usually it takes for a patient to come back to normal life (walking without support, driving, day to day jobs) barring sports life?

    Request your precious advise. Once again, thank you!!!!

    Sourabh Jindal

    • It is not unusual for it to take a number of weeks to restore your motion. Some people can take longer than others.

  • Hi im 17 years old, and i had acl reconstruction, last year on September, i waited about 6 months and didn’t go back to playing soccer, but started with excersise? now after few months a ball start to grew under my surgery scar? my question is, is that something i should be scare about or concern about?

    • I don’t know .. it might be a cyst, or it might be related to the hardware used to hold your new ACL in place. No rush… but have your doc take a look.

  • Hi Doctor, I just had an Acl recon 3 weeks ago. The swelling has gone down. I was just wondering what I can do to straighten my knee and if I can do one legged skipping just to keep fit. Thanks

    • Are you going to Physio? Getting the leg straight is very important. Do not jump on one leg :-( There are many exercises on YouTube etc… try to meet with your doctor or physical therapist to determine which are correct for you.

  • Hey, I had surgery on a torn ACL using a hamstring autograft and an outer meniscus repair about two weeks ago. I’m kind of worried that i might stretch out the new graft, how can you prevent that from happening while the new graft grows into place? I walk with crutches and sometimes accidentally hit my leg against the door or something and i wonder if that can cause any damage?

    • The graft should be strong … it should not be easy to stretch it or injure it.

  • Hi, my name is Robert I’m 34, I had both meniscus trimmed and repaired along with an acl reconstruction with my hamstring tendon. The surgery was done 2 weeks ago and I was walking with my brace unlocked at 45 degrees and my knee buckled forward happened twice in two days. It’s been a little sore afterwards around my knee cap. Is this a major concern or is this common because my leg is still weak from the trauma of surgery?

    • Hi Robert…
      Your knee should not buckle or feel unstable after an ACL reconstruction. I would probably schedule a follow up with your doctor.

      Good Luck!
      Howard Luks

  • My 15 year old had ACL reconstruction surgery and 30% of her posterior meniscus removed 9 1/2 months (July 14) ago. She doesn’t have pain. She underwent physical therapy and was progressing until she started to add in plyo and agility more than 2 days a week. When she tries more activity she has swelling in her knee with limited range of motion. She had prednisone at month 4 and 6 and cut way back on conditioning at the 6 month mark, only doing strength training of the quads and hamstrings. She went month 8 and 9 without swelling and was released by her orthopedic surgeon on 5-8-15. She started a sports metrics program 3 days a week to begin working on speed strength and agility and week 2 she already has swelling again. She is not taking any NSAIDs. She had a MRI month 7 because of the swelling and graft was fine. Is it normal to have swelling with activity this far after surgery? She played basketball, softball, and volleyball and wants to return to sports after sitting out her freshman year but I don’t with the swelling if that will be possible. Of course basketball is her favorite sport.

    • HI William … Swelling this far out from surgery is not normal. Activity related swelling is telling you that the knee isn’t happy. The question is why? The graft might look fine on an MRI, but that isn’t as important as what it feels like on exam. In addition, other issues could be bothering the knee. Losing any meniscus at this age can be an issue too. I would consider another opinion to put a second set of well trained eyes and hands on your child’s persistent knee issue. That might be able to tell you why the swelling keeps occurring and what you can do or should do to prevent it.

  • Hello. This is my second ACL surgery on the same knee within 3 years. However I’ve been relying on my “good leg” for about 4 years now. 2 weeks ago I had my second ACL surgery but now my good knee is swelling and cracking and feeling sore. Any ideas why it would be “cracking”?

  • Hi doctor, I am 26 years old. I had a complete ACL tear along with grade-1 injury to MCL and PCL two and half years back. I tried physiotherapy and gained full range of motion and stability within an year following the incident. After that I used to do mild sports such as badminton and cricket. Recently I fell down again and feeling difficult to walk . I am able to bend the knee around 90 degrees only. I had an MRI and consulted the doctor who said that in addition to ACL tear, small oblique tear in the posterior of medial meniscus is also observed. He is suggesting for a surgery to have ACL reconstruction and meniscus repair.
    Is it advisable to go for surgery or can I manage with PT as did earlier? Is there any problem if I delay it for 1 or two years?

  • Hi, Doctor! I have a friend who has an ACL. I don’t know all the details. But he is saying that once you have an ACL, there’s no chance of your knees being cured. Is PT enough to cure ACL? Thanks!

    • Some patients may do very well without ACL surgery. But many more will have instability and they will continue to hurt the knee more. Surgery, if performed correctly can be successful and there is an 80% chance of returning to sports.

  • Hi, My name is Chazz and I tore my ACL bench pressing decline by arching my back to much. I was doing a lot of weight and I just felt a pop. No pain or anything I thought I just crack my knee. I ignored it for a wile. I no now that I tore my ACL then. About 2 weeks later I was playing rugby and I tore my mcl. I no I tore both of them because I went to my docter who performed surgery for both ligaments. I went to rehab for about 2 months with a very good physical therapist and then quit because my insurance was up. I did no ice as much as a should have and smoke cigarets wich im sure affected the healing process. I was still trying to do rehab on my own. Not knowing exactly how I should have performed the rehab exactly. I am back to icing my knee regularly and stopped smoking. I tend to push my body to hard however and do not think it healed right. I have got my knee back to were I can perform very athletic moves. However the very high impact moves still agitate the front of my knee and also when I work out quads such as squats. To be specific only in the front of the knee were they took part of my meniscus to repair my acl hurts.. I defiantly plan on going to see a docter to get another MRI done and surgery if needed. My main question is do u think I have done cartilage damage or permanent damage. I understand u would most likely need to see a MRI to fully know but until I save enough money to get another MRI I would just want to no the opinion of a professional through what I wrote. I had the surgery on august 7th almost 2 years ago so almost 1 year and 10 months ago.

    • Hi Chaz … A cartilage injury could be one reason the knee still hurts, it could also be the meniscus, or perhaps something we call a cyclops lesion… a ball of scar tissue in the front of the knee.

  • Hi Dr,

    I went through a successful ACL reconstruction surgery 2 years ago. Excuses aside, I have done next to NO physio at all ever since. My quads and hamstring are significantly smaller than those in my unoperated leg. No pain is felt unless I really stress my leg, and when I jog and work out all seems to be fine. Now for my outrageous question; can I gradually get back to soccer as I BEGIN my physio?

    • You can .. but you need to commit to months of strengthening and conditioning as well as agility work. Otherwise you WILL re-tear your new ACL.

      • Thank you for your response, Doctor. Should I understand from your answer that I can get back to sports simultaneously as I begin the period of strengthening? Or must I compmetely stay away from sports until I go through proper physio?

      • I would strongly suggest that you go through the physio first. IT’s better then having another ACL surgery :-(

  • Thank you for your response, Doctor. Should I understand from your answer that I can get back to sports simultaneously as I begin the period of strengthening? Or must I compmetely stay away from sports until I go through proper physio?

  • Hi there…I had an acl hamstring reconstruction that went very well 2 years ago and worked really hard to re build all the muscles. Now thought sometimes when I twist just slightly it’s feels like my knee dislocates/pops out and it’s acute pain then I have to push my knee back and it pops back in so I can walk again. What could cause this please? It seems to be happening more frequently and I am scared it’s going to get more damaged and effect the sports I do.

  • Hello doctor,

    I got my ACL reconstruction done and with partial mensicectomy. Its 12 months post OP now..

    all was well till last week when i felt confident enough to get back to my fav sport, basketball..

    2 games later i suddenly feel my knee is unsually loose and slight pain running all the way from knee towards the ankle.

    I went back home and iced the knee in hope to feel better next morning.

    shocked to find knee still feels loose next morning and unusual muscle spams across the knee while i walk…

    What could be the possiblilties in this?…

    do i have to run back to my surgeon??.. very disappointed after waiting a long time..

    • Sorry Siby … I would see your surgeon or perhaps a second opinion too.

  • I already have…the re constructive surgery is all ok and nothing else shows on an MRI. Do you have any thoughts on what it might be please

  • Hi Dr. Luks,

    I tore my ACL and sprained my MCL a month ago playing soccer. I am 23 and am in veterinary school so soccer was just for fun and I do not have to return to the sport. That being said I am a very active person that lifts weights, runs, bikes, hikes, surfs, and the veterinary field requires a lot of kneeling. I fortunately did not damage any cartilage and my orthopedic surgeon was not very helpful in advising whether or not I should have a reconstruction done. I want to be able to be active without worrying about my knee giving out and decrease my chances of damaging the cartilage. I know it’s difficult to say without seeing me but would you recommend I get a reconstruction? Thank you!

    • You are right Breanna … I can’t tell you. It depends on whether or not your knee feels unstable after your rehab is completed.

  • Hi Doc,

    I had ACL reconstruction for my right leg 3.5 months back. I had 10 days of PT. I can fully bend my knees. I can fully extend as well but when i walk , my right leg bends and i feel pain in lower part of my knee. I work a desk job. So i have to be sitted for most of my time but when i get up and walk, i feel some discomfort and can see there is slight bend. because of which i limp as well. And same i feel when i get from bed in the morning. I still not able to Jog or run. Is this normal?

      • thanks doctor for quick response. One more question. there is pain when i try sit on the floor(squat) and while wlking on the stair..

  • I am 4 weeks out from a full thickness ACL tear, partial tear of the MCL, superior and posterior fibbers of the medial patellofemoral ligament and retinaculum. I also have a sprain of the popliteus tendon, and sprain involving the fibular attachment of the biceps femurs and fibular collateral ligaments. There is also a depressed fracture involving the posterior aspect of the lateral tibial plateau. Lastly I have a flap tear involving the medial aspect of the posterior horn of the lateral meniscus.

    I am in a DonJoy brace, and doing physio. With the brace on my knee collapses inward and gives out with a sharp pain posterior and lateral. When I am on my feet for any length of time the outer part of my foot and small toe go numb.

    I’m a 48 yr old fit female and have been told I that due to my age surgery would not help. FYI I live in Canada.

    What do you think?

    • It sounds like you have a multi-ligament injury. They usually do not well without surgical intervention. 48 is not old.. especially if there is no evidence of arthritis in your knee. You need a good hands on exam to document exactly what it torn or stretched. Posterolateral corner injuries typically need to be addressed early on for th most favorable results.

  • I have recently had a patela tendon graft to my right knee. I had a tear in my ACL leaving me with about 60% strength my surgeon told me. This injury was from 10years and I was only properly diagnosed 4 years ago. Know affording the time off from work I underwent surgery. With my old ACL I was able to deadlift 215kg and squat 160kg weighing 85kg bodyweight but always had the worry of the knee giving out and always over compensated with the other leg. Was I right to choose surgery? I’m worried I won’t come back even stronger? Will my patela graft last me a lifetime? I’m not planning on playing high demand sports but to aim higher on the weights for powerlifting. I’ve missed and forgotten what it is like not having to worry about unstability in the knee. Will the dreaded mental scars go with confidence?

    • Ahhh! As many of my posts mention, the psychological recovery from an ACL recon is just as significant as the physical component. Give it time… Keep working on your strength and your agility and core…. your confidence will come with time. That might be 1-2 years for some people.

  • Hey Dr. Luke, I am 7 months post opp for acl and all reconstruction due to dirtbiking accident. I am back to work full time with a heavy load. I’m constantly bending, twisting, crouching, kneeling while lifting. Everything has been fine. Done alot of physio pre and post opp. The other day I kinda stumbled and when I caught myself I felt a pinch in my knee. Kinda down under the knee cap. Since then every random amount of steps it pinches or pins and needles, the it goes away for it bit. It only been a few days but I do seem like it’s getting better. I’m thinking it’s over worked after tweaking it a bit when I stumbled. I do average 20000 steps a day just at work, with picking up cases of pop and two wheeling it into stores. Any advice or help would be much appreciated. Thanks again

    • sounds like everything will be fine… i would wait this out and check in with your doc in a month or so if your symptoms persist

  • Hi Doc

    Very informative article, I am in my 5th week of post ACL surgery. My knee is still swollen and stiff. On the CPM machine i can bend to 86 degrees but physically about 35 degrees. I feel like something clings onto my bones and is stopping me from bending as I reach beyond a certain point. Also I feel like something is limiting me from the medial side. I am still walking on 1 crutch. Is it normal to experience that.
    Please advise.
    Thank you.

  • Hi Doctor,
    I a going in for surgery in 5 days for an ACL reconstruction and a meniscus tear which shifted to the wrong position, something about a bucket handle where the meniscus tears and moves after the injury. All this while playing soccer.

    I am an 22 year old Engineering student and finals and projects are coming up, will I be able to work through the pain and keep my late night studies going?

    Is physical therapy that necessary? Two weeks after the injury, the swelling went down and I was able to walk around with a slight limp. Maybe I am acting too tough and stubborn and not taking this seriously.

    Please advise.

    • You need to be able to take your knee issue very seriously. You will not be able to study for a minimum of a week to 10 days because of pain and the pain medicine. More important you will need to commit to the rehab otherwise it’s not worth having the surgery. THis should be considered a big deal.
      Good Luck

  • I’m 17 year old girls and I tore my acl in November and had surgery in January, it’s been 7 months and my knee still hurts all the time, is that normal? I am also not able to bend it 100% of the way yet. and in the past few days I have had very bad pain whenever I walk on it, I feel like it could be because I have been using it a lot more but I’m unsure and wanted your opinion

    • HI Zenya .. While some people might have long standing pain .. It’s not normal … perhaps a second opinion might help you.

  • Hi Dr. Luks,

    I had ACL surgery (a patellar tendon graft) on April 29th of this year, and surgery went well. I am now 10 1/2 weeks into recovery. Unfortunately, after the first week, when I was under doctor-ordered bed rest (and on a continual-flexion machine), I have been very sporadic about doing my rehab exercises, and I noticed about a month ago that my knee had gotten tight and stiff. My question is, could this be from arthrofibrosis, including the shrinkage and tightening of the knee’s joint capsule? I’m back to doing the exercises, and I have not lost much range of motion (maybe a degree on extension), but I can’t shake the tightness. What do you think, doc? If there is arthrofibrosis, can it be reversed?

  • Hey Dr.Luks,
    I had my ACL reconstruction surgery back in December and it’s been around 8 months into my recovery. I still have some pain when I’m trying to do plyometrics and it really limits me, I wanted to know if this is normal. I’m also 18 years old and I had an allograft I’m trying to return to basketball but I’m having a tough time trying to get back into it any info will help me out thank you very much

    • Sorry Jason …
      Have you seen another orthopedist for a second opinion? It might be worthwhile.

  • I had acl surgery 5 weeks ago and I still can’t fully extend my leg by myself. If I’m pushed to do so I can but not on my own.

    I can’t walk yet either. Is this normal? I suppose I should have strengthen more my quad before the surgery.

    • Some people progress slower than others. Working on full extension is very important. Sometimes a “static extension’ brace helps.

  • Hi Dr. Luks,

    I am currently in my early 4th week since twisted my knee. Doing a MRI next two weeks. Dr told me it could be ACL injury. just a while ago, i accidentally took a heavy step on my injured knee and i felt a tweet on the same spot. What is the potential effect of that tweet and what can i do at the moment to prevent it from happening again?

    • usually we tell people to avoid squatting, turning and twisting, running and pivoting until we know what’s going on.

  • okay so my friend had surgery for well over a year now but her parents, her, and i think that the surgeon messed up cause her knee has been loose and is increasingly in pain. she says she thinks something has retorn even though she rested for about 9-10 months and was in therapy at the time. she then went to play soccer but only did some simple passing and jogging she told me it hurt at the time and even when she walks or even when she is laying down. is it possible that something has retorn in her knee and the surgeon did not do a good job and messed up somehow.

    • Unless I can see him/her and examine them and look at recent X-rays or perhaps a repeat MRI I can not comment further.
      We would be more than happy to see them as a second opinion….
      contact [email protected] for further details

  • Hi Doc,

    I am 34 year old and I have almost 12 year old ACL injury in right knee.. Now recently i have started feeling light pain and locking in my knee. Recent MRI and Xray is showing some sign of meniscus damage and post trauma arthritis. One doctor suggest to go for complete reconstruction of ACL and another doc suggest to do Can you please advise what should i do in this case. My concern is it fine to go for ACL reconstruction after 10-12 yrs? and will surgery really helpful?


    • If you do not have complaints of instability then a reconstruction isn’t always advised. A reconstruction will not stop osteoarthritis from occurring. That will happen because of your meniscus tears.

  • Hello dr.,
    I had an acl surgery 4 months ago, and have undergone usual pt and regular exercises( did not start running stage though), it happens sometimes i feel a slight slip or buckle of my knee only in the forward direction while walking so it bends and then i regain control ( once or twice a week) …
    Is it normal at this stage ??can it be just from weakness of muscles or shld i be worried ??

    • Hard to say … it could be due to weakness, or a loose graft. Best to talk with your doc or a second opinion for a fresh set of eyes.

  • Hello Doctor,
    It’s been 3 months since my ACL reconstruction surgery. The first 2 months went pretty good, with the physiotherapy advised by the doctor. And the the last month I got busy with my college, couldn’t do my exercises regularly. Lately, when I walk too much, I feel that my knee is heavy. Is it a bad sign? Also now, should I continue with the physiotherapy or go to a gym instead? And when can I return to my sport?
    Thank you sir.

  • Hi Doctor,
    I tore my acl along with tears in both my medial and lateral meniscus, and damaged my articular cartilage. I have been online constantly to try and find any helpful information I can. I actually have my surgery tomorrow, but I am worried that my physical therapist is being a little lax in his plans for me after surgery. I feel like he does not take specific interest in his patients and that I am just another patient with a check. So I was wondering if you could send me a link to some sites that have some workouts and things i could do to speed up or help with my recovery, or if there’s any other information you think I should know.

    • It depends on what your doc requests. Most of us use the MOON protocol… but each physician and each case is a bit different, so check with your surgeon.

  • Hi Doctor!
    I partially tore my ACL in my right knee about 7 years ago while playing socer. I got a custom made brace and played volleyball for a little while after that before hurting myself again. After that, I started hurting my knee while a regular walk so I fiiinally had surgery. I’ve had a brace in case I wanted to play sports after my recovery but decided to stop sports for a while because I didn’t felt ready and we didn’t have the physiotherapist for that where I lived. I now have acces to all of the professionnals I need (University), so I started playing for the Province Handball team and tear my meniscus while jogging (training) for my sport. So I had surgery to fix that 2 summer’s ago. Now I’m having sports class (handball and soccer) and stretch as much as I can before I start playing but today I did a regurlar movement and I guess I twisted my knee and I felt my ACL in my knee scratching another structure. I stopped instantly because I was scared I tore it again. Today, after class I went to get my new brace and insoles so I guess It’s gonna help a lot.

    After all I’ve been trough I’m trying my best to do everything that I can to reduce the risk of injuring my knee again or the other one.
    My question is.. right now, it’s been about 6 hours since I “twisted” it and it is still very sensible and hurt a bit when I normally walk, how can I know if it’s just a little thing or if I tore it again or tore anything else in my knee?
    Thanks a lot in advance for your answer!


  • Hi doc, back in 2011 I had my acl replaced. I did the physio and started playing football a year later. After a few months my knee locked twice while playing football and twice on nights out. I haven’t played since. I had some scans and they showed a number of small tears. Today I had keyhole surgery to repair the tears and remove some damaged cartalidge. He told me after the op I need to give up football because although he repaired the tears he said my acl was slightly vertical instead of horizontal which meant it was only at 60% and could damage my knee. I’m only 25 and only train at football 1 hour a week and play every Saturday would I need to give up?

    Also is my acl vertical because the previous surgery was done wrong or could it naturally happen?

    Thank you for your time.

    • vertical placement is a technical issue … surgically induced. But there are varying degrees of verticality. Also.. I can’t say whether or not you can play. If you have instability of the knee then it is not a good idea.

  • Thank you I will do my exercises and see how stable it is. I have been doing loads or running recently before the key hole and can max out the leg machines. The knee hasn’t locked since march. I know it’s hard for you to say without seeing but does it sound severe?

  • Hi,
    I tore my ACL when I was 18, had a reconstruction and it worked well,
    I went to play soccer again at age 21 and had a tear in my meniscus,
    Upon having a debridement, they discovered a 1mm x 1mm piece of metal in my knee,
    and I have grade 2 damage to the cartilage.
    During the same surgery my ACL had fully healed from reconstruction.
    I am now 23, and having had the debridement, my knee is no better or stable.
    I would like to play soccer again, but have been advised it is not possible?
    Are there any treatments which could sort my problems?

    Kind Regards

  • Hi dr Luks
    It’s Teresa Kasman . I think I would like to try alternative options for my rotator cuff injury. I’m thinking PT, NSAIDS, steroid injections, before surgery . The steroid injection the other day worked amazingly . Therefore it gave me hope on avoiding surgery. What is your opinion?

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