ACL Reconstruction:
The First Week

ACL Reconstruction

The first week after an ACL reconstruction is usually the worst. Not only did you just have surgery, but you have lots of questions and worries. Your knee is painful, swollen, bruised, and unresponsive.

Your body feels miserable from the anesthesia, and you can't sleep at night. It hurts to move, and those exercises are really a pain.

It sounds awful, but there are a few things you can do in the first week, or the first few days before you start rehab that can greatly increase the speed of your recovery, and reduce your pain and swelling.

Extension is the Key

I see all of my ACL reconstruction patients prior to their surgery. We have a pre-operative visit in which I instruct them in their exercises for home, fit them with crutches, provide an ice compression wrap, and answer any questions they have about the surgery, rehab, and recovery.

I tell all of my patients that the single most important thing after surgery is to maintain their knee extension.

Why do I tell them this?

Full knee extension is the key to many facets of ACL rehabilitation. Your quadricep muscles cannot fully contract if you cannot extend your knee. You cannot walk normally if you cannot extend your knee. Your muscles cannot relax and recover if you cannot extend your knee.

The problem is that laying with your knee extended and propped up on a pillow at the ankle is not comfortable. It hurts.

I can always tell which ACL recconstruction patients kept their knees extended when they were elevating their leg and recovering. I can also tell which patients didn't keep their knees extended in the first week.
Achieving full knee extension is essential in the first week of rehab after ACL reconstruction. It sets the foundation for all that is to come. You can get a jump start on this by keeping your leg elevated when you are sitting around at home, putting a pillow under your low leg and heel and letting your knee straighten out. It isn't the most comfortable position, but it is the most helpful.

Motion is Good

Range of motion is slow to return after ACL reconstruction. And the first time you try to bend your knee, it will feel like it is going to explode.

I promise, it won't.

You have to keep bending it, despite the discomfort.

Is It Safe?

Patients always ask "Will it hurt the new ACL if I bend it too mcuh?" The answer is no. You cannot cause damage to your new ACL by bending your knee.

First of all, after your ACL reconstruction surgery, before you woke up, your physician moved your knee through a full range of motion. They bent it all the way, and straightened it out all the way. They wouldn't do this if it could cause a problem.Once you wake up from surgery, however, you are swollen and painful, and the muscles are spasming. This prevents you from being able to bend it.

The more you move your knee, the better it will start to feel.

Imagine sitting in the same position for several hours, without being able to re-adjust at all. You would get very uncomfortable. You knee is the same way. It isn't able to "re-adjust" and so it becomes uncomfortable.

You should try to bend your knee repeatedly, several times a day. The more you can move it, and allow it to re-adjust, the better it will feel.

Ice and Compression

The use of ice and compression is essential to improving your recovery time in the frst week after an ACL reconstruction. The more you can ice your knee, the lower your pain levels, and the less swelling. After the first couple of days, you will actually enjoy icing. It will feel so good.

Swelling is the enemy during acl reconstruction rehab. It slows everything down, and causes much of the pain associated with this surgery. So everythng you can do to reduce it is going to get you better faster.

Compression is also important, especially to keep the swelling from moving into your lower leg and ankle. Use an ace wrap or compression sock to keep your low leg from getting swollen. It will keep your pain down, and also improve your recovery time.

ACL Surgery Stories
If you have had an ACL reconstruction, or are getting ready for this surgery, I want to hear your story. Whether you have questions you want answered, or just want to share your experience, this is the place for you.


The first week after an ACL reconstruction can be frustrating or it can be a time when you get a head start on your recovery. Formal rehab does not usually start for at least 3-4 days, sometimes a week after surgery. This time is a great chance to start working on your recovery by using the tips above.

Your knee will thank you, your clinician will thank you, and you will feel better faster.

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