What Not to Do After ACL Surgery: Avoid These Mistakes

Your ACL recovery is vital for long-term knee health. Many people face ACL injuries; for instance, the annual incidence of ACL tears is about 68.6 per 100,000 people. A successful recovery depends on what you do and, more importantly, what you avoid.

This guide focuses on what not to do after ACL surgery. We will help you navigate common mistakes that can jeopardize your healing. You must adhere to medical advice to prevent re-injury and ensure a full return to activity. Avoiding these mistakes is crucial for your successful recovery.

Key Takeaways

• Listen to your body and medical team. Do not ignore pain or skip physical therapy sessions. This helps prevent serious problems.

• Avoid certain movements. Do not put weight on your leg too soon. Do not twist or hyperextend your knee. This protects your new ACL graft.

• Be patient with your recovery. Do not rush back to sports or heavy activities. Your knee needs time to heal fully.

• Take care of your overall health. Eat well, sleep enough, and manage stress. These things help your body heal faster.

Immediate Post-Op Pitfalls

The first few days after ACL surgery are crucial. You must avoid certain actions to ensure proper healing. Many common mistakes can set back your recovery. This includes neglecting the proper use of crutches.

Ignoring Pain Signals

You might feel pain after surgery. Your body uses pain to tell you something is wrong. Do not ignore severe pain. If your pain worsens or does not get better with medicine, contact your doctor. This could mean an infection or other healing problems. Uncontrolled pain and swelling can also signal internal bleeding. Ignoring these signs can lead to serious issues like graft failure.

Neglecting RICE Protocol

RICE stands for Rest, Ice, Compression, and Elevation. This protocol is vital for reducing swelling and pain. You must follow it carefully. Neglecting any part of RICE can slow your recovery.

Over-Icing the Knee

Icing helps reduce swelling. However, too much icing can harm your skin and nerves. Apply cold therapy for 15-20 minutes per session. Allow a break of at least 30-60 minutes between sessions. You can use an ice machine 5-6 times daily for 20-30 minute sessions. Continue this for 2-6 weeks. Always ensure breaks between icing.

Improper Sleeping Positions

How you sleep matters. Avoid sleeping on your stomach. Do not sleep on the same side as your operated knee. The best position is on your back. Elevate your operated leg slightly above your heart. Place a soft pillow under your calf, not directly under your knee. If you sleep on your side, use a pillow between your legs. This keeps your knee stable. Wearing a knee brace at night can also protect your knee.

Neglecting Knee Care

Your surgical incision needs careful attention. Keep it clean and dry. Follow all instructions for dressing changes. Do not let water get on the incision until your doctor says it is safe. Neglecting this care can lead to infection.

Movement & Activity Missteps

Your recovery journey involves careful movement. You must understand which physical actions and movements to strictly avoid. These are essential activities to steer clear of to protect your healing knee.

Putting Weight Too Soon

You might feel tempted to put weight on your operated leg. Do not do this unless your surgeon or physical therapist tells you it is safe. Your new ACL graft needs time to heal and integrate. Putting weight on it too early can stress the graft. This can lead to re-injury or slow your recovery. Always use crutches or other assistive devices as instructed.

Twisting or Pivoting

Twisting or pivoting movements put immense stress on your ACL. You must avoid these motions completely. Your knee is still very vulnerable. The healing process continues, and your knee strengthens over time. However, movements that twist your knee can compromise this recovery. You should avoid twisting or pivoting motions for at least 6 weeks to 3 months after surgery. This gives your graft crucial time to mature.

Hyperextending the Knee

Hyperextending your knee means straightening it beyond its normal range. This can be very dangerous after ACL surgery. Knee hyperextension greater than 5 degrees significantly increases the risk of graft failure. Patients with this degree of hyperextension have a five times higher failure rate. This is especially true for those with hamstring grafts. If you have ligamentous hyperlaxity or knee hyperextension, you face a higher risk of failure. Many experts believe patients with knee hyperextension have higher rates of reconstruction failure. While some hyperextension can improve function, it also increases the risk of graft rupture and instability.

Squatting Too Deeply

Squatting is a common exercise, but you must control its depth. In the early postoperative period, partial squats can put your ACL graft at risk. This risk depends on your weight and other knee factors. The choice of exercises and their timing is complex. It depends on your specific situation.

Here is a general guide for squatting progression:

• Weeks 0-2 (First Stage): You can perform double-leg quarter squats.

• Weeks 3-6 (Second Phase): You can progress to mini-squats and wall squats.

• Weeks 7-12 (Third Phase): You can continue with wall squats and lunges.

Your physical therapist will guide you on safe squatting depths. They will also tell you when to increase the intensity.

Lifting Heavy Objects

Lifting heavy objects puts strain on your entire body, including your knee. This can compromise your healing ACL. You should avoid lifting anything heavy until your doctor or physical therapist clears you. This prevents unnecessary stress on your graft and surrounding muscles.

Driving Too Early

Driving requires quick reflexes and the ability to use your pedals. You must not drive too early after surgery. The timeline for safe driving varies. It depends on which leg had surgery and the type of graft.

Most patients can resume driving within 1 to 3 weeks after arthroscopic knee surgery. This timeframe depends on your individual recovery and comfort. Clinical tests, like the stepping test, can help determine when you are ready.

Walking Too Much

You might feel good enough to walk more than advised. However, walking too much too soon can be detrimental.

Your ACL graft is particularly vulnerable during these first few months of rehabilitation. The graft focuses on cellular growth to adapt to the bone and tendon.

Rest is a critical part of your recovery.

After you tear your ACL, stay off of your leg, and ice your knee. Also, elevate the injury and wrap your knee (compress it with a bandage). Doctors call this RICE – rest, ice, compression and elevation. If you begin RICE therapy early, you may minimize the swelling.

Even if you can walk with a torn ACL, seeking treatment and resting your knee is best.

If you have surgery, doctors will use a tendon to reconstruct your torn ACL. You’ll need to use crutches at first, limiting your weight-bearing and walking.

Avoid excessive walking to prevent further injury.

Pushing Through Pain

Pain is your body’s warning system. You must listen to it. Pushing through pain can indicate you are doing too much. It can also mean you are performing an activity incorrectly. Do not ignore persistent or increasing pain. This is a crucial part of what not to do after ACL surgery. You should avoid bending your knee beyond comfortable limits if it causes sharp pain. Always communicate any pain to your physical therapist or surgeon.

Rehab Roadblocks & Common Mistakes

Your journey through ACL recovery involves more than just physical movements. It also includes how you approach your physical therapy. Many common mistakes can hinder your progress. You must understand these pitfalls to ensure a successful outcome.

Skipping PT Sessions

Physical therapy sessions are the cornerstone of your ACL recovery. You might feel tempted to skip a session if you feel good or busy. However, skipping physical therapy sessions can hinder your progress. It can lead to complications or a prolonged recovery period. Consistency in rehabilitation is crucial for a successful outcome.

Without proper stretching and movement, scar tissue can form. This stiffens your joints and prevents a full range of motion. Even short periods of rest lead to significant muscle loss. This reduces joint support and increases stress on your healing ligaments and tendons. Incomplete recovery means your body has not relearned proper movement patterns. This makes re-injury much more likely.

Skipping sessions also carries long-term risks. Subtle changes in knee movement can lead to uneven weight distribution. This accelerates cartilage wear and increases your risk of osteoarthritis over time. Your knee may feel wobbly or less secure, especially during dynamic movements. This leads to compensatory movement patterns that further stress the joint. Ongoing pain, stiffness, or instability can reduce your participation in physical activities. This affects your overall fitness and daily life. You may also lose confidence in your knee’s reliability. This leads to fear of re-injury and avoidance of previously enjoyed activities, impacting your emotional well-being.

Doing Too Much Too Soon

You might feel eager to regain your strength and return to activity. However, pushing yourself too hard, too fast, is a common mistake.

“One of the biggest challenges faced by ACL patients is the tendency for their physical therapist to underload them early in the process and then rapidly overload them in the middle- to late-phase,” said Tommy Mandala, physical therapist and founder of All in ACL.

A common sign of doing too much too soon is rapidly progressing to activities like running without prior strength testing. One individual started running on a treadmill at three months post-op without a strength test. This led to feelings of weakness and instability. Graduating from low-level bodyweight movements directly into running on a depleted leg is a significant leap. These ‘huge leaps’ are a primary cause of high re-injury rates in ACL rehabilitation.

“Studies show that successfully passing a series of single-leg hop tests, along with a series of strength tests for your quad and hamstring, all with symmetry of 90% matching the other side, reduces risk of reinjury by 84% when returning to sport,” added Mandala.

Another sign is being cleared for return to sport based solely on a timeline rather than objective physical criteria. One individual was told it was their ‘rehab graduation day’ at four months post-op and sent on their way without any strength testing. This indicates a rushed approach. You must avoid these mistakes.

Not Doing Enough

While doing too much is harmful, doing too little is also a problem. You need to consistently perform your prescribed exercises. Your muscles need regular stimulation to rebuild strength and endurance. If you do not engage in enough activity, your recovery will slow down. Your knee will not gain the necessary stability. A structured rehabilitation plan requires your active participation.

Improper Exercise Form

Correct form is vital for every exercise. Improper exercise form can put undue stress on your healing knee. It can also lead to other injuries. A common example of improper exercise form during ACL rehabilitation is valgus alignment of the knee. This occurs when your knee drifts inward instead of tracking out over your toe during movements like single-leg squats. Maintaining proper alignment, where your knee tracks over your toe, is crucial to avoid this improper form. Your physical therapist will guide you on correct technique. Listen carefully and ask questions if you are unsure.

Comparing Progress

Every person’s recovery journey is unique. You might see others progressing faster or slower than you. Do not compare your progress to theirs. Your body heals at its own pace. Factors like age, graft type, and overall health influence recovery speed. Focus on your own milestones and celebrate your personal achievements.

Ignoring PT Instructions

Your physical therapist is an expert in ACL rehabilitation. They design your program specifically for your needs. Ignoring their instructions can have serious consequences.

• Pain: Untreated injuries can worsen. Small tears can become larger ones. This leads to increased pain and extended recovery.

• Arthritis: Altered joint mechanics due to untreated ligament injuries can cause other bones and tissues to overcompensate. This leads to cartilage wear and eventually osteoarthritis.

• Instability: Your knee may become unstable. This leads to catching, clicking, or repeated buckling during certain actions.

• Disability: Partial ACL tears can progress to complete ruptures. This severely impairs your ability to bend or straighten your knee, bear weight, or walk normally.

Ignoring instructions can also lead to improper healing of your injury. You may experience long-term discomfort or chronic pain. Stiffness and reduced range of movement are also possible. You face an increased risk of re-injury and further damage. This can cause delayed recovery and potential for additional complications.

Avoiding Non-Rehab Activities

Your recovery is not just about exercises. It also involves your overall well-being. Do not avoid all non-rehab activities. Gentle walks, social interactions, and hobbies that do not stress your knee are important. These activities help maintain your mental health and prevent feelings of isolation. They also contribute to a balanced recovery.

Impatience & Over-Pressuring

ACL recovery is a marathon, not a sprint. You must cultivate patience. Feeling impatient or trying to rush the process can lead to significant setbacks. You might push yourself too hard, ignoring pain signals, or skipping necessary rest. This increases your risk of re-injury. Trust the process and your medical team. Give your body the time it needs to heal properly. This is a critical part of what not to do after acl surgery.

Lifestyle & Mental Health Blunders

Your recovery from ACL surgery extends beyond physical therapy. Your daily habits and emotional well-being play a huge role. Do not make these common lifestyle and mental health mistakes.

Neglecting Nutrition & Hydration

Do not overlook your diet. Proper nutrition fuels your body’s healing process. You need increased caloric intake beyond your Resting Metabolic Rate (RMR). This supports recovery and rebuilds soft tissue. Focus on quality foods. These include protein, carbohydrates, fruits, vegetables, and omega-3 fats. Aim for around 3 grams of protein per kilogram of body weight. Distribute this protein throughout your day. Eat 20-30 grams every 2-3 hours. Consider sources like eggs, chicken, soy, and fish. You also need Vitamin D3, especially in winter. Do not forget to stay hydrated. Water is crucial for your body. Drink half your body weight in ounces of water daily.

Returning to Work Prematurely

You might feel pressure to return to work quickly. Do not go back too soon. Your body needs time to heal. Returning prematurely can put stress on your knee. This can slow your recovery. Discuss your return-to-work timeline with your doctor. Ensure you have their clearance.

Ignoring Mental Health

Do not ignore your mental well-being. ACL recovery can be tough. Many athletes experience fear, isolation, and anxiety. Some face depression. The incidence of depression and anxiety is 2.9 times higher for athletes with musculoskeletal injuries. You might feel a loss of identity or purpose. Fear of re-injury is common. It can stop you from returning to your sport. Higher fear levels at 6 months and 1 year post-surgery link to a lower chance of returning to sport. Seek support if you feel these emotions. Talk to your doctor or a mental health professional.

Not Getting Enough Sleep

Sleep is vital for recovery. Your body repairs itself during sleep. Do not skimp on rest. Aim for 7-9 hours of quality sleep each night. Poor sleep can hinder healing. It can also affect your mood and energy levels. Prioritize your sleep for a stronger recovery.

Long-Term Re-Injury Risks

You have worked hard on your recovery. Now, you must protect your knee long-term. Avoiding certain mistakes is key to preventing another injury. This section focuses on what not to do after acl surgery to keep your knee healthy.

High-Impact Sports Too Soon

Returning to sports too early is a major risk. Historically, doctors suggested returning to sport after 5 to 6 months. However, this timeline is often too soon. Your knee ligament needs more time to heal completely. Research shows athletes who returned to knee-strenuous sports at 9 months or later had fewer new ACL injuries. Those who returned earlier than 9 months faced about 7 times higher risk of re-injury. Full recovery often takes 6 to 12 months. For young athletes, waiting at least 9 months is best. High-impact sports include soccer, basketball, football, and skiing. Do not return to these activities until your doctor clears you. Patience protects your long-term health.

Discontinuing Rehab Exercises

Your ACL rehabilitation does not end when you feel better. Stopping your prescribed exercises too soon weakens your knee. You need to maintain muscle strength and joint stability. Continue your exercises as your physical therapist advises. This ongoing effort prevents future problems.

Ignoring Persistent Symptoms

Your body gives you signals. Do not ignore pain, swelling, or instability in your knee. These symptoms can mean something is wrong. Report any persistent issues to your doctor or physical therapist. Early attention can prevent bigger problems.

Neglecting Warm-Ups

Always warm up before any physical activity. A proper warm-up prepares your muscles and joints. It increases blood flow and flexibility. Skipping warm-ups makes your knee more vulnerable to injury. Make this a regular habit.

Skipping Strength Training

Strength training is vital for long-term knee health. Strong muscles support your knee joint. They reduce stress on your ACL graft. Continue a regular strength training program. Focus on your quadriceps, hamstrings, and glutes. This ongoing effort is a crucial part of your acl rehabilitation.

Recognizing Red Flags

After ACL surgery, you must pay close attention to your body. Certain signs can indicate serious problems. Do not ignore these red flags. Report them to your medical team right away.

Dismissing Infection Signs

An infection can severely complicate your recovery. You must recognize the signs. Do not dismiss them.

• You might feel increased or persistent pain. Medication may not help.

• Your swelling could increase or worsen.

• You may see redness or heat in the surgical area. This might worsen or have discharge.

• Intense redness could spread to nearby areas. It might come with more pain.

• Your surgical region might feel warm. Compare it to the skin nearby.

• Any discharge from the incision site is a concern. This is especially true if it is yellow or green.

• You might have a fever above 101°F (38.3°C). This fever could last several days. It is worse with increased pain, swelling, heat, or drainage.

• You could experience a sudden decrease in your range of motion. This is especially true with other infection symptoms.

• Yellowish drainage from the incision area is a bad sign. It might be bulky or pus-filled. It could also have a foul smell.

Ignoring Blood Clot Symptoms

Blood clots are a serious risk after surgery. You must know the symptoms.

• You might notice swelling in one leg. It could be a lump. This can make walking hard. Swelling in both legs is rare.

• You may feel persistent discomfort. This could be a cramp or soreness in your calf.

• Your affected leg might look red or feel warm.

• Veins in your leg could appear larger or bulge.

• You might feel a throbbing pain in your leg. This is especially true when you walk.

A blood clot can also travel to your lungs. This is a pulmonary embolism. Seek immediate help if you experience:

• Sudden chest pain. It might worsen with deep breathing.

• Shortness of breath or rapid breathing.

• Coughing up blood.

• Dizziness or light-headedness.

Not Reporting Instability

Your knee should feel stable after surgery. Do not ignore feelings of instability. If you do not report it, you face higher risks.

• You could have a 13-fold higher chance of meniscal tears.

• You face a higher risk of recurrent instability. Failure rates can reach 88% after three years without surgery.

• Your instability could get worse over time.

Reporting instability helps your doctor assess your knee. They can check for residual laxity. This helps ensure your knee heals correctly.

Delaying Follow-Ups

Your follow-up appointments are crucial. Do not delay them. These visits allow your surgeon to check your progress. They can spot potential problems early. Delaying follow-ups can mean missing critical issues. This could lead to worse outcomes. Always attend your scheduled appointments.

ACL recovery is a marathon, not a sprint. It demands your patience and discipline. Avoiding common mistakes is paramount for a successful recovery. You must strictly adhere to your surgeon’s and physical therapist’s guidelines. Prioritize your healing. Listen to your body. Remember what not to do after ACL surgery ensures you return to full activity safely and effectively.