ACL Rehab – Knee Pain a Year after ACL Surgery

Those of you who read my last post ACL Repair Recovery – Working through Knee Pain will know that I recently returned to skiing some 9 months after ACL surgery. I was certainly diligent with my ACL rehab but this was aggressive skiing and the outcome was a significant amount of knee pain.

Here’s the major learning from this post – ACL rehab is for life, not just the 6 months after surgery.

Of course I wore my DonJoy Ski Armor ACL brace while skiing which I expected would protect me from the rotational forces that could potentially re-tear my ACL. However, the significant pain left me unsure as to the cause of that knee pain and the potential damage I had caused.
This week I had my appointment with Larry Meyer at Boulder Sports Medical Center. Larry runs the PT department there and was responsible for overseeing my recovery from ACL surgery.

The first shock for me was to see the amount of lateral movement that still existed in my knee joint. Only a qualified Physical Therapist can safely manipulate the joint and explore potential injuries and that means maintaining an active relationship with your PT is an imperative if at all possible.

In my case, seriously limited by my Healthcare plan in the US, I only had PT for 8 weeks or so after ACL surgery (to the end of May 2011) and then diligently followed the MOON guidelines through the summer. I returned to running towards the end of the summer and was in good shape at that point in terms of rebuilding muscle and joint strength.

However, seeing the lateral movement in my knee joint, something had clearly gone wrong over the latter part of 2011 or I had, indeed, injured my knee skiing. The thought of surgery and another 6 months of ACL rehab was extremely worrying so Larry decided to test my ACL strength (or lack of) using a Knee Ligament Arthrometer. Using my good, left, leg as a benchmark, Larry tested my right ACL and the fantastic news was that it was actually stronger than my good ACL!

So, why the knee pain? And here’s the massive learning for me which I don’t understand entirely but which is accurate and factual. ACL rehab is for life, not just for the six months after ACL surgery. Particularly in cases, such as my own, where the other ligaments are damaged during the original injury, the need to constantly work to maintain the muscle and ligament strength around the knee joint is paramount.

And this is something I did little of during the latter part of 2011. My visits to the gym tapered off and I honestly felt that my ACL rehab was complete. In not keeping up the PT I suffered muscle atrophy (wasting) and the LCL and MCL ligaments (running vertically down the side of my knee) had loosened up and consequently lost their strength. Why this didn’t happen to the same degree in the other leg is the part I don’t understand.

Hence, when I returned to skiing, I was doing so on an extremely weak leg and the pounding of skiing, exacerbated by the fixed position of my foot in my ski boot, led to excessive forces on the knee joint that it was unable to cope with. The diagnosis, without the benefit of an MRI, is that I may have damaged the meniscus but that a course of 8 weeks PT (twice a week) should see me regain the strength in and around the knee joint. If I still suffer problems after that then I may need to explore the possibility of having damaged the meniscus.

Whatever the outcome, post-ACL surgery rehab requires continuous PT and, I guess, there is no such thing as having fully recovered. Maintaining an active life style combined with specific knee strengthening exercises is certainly going to be a feature of my life from here on.