An insight into ACL injury and recovery
For some reading this, you have recently injured your ACL (anterior cruciate ligament) and are looking for information about what to expect and how it feels and affirmation that you are not the only person to have this happen to them.
For others, you may find the topic interesting, whether you have experienced the injury yourself already, have a friend or family member dealing with one or are just genuinely interested in the ins and outs of the process.
Parts of this piece may be uncomfortable reading as I want to describe as best I can the feelings, emotions, sounds, sights etc. that I experienced throughout my injury, pre-hab, surgery and rehab.
From injury to surgery number 1
In the last 7 years, I have had three surgeries on my right knee, all relating to an ACL tear.
Now, for those who may have recently been told they have injured their ACL and are looking for more info about what the H-E-double hockey sticks one of those is, I’ll tell ya.
Your ACL is one of the ligaments in your knee which is responsible for maintaining stability of the knee joint. If you were unlucky enough to have done as good a job of messing yours up as I did mine, you won’t be able to put any weight through the injured leg without the joint ‘sliding about’. Very unsettling feeling; makes me shiver, reliving it!
On the inside side of your knee is the MCL (medial collateral ligament). This is one that I damaged in my initial injury, and this is a ligament which is fairly adept at repairing itself given enough time.
The ACL often tends to not be able to repair itself and usually requires surgical interventions to repair and help it do its job properly again.
ACL injuries are most common in sports people; those who play football (soccer), rugby, tennis, badminton, squash…any sport which has the participant stopping and changing direction suddenly.
My injury, both times, came through playing football. I’m based in the UK, so when I say football, I mean football.
At the moment my first ACL injury happened, when I was 22 years old and fresh out of uni, my initial thought was; “I’ve broken my knee”. I thought that because there was a loud ‘POP’ noise that came from my knee, and I immediately (like a lot of pro footballers) went to ground and started screaming and rolling in pain. Except this time, it was genuine. And when I say ‘pain’, it felt like an intense, dull ache all around my knee joint that began throbbing.
I couldn’t put any weight on it without the joint ‘sliding’ and, as it began to swell more and more, the RoM (range of movement) became less and less, very quickly.
Ambulance called, gas & air, trip to A&E and a brand new set of crutches.
After X-rays, MRI scans and a few tests and conversations with nurses and doctors, it was revealed that I had achieved the ‘unhappy triad’, meaning I had partially torn my MCL, significantly torn my ACL and had a ‘bucket handle tear’ of my lateral meniscus (cartilage on the outside side of the knee). The bucket handle tear was very annoying because, ultimately, it meant I was relying on crutches for 5 months because I just couldn’t get the RoM required to walk. The ‘bucket handle’ was stopping my knee from bending fully and from extending anywhere near the normal range for the knee.
Although I could fully weight bear (with the help of a special knee brace), I couldn’t get around without at least one crutch because of the lack of RoM in the knee. This was solved with the first of my 3 surgeries. This one had ghe surgeon trim the ‘bucket handle’ away (they either trim away or stitch it back, depending on severity of the damage) which meant I could regain almost full RoM, which meant I could then focus on seeing how far I could go with half an ACL.
Skip a bit of time to surgery number 2
The slightly shorter version of this story is that I wanted/needed ACL reconstruction surgery if I wanted to return to playing sport again. And at the time, my career aspiration was to join the RAF as a physical training instructor, which meant I needed to be in tip-top shape.
So, off to surgery I went. Anaesthetised, very chatty. Asleep. Wake up groggy but still super chatty. Asleep again. Wake up in my hospital room. Knee heavily bandaged after having a hamstring graft too repair the damage. Next day, I’m home, on crutches again but this time I knew it wouldn’t be five months!
As soon as I woke up the morning after surgery, still in hospital, the physio dropped by and started showing me how to negotiate stairs properly with crutches. Whether you have this training or not, you find your own adaptation of dealing with stairs. As long as you gradually increase the ‘normality’ of stair use as your rehab progresses, you’ll be golden.
And the rehab process began. If you’re not already aware, rehab for an ACL tear is, or should be at least 9 months before you contemplate seriously getting back to sports-like movements. Pros often manage to return sooner but it isn’t without risk of recurring injury. They are still human, like the rest of us!
For me, I wanted to leave it as long as possible before playing football again. So I left it about 2 and a half years! In the meantime, I had become a personal trainer and class instructor, so I was still doing similar movements every week.
I’ve made the rehab process seem like a doddle there. It isn’t. There were times when my mum would have me laying over a chair and she would be leaning on my leg to get it straight. Top tip: if you’re going to try this, dose up on painkillers about 30 mins before!
For me, rehab meant weekly visits to the local hospital for group physical therapy sessions which turned out to be a load of fun because of the people there! A lot of exercises done at home to strengthen and stabilise the knee joint and consciously putting more weight through the injured leg and consciously trying to not walk with a limp. Harder than it sounds!
Back to sport
As I said, at this point, I have moved out of my parents place and am now a class exercise instructor and personal trainer, so I am putting huge emphasis on exercising safely to help others not do what I did and do high intensity sport without being strong enough or practiced enough and get injured because of it.
I ended up playing 5-aside football again about two and a half years after the initial injury, which is a long time. Mainly because I was terrified of re-injury. That first tackle is a heart-in-mouth moment, but you come through it. I played 5-aside for a couple of years and was enjoying playing again, albeit at a very casual level.
Still. The ACL ‘pops’ again, even in a very casual 5-aside game. Everybody heard it this time. Same knee, same ligament. This time around, I knew instantly what had happened. The same feeling of an intense, dull ache around the joint, immediate swelling and no ability to put weight through that leg.
Another trip to A&E, another set of crutches. This time, the crutches were gone before 2 weeks.
I was lucky enough to have excellent health care through my workplace, which I took full advantage of by going private, with a superb surgeon and physio, to boot.
Another surgery beckoned. Another chatty anaesthetic experience. Asleep. Wake up groggy in the recovery room but this time feeling very nauseous and I think I might have tried to hack something up from my empty stomach. Asleep again. Wake up in my hospital room with my very new fiancee (we got engaged the day before because it was the last time I’d be able to get onto one knee for a long time!).
Second ACL reconstruction surgery meant I had the patella graft this time, which is thought to be the stronger fix anyway. Fingers crossed! Let me tell you, though, and coming from someone who has experienced both hamstring and patella grafts…Patella graft may be the stronger fix, but OH MY GIDDY AUNT did it ever hurt?! It was so much more painful, post-op, compared to the hamstring graft. I didn’t even want to attempt the stairs at home for about 5 days! I slept on the sofa, unable to stretch (I love a good stretch), unable to bend the knee (just try not bending your knee for a day. One day, try it.). Every time I wanted to change position or get up, the pain was excruciating. And that was with painkillers!
Now I’m not trying to put you off having the patella graft, if you’re presented with the choice. Believe me when I say, it is worth the hardship to have the stronger graft, or you may well end up going through it all again, like I have!
The second time around, I decided that I would try to document the process as best I knew how, so that people like yourself could gain assurances over your own process. This can be found on my Instagram: josh rutley_healthcoach — you may have to scroll down a bit to find them…It was circa May 2019.
Failing that, I am always happy to discuss your experiences and mine, or for people who have questions about the ACL reconstruction and rehab. I can, at the very least, share my own experience and how I felt during the whole thing. It’s become such a huge part of my life now that I integrate it into what I offer as part of my business; ACL prehab/rehab exercise. See the testimonials on my website: www.joshrutleyhealthcoach.co.uk — Seb made incredible progress with his rehab working with me.
A lot of people’s aim for the end of their ACL reconstruction, is to return to the sport they love. I was the same after my first one, and I achieved it, only for my knee to tell me in no uncertain terms, that it wasn’t happy about that decision. So now, I coach. Before my first ACL injury, I was fresh out of university where I studied Sports Coaching and haven’t put it to proper use since. I coach a local under 7s football team, proving the point that; ‘those can, do. Those who can’t, teach’ (or coach, in my story).
Stepping into a coaching role is fantastic for me. The kids’ enthusiasm and love for sport is infectious. We haven’t won a match yet. But they have enormous fun, kicking a football around with their friends and scoring goals!
I do get very tempted to join in but I think I’ll leave it to them now.
Please, if you want to discuss anything from this piece, feel free to ask me directly or use it as a platform to talk with other people about their experiences.