(Slight Positive Update) 80 -> 120 deg flexion from post op week 4 to week 6

Hi everyone,

I wanted to write about something that I recently went through post ACLR surgery, the mistakes that I made and my experience of trying to improve flexion in a short period of time. I have seen others post about issues with stiffness and flexion as well so hopefully if you are in the same boat, you too can overcome it.

I am 6 weeks post op with patella autograft and meniscus trim. My surgeon is a medical director for a nba team so he has an aggressive protocol but standard for all of his patients. His protocol for flexion is 105 deg week 1, 115 deg week 2/3 and 130 degrees by week 5/6.

I started PT right away after my surgery and was going 2 times a week. I always struggled with flexion since the beginning and barely reached 85 degrees assisted during week 2 and it didn't improve much as I was hard stuck at 92 degrees assisted on week 4. My knee was still really swollen and that didn't help either.

I had my first visit with surgeon 4 weeks post op. Going in to this appointment I thought I was doing alright with recovery, just lagging behind flexion. During our meeting he told me to lie down and bend my knee, that morning I was a little stiff and could only bend to like 80 degrees. He felt my knee and right away his demeanor changed and he chewed my up for not doing enough and to fire my PT because they weren't doing a good job. My surgeon had a saying during my first ever visit that "Surgeon + Patient + PT = Results". Reminded me that 2 of those 3 weren't being met. He told me "I am gonna see you again in 2 weeks and if you don't get to 120 degrees, I am taking you back to the operating room. I gotta scare you a little bit, you have a stiff knee." I was crushed and left that appointment feeling like shit. I was hopeless. But it was a wake up call for me.

I got a new PT for 2 times a week and started going 4 times total. She gave me an amazing plan and told me I need to do knee slides like every hour of the day if I wanted to reach that 120.

This is also where I figured out my first mistake. I wfh so post surgery for the first 4 weeks I was working from sitting on a bed keeping my knees straight all the time. This made my knee very stiff and my patella wasn't mobilized enough. So I started sitting on the chair active bending my knee while working and let gravity do its job.

Secondly, I ditched the brace because that was also making my knee really stiff. Instead I opted to use the crutches for support. Right away I was seeing small improvements from these 2 changes. I wasn't confident weight bearing at 4 weeks so my new physio gave me an exercise plan that included wall sits, and sit to stand from a chair with weight bearing. These exercises made me more confident in the abilities of my knee and my flexion also improved.

Thirdly, I found an awesome blog with 11 steps to improve knee flexion and I did it at least once a day. https://prepperformancecenter.com/11-steps-to-improve-knee-flexion-after-acl-surgery/

Fourth, I bought a used stationary bike and kept doing it for 10-15 mins each day. At first I was on the highest seat level 6. Slowly I started bringing it down.

Within one week I was at 105 degrees unassisted from 80 and 115 assisted.

I diligently kept doing my exercises every day. 2 sets of heel slides every 2 hours, quad activation exercises and normal walking around without crutches.

Today I had my visit with the surgeon 2 weeks later and I was at 120 deg unassisted and 130 assisted. He told me good work and to keep it up. Hearing those words almost brought me to tears in the car because I thought of all the times I didn't wanna do heel slides but kept doing them.

Here are the other exercises my PT gave me

  • Assisted heel slides
  • Wall slides
  • Leg raises
  • 70 deg wall sits
  • Sit to stand and back
  • Heel raise

If you are in the same boat, do not be disheartened. Diligently do your exercises, you can make strides in your flexion. It will be uncomfortable but it's necessary step to get back to 100%. I am no professional so please consult with your PT/doctor about any of the exercises stated above as each patient has different weight bearing protocol. Sorry for the really long post.

TL,DR: Was told by my surgeon during post op week 4, if I don't get to 120 deg by week 6, I would need MUA. I was at 80 degrees unassited then. I pushed hard doing exercises and heel slides every 2 hours and with good PT program got to 120 degrees unassisted in 2 weeks. Also improved strength and trust in my knee. Keep doing those exercises and you can also get there.